Early ADL Education for Wrist Fractures

Overseen By Sarah Doerrer, PhD

Age: 18+

Sex: Any

Trial Phase: Phase 1

Sponsor: George Washington University

Disqualifiers: Neurological conditions, Cognitive deficits, Psychological deficits, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 9

Duration: 12-14 weeks

64 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if early education in daily activities (ADL Education) can enhance recovery after wrist surgery. Participants will be divided into two groups: one group will learn and practice using their hands for daily tasks soon after surgery, while the other will concentrate on regular wound care. The trial will assess pain, hand movement, and grip strength over time. It is suitable for individuals who have recently undergone wrist surgery without other major hand or arm injuries. As a Phase 1 trial, this research seeks to understand how the treatment functions in people, offering participants the chance to be among the first to benefit from this innovative approach.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this protocol is safe for early ADL education after wrist fractures?

A previous study showed that starting daily activities soon after wrist surgery yielded promising results. Patients who began moving early experienced fewer problems and recovered better. Research has shown that beginning exercises shortly after surgery can improve wrist movement and reduce pain. Another study found that early activity did not cause more harm; instead, it improved hand and wrist strength and flexibility.

These findings suggest that early activity is generally safe and well-tolerated for people recovering from wrist fractures. However, since this trial is in its early stages, it primarily focuses on ensuring the approach's safety. The treatment is still being carefully tested. Prospective participants should know that early evidence suggests it is a safe and potentially helpful way to recover. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores the impact of early Activities of Daily Living (ADL) education on recovery after wrist fractures treated with surgery. Unlike the standard postoperative care, which typically focuses on basic recovery instructions, this approach includes additional education on how to safely resume everyday activities. By using video and handouts with QR codes, the trial aims to provide accessible, on-demand learning that could potentially speed up functional recovery and improve patient outcomes. If successful, this method could offer a more engaging and effective way to help patients regain independence more quickly after wrist surgery.

What evidence suggests that ADL Education is effective for wrist fractures?

Research shows that returning to daily activities soon after a wrist fracture can be beneficial. Studies have found that engaging in these activities improves wrist movement, grip strength, and overall hand function. In this trial, participants in the experimental group will receive Early ADL Education, which teaches them how to safely use their injured wrist early on. This approach has been linked to less pain, improved hand use, and better performance in tasks like writing and picking up objects. These findings suggest that safely using the injured wrist soon after surgery might speed up recovery and ease daily life. ^{1 2 5 6 7}

Are You a Good Fit for This Trial?

This trial is for individuals who have had surgery (open reduction and internal fixation) to fix a broken wrist, specifically the distal radius. Participants should be in the early stages of recovery and able to follow postoperative instructions.

Exclusion Criteria

Individuals with psychological deficits which would limit the ability to correctly report information on outcome measures

Individuals with multiple injuries to the affected upper limb

I have a condition that affects my arm or hand.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person)

Treatment

Participants receive educational intervention or standard care video and handout post-surgery

12-14 weeks

4 visits (in-person)

Follow-up

Participants are monitored for function, pain, and fear of movement with various outcome measures

14 weeks

4 visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• ADL Education

Trial Overview The study compares two approaches after wrist surgery: one group receives special education on performing daily activities with their injured hand, while the other gets standard wound care guidance. Their recovery progress will be measured at several points using various tests for pain, fear of movement, strength, and fine motor skills.

How Is the Trial Designed?

Group I: ADL/Postoperative Instruction Experimental Treatment 2 Interventions

Participants in the experimental group will watch a video instructing them on early ADL participation after DRF fracture treated by ORIF and postoperative care. Participants in the experimental group will also receive a handout on ADL participation and postoperative care with a QR code to the video.

Group II: Postoperative Instruction Active Control 1 Intervention

Participants in the control group will watch a video instructing them on postoperative care. Participants in the control group will receive a handout on postoperative care with a QR code to the video.

Who Is Running the Clinical Trial?

George Washington University

Lead Sponsor

Trials

263

Recruited

476,000+

Published Research Related to This Trial

Early motion is an important strategy in treating hand and wrist fractures, as it can help improve recovery and function.

The decision to use early motion should be based on a careful assessment of the benefits versus the risks for each individual patient, ensuring personalized treatment plans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Early motion in the treatment of fractures and dislocations in the hand and wrist. Margles, SW.[2016]

In a study involving 300 participants aged 60 and older, there was no significant difference in wrist pain or function at 12 months between those treated surgically with a volar-locking plate and those treated nonsurgically with a cast.

Although patient-reported treatment success was higher in the surgical group, the overall outcomes for pain and quality of life were similar, suggesting that surgical intervention may not provide substantial benefits over nonsurgical treatment for this age group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Surgical Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients: A Randomized Clinical Trial. Lawson, A., Naylor, JM., Buchbinder, R., et al.[2022]

The Dutch version of the DASH questionnaire has been validated for use in assessing pain and disability in patients with hand and wrist injuries, based on a study of 370 patients.

The findings suggest that the DASH should be treated as a unidimensional measure, meaning a single overall score is sufficient for evaluating patient outcomes rather than relying on subscale scores.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Structural validity of the Dutch version of the disability of arm, shoulder and hand questionnaire (DASH-DLV) in adult patients with hand and wrist injuries. van Eck, ME., Lameijer, CM., El Moumni, M.[2019]

A study involving 48 patients with distal radius fractures showed that those who followed an independent home exercise program had significantly better wrist functionality after 6 weeks compared to those receiving physical therapy, achieving 54% grip strength and 79% range of motion compared to their uninjured wrist.

The home exercise group also reported nearly 50% lower scores on the Patient Related Wrist Evaluation (PRWE), indicating better overall wrist function, suggesting that home-based rehabilitation can be an effective alternative to traditional physical therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physiotherapy after volar plating of wrist fractures is effective using a home exercise program. Krischak, GD., Krasteva, A., Schneider, F., et al.[2022]

Wrist arthrodesis is recommended for distal radial fractures with severe bone loss, as it effectively restores alignment and stability, controls pain, and promotes early functional recovery.

The procedure can reduce treatment costs and complications by allowing for simultaneous carpectomy or using local bone grafts, making it beneficial even in cases of polytrauma or multiple fractures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Early wrist arthrodesis for irreparable intra-articular distal radial fractures. Freeland, AE., Sud, V., Jemison, DM.[2019]

In a study of 204 hip-fracture patients undergoing rehabilitation, improvements were observed in all activities of daily living (ADLs), with walking showing the highest efficiency and effectiveness post-rehabilitation.

Key determinants of functional outcomes included basic ADLs such as eating, bathing, and bladder control, suggesting that assessing these activities can help predict recovery and guide treatment for hip fracture patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Determinants of outcome in hip fracture: role of daily living activities. Gialanella, B., Ferlucci, C., Monguzzi, V., et al.[2015]

In a study of 24 patients who underwent hand and wrist fracture surgery, postoperative physician phone calls did not lead to improved patient compliance with treatment recommendations or better clinical outcomes, as measured by the Brief Michigan Hand Questionnaire and satisfaction ratings.

Despite the lack of improvement from phone calls, the study found that a significant number of patients (67%) did not follow up as recommended, and 33% experienced complications, highlighting ongoing challenges in patient adherence to postoperative care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effects of Postoperative Physician Phone Calls for Hand and Wrist Fractures: A Prospective, Randomized Controlled Trial. Loewenstein, SN., Pittelkow, E., Kukushliev, VV., et al.[2022]

In a study of 100 patients recovering from hand, wrist, shoulder, foot, or ankle fractures, those involved in litigation required significantly more help with daily activities, averaging over 3 hours more assistance per day compared to non-litigants (6.4 hours vs. 2.75 hours).

The need for help with activities such as dressing, shopping, and cooking was strongly influenced by whether patients were claiming compensation for their injuries, with a significant correlation found (p<0.0001), while complications from fractures did not affect litigation outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Extra help required by litigants after simple fractures--a questionnaire based study. Atkinson, JJ., Woods, MJ., Lovell, ME.[2015]

The ADOC-H decision-aid effectively encouraged 8 patients with distal radius fractures to engage in 158 activities using their injured hand, leading to improvements in wrist motion, grip strength, and overall arm function.

Occupational therapists found the ADOC-H to be a valuable tool for promoting real-life use of the injured hand, particularly for patients hesitant to use their hand due to fear of pain or injury.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The clinical utility of a decision-aid to facilitate the use of the hand in real-life activities of patients with distal radius fractures: A case study. Ohno, K., Saito, K., Matsumoto, H., et al.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11465607/

Early Daily Activity: Development and description of an ... To describe the theoretical development and structure of an occupation-based intervention for people with a surgically repaired distal radius fracture.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6358444/

Postoperative Treatment of Distal Radius Fractures Using ... The patients worked on movement, activities of daily living (ADL), and edema control as well as orthosis adjustment as necessary. After 6 weeks, with ...

3. research.aota.org research.aota.org/ajot/article/77/5/7705205040/24952/Occupational-Performance-1-Year-After-a-Distal

Occupational Performance 1 Year After a Distal Radius ... Results have shown that pain and disability decrease the person's ability to use the injured hand during activities of daily living (ADLs) and ...

4. jospt.org jospt.org/doi/10.2519/jospt.2024.0301

Distal Radius Fracture Rehabilitation ... activities of daily living (ADLs) tasks that involve the use of wrist/hand. These tasks include writing, turning over a page, picking up ...

5. researchgate.net researchgate.net/publication/304344971_Early_occupational_performance_intervention_enhances_outcome_after_distal_radius_fracture_A_nonrandomized_controlled_trial

Early occupational performance intervention enhances ... DRF often causes reduced range of wrist motion (wrist ROM), loss of grip strength and dexterity as well as pain and edema of the injured hand, ...

6. jhandsurg.org jhandsurg.org/article/S0363-5023(25)00331-4/abstract

Evaluating the Safety of Limited Load Bearing for Activities ... Evaluating the Safety of Limited Load Bearing for Activities of Daily Living Following Volar Locked Plating of Select Distal Radius Fractures.

7. withpower.com withpower.com/trial/early-phase-1-radius-fractures-1-2023-b9017

Early ADL Participation for Wrist Fracture Recovery The available research shows that Early ADL Participation for Wrist Fracture Recovery can be effective in reducing complications and improving patient ...