| Summary: | 碩士 === 國立成功大學 === 物理治療學系 === 102 === Background: Distal radius fractures (DRF) were the most common upper limb fractures and the prevalence was increased with age. In addition, the complications following DRF might be the cause of chronic pain in elderly. Although there were varies studies that investigated the effect of different rehabilitations on DRF patients, the findings were controversial and no standard rehabilitation protocol has been recommended. In particular, little has been done to investigate the effects of early intervention or complications prevention following DRF. Purpose: The purpose of this study was to examine the effects of a stage-based rehabilitation program that aimed at edema reduction and neuropathy prevention in the immobilization stage and at improving soft tissue tightness and muscle power in the post-immobilization stage for patients with DRF. Methods: 16 DRF participants were included and assigned into the experimental group (n=8, age: 57±17.2 years) and control group (n=8, age: 64.4±8.6 years). All subjects participated in the initial assessment and a general home program at 2 weeks after DRF. An additional stage-based rehabilitation protocol was provided to the experimental group including manual edema mobilization and nerve mobilization program twice a week from week 2 to week 6 after DRF and soft tissue mobilization once a week from week 7 to week 9 after DRF. Re-assessments were arranged for both experimental and control group at the end of week 4, 6, and 12 after DRF, respectively. Pain, grip strength, finger mobility, swelling, finger temperature and functional performance of the upper limb were evaluated regularly and additional measurements for nerve mobility were arranged starting from weeks 4 after DRF (at week 4, 6 and 12 after DRF) and for hand volume starting from week 6 after DRF (at week 6 and 12 after DRF). Finally, complication following DRF was assessed at the end of the study. Results: Significant improvements were found in both groups since 6 weeks after DRF in the measurements of grip strength, finger swelling and finger mobility (p〈0.05). On the other hand, an earlier improvement was found in the measurement of grip strength at week 4 after DRF for the experimental group in comparison of the control group and the recovery rate of grip strength was significantly better in the experimental group at week 12 after DRF. In addition, significant improvement in motion pain and nerve mobility were only found in the experimental group at 12 weeks after DRF (p〈0.05). On the contrary, the control group demonstrated increased motion pain at week 6 after DRF before the occurrence gradual reduction in the later stage. Finally, no significant group differences were found in the occurrence of complications at 12 weeks after DRF. Conclusion: This study has demonstrated favorable outcomes of the stage-based rehabilitation program in patients with DRF, especially in the grip strength, motion pain and nerve mobility. On the other hand, the general home program provided in this study has also shown significant improvements in the finger swelling, finger mobility and the functional performance of upper limbs. This study has provided evidence to support the early intervention program focusing on the edema control and nerve mobilization followed by a 3-week program of soft tissue mobilization. On the other hand, for the convenience of patients’ needs, a general home exercise program was also recommended starting from week 3 after DRF though with less significant improvements.
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