Journal of Rehabilitation Medicine 51-9 | Page 14

J Rehabil Med 2019; 51: 638–645 REVIEW ARTICLE EVIDENCE-BASED REHABILITATION THERAPY FOLLOWING SURGERY FOR (PERI-)ARTICULAR FRACTURES: A SYSTEMATIC REVIEW Marlous L. A. P. SCHNACKERS, MSc 1 , Yvette Y. VAN HORN, MD 2 , Guido H. H. MEYS, MSc 2,3 , MSc, Peter R. G. BRINK, MD, PhD 4 , Rob J. E. M. SMEETS, MD, PhD 5,6 and Henk A. M. SEELEN, PhD 1,5 From the 1 Centre of Expertise in Rehabilitation and Audiology, Adelante Rehabilitation Centre, 2 Department of Amputation, Traumatology and Orthopaedics, Adelante Rehabilitation Centre, Hoensbroek, 3 Department of Rehabilitation Medicine, Zuyderland, Heerlen, 4 Trauma Centre Limburg, Maastricht University Medical Centre, 5 Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht and 6 Libra Rehabilitation and Audiology, Eindhoven/Weert, The Netherlands Objective: To assess the availability of explicitly re- ported protocols describing post-surgery rehabili- tation of (peri-)articular fractures of the proximal humerus, acetabulum and/or tibial plateau, and to critically review any scientific evidence on the effec- tiveness of these protocols. Data sources: MEDLINE (PubMed), Cochrane databa- ses, CINAHL, PEDro and Embase (Ovid) were sear- ched to November 2018. Furthermore, stakeholder internet sites, clinical guidelines and standard text- books were searched. Study selection: Screening was performed indepen- dently by 2 researchers based on a priori defined eli- gibility criteria. Data synthesis: Five papers addressed post-surgical rehabilitation of proximal humerus fractures, one paper addressed acetabulum fractures. No eligible information was found on stakeholder sites or in standard textbooks. Overall, the main focus of the protocols identified was on the International Clas- sification of Functioning, Disability and Health (ICF) “Body Functions and Structures” level. In general, little information about therapy dosage was repor- ted. None of the protocols provided scientific eviden- ce on which the content of described rehabilitation programmes was based. Conclusion: This review reveals a paucity of expli- citly formulated protocols focussing on post-surgical rehabilitation of common (peri-)articular fractures targeting patient-centred care at all ICF levels. There is a need for more scientific evidence on which to base protocols regarding common (peri-)articular fracture rehabilitation. Key words: rehabilitation; aftercare; (peri-)articular frac- tures; therapy protocol; systematic review; tibial plateau; proximal humerus; acetabulum. Accepted Aug 21, 2019; Epub ahead of print Sep 5, 2019 J Rehabil Med 2019; 51: 638–645 Correspondence address: Henk A. M. Seelen, 1 Centre of Expertise in Rehabilitation and Audiology, Adelante Rehabilitation Centre, Hoens- broek, the Netherlands. E-mail: [email protected] B one fractures sometimes require reduction and internal fixation. These fractures are relatively simple to treat and rarely result in functional limita- LAY ABSTRACT The aim of this study was to review the scientific litera- ture on the availability of explicitly reported protocols or guidelines for therapists describing rehabilitation treat­ ment of patients with one or more complex fractures of the upper arm, pelvis or knee joint that needed to be operated on. Online databases, stakeholder internet sites, clinical guidelines and textbooks were searched. The papers found were critically reviewed. Five papers describing the rehabilitation of patients with an upper arm fracture and one paper on rehabilitation treatment after a pelvis fracture were identified, mainly describing muscle strength, joint mobility or endurance issues. Little information about therapy dosage was reported. No scientific evidence was provided on which to base the rehabilitation programmes. This review reveals a lack of explicitly formulated rehabilitation protocols fo- cusing on improving patients’ activities of daily living and of patients’ participation in social life. More scienti- fic evidence is needed on such protocols. tions. However, depending on the location, nature, complications and healing process, some fractures are more complex to reduce and fixate. In general, peri- and intra-articular fractures are more demand- ing. In addition, the adjacency of the fracture fixation to the joints makes after-treatment more challenging. The choice of rehabilitation protocol depends on the reduction and fixation strategy used. Clinical practice has shown that rehabilitation greatly influences the recovery of the patient (1–4). In current clinical practice, rehabilitation is pro- vided according to the International Classification of Functioning, Disability and Health (ICF) (5). This classification specifies 3 levels of functioning, i.e. the “Body Functions and Structures” level, the “Activity” level and the “Participation” level. The ultimate goal of rehabilitation therapy is to improve the functioning of the patient at the Activity and Participation levels. Whereas a myriad of information is available on the (surgical) reduction and fixation procedures and protocols of (peri-)articular fractures, as well as on the processes involved in bone healing (e.g. www. aofoundation.org), the ensuing rehabilitation after- This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2599 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977