Evidence-based rehabilitation after (peri-)articular fracture surgery
Descriptive analysis and methodological assessment
of the effectiveness of the studies
In the present paper, descriptive analysis and metho
dological assessment of studies examining the effec-
tiveness of the protocols of the eligible papers was
strived for. However, only the papers of Handoll et al.
(10) and Moeckel et al. (9) reported on effectiveness
obtained from clinical trials, whereas the rehabilita-
tion protocols of Burton & Watters (1), Compito et al.
(8), Cuomo & Zuckerman (2), and Maurer et al. (4)
were not studied for their effectiveness. Furthermore,
the aim of the clinical trial reported on by Moeckel et
al. (9) was not within the scope of the present paper,
i.e. the focus was not on evaluation of the rehabilita-
tion protocol. Consequently, we only performed the
methodological assessment and descriptive analysis
for the effectiveness study described by Handoll et
al. (10). This methodological assessment resulted in a
total Van Tulder score of 12 out of 19. The subscores
for internal validity, descriptives and statistics were 6
out of 11, 4 out of 6, and 2 out of 2, respectively (for
scores see Appendix 1).
The results of the descriptive analysis of the effective-
ness study performed by Handoll et al. (10) are presented
in Table III. Handoll et al. (10) equally allocated 250
patients with proximal humerus fractures to either an
643
intervention group or a control group. In 193 of the pa-
tients included in the study, tuberosity involvement was
identified. In the intervention group surgical treatment of
the fracture was provided and rehabilitation according
to the protocol described under “Content description” in
the present paper. Patients allocated to the control group
received non-surgical treatment of the fracture with simi-
lar rehabilitation treatment. No statistically or clinically
significant differences were found between the groups.
DISCUSSION
The aims of this review were: (i) to assess the availabi-
lity of explicitly reported physiotherapy/occupational
therapy protocols or formal guidelines describing
rehabilitation following surgery of (peri-)articular
fractures of the proximal humerus, the acetabulum
and/or tibial plateau; and (ii) to critically review any
scientific evidence on the effectiveness of (parts of)
these protocols.
In general, many authors state that rehabilitation is
as important as proper fracture reduction and fixation,
although only a few authors describe their rehabilita-
tion protocol extensively. Regarding the post-surgical
rehabilitation of fractures of the proximal humerus,
acetabulum and tibial plateau, 6 eligible papers (1, 2, 4,
Table II. Overview of the time phases/load-bearing epochs and the treatment activities performed
Burton &
Watters Compito et al. Cuomo &
Zuckerman
Handoll et al. Moeckel et al. Maurer et al.
Phase ICF level Goal I II I II I II I I II I
II
1 Body Functions and Structures Mobility
Strength +
– B +
– – +/–
– B –
– +
– – +
+/–
–
–
Activities
Participation
2 Body Functions and Structures
Activities
Participation
3 Body Functions and Structures
Activities
Participation
4 Body Functions and Structures
Activities
Participation
Coordination – – – –
Pain reduction – – – +/–
Endurance –
–
–
+
+
–
–
?
–
–
+/–
+/–
+
?
?
–
– –
–
–
+/–
+/–
–
–
?
–
–
+/–
+/–
–
?
?
–
– –
–
–
+/–
+/–
–
–
?
–
–
+/–
+/–
–
–
?
–
– –
–
–
+/–
+/–
+/–
–
?
+/–
–
+/–
+/–
+/–
–
+/–
+/–
–
Mobility
Strength
Coordination
Pain reduction
Endurance
Mobility
Strength
Coordination
Pain reduction
Endurance
Mobility
Strength
Coordination
Pain reduction
Endurance
–
C
–
C
–
–
–
C
–
–
–
–
II
n/a
C
B
B
B
C
B
B
B
B
– ?
– –
–
–
–
+/–
+/–
–
–
?
–
–
+/–
+/–
–
–
?
–
– –
–
–
+
–
?
–
–
–
–
+/–
+
+/–
–
?
+
+/–
–
+/–
–
–
?
–
–
–
–
–
–
C
–
C
–
–
C
C
Phase (1, 2, 3, 4)=subsequent time phases and/or epochs in which load-bearing is increased successively; Column I: Goal targeted: –: no, +/–: yes, but
brief description; +: yes and clear description, ?: unclear; Column II: Therapy dosage specified: –: no; A: therapy duration specified (not found); B: therapy
frequency specified; C: therapy intensity specified.
J Rehabil Med 51, 2019