644
M. L. A. P. Schnackers et al.
Table III. Descriptive analysis of effectiveness study of Handoll et al. (10)
Patients Intervention
Total (n)=250 Surgical treatment & Non-surgical treatment No significant or clinically relevant between-group
rehabilitation
& rehabilitation
ICF-level
Variable of interest (outcome
measure)
FU + ACT Patient-reported assessment of pain
and impairment of activities of daily
living (Oxford Shoulder Score)
PART
Health status (12-item Short Form
health survey)
FU
Surgical and other shoulder fracture-
related complications
FU
Secondary surgery to the shoulder
Experimental group (n)=125
Control group (n)=125
Age, mean (SD)=66.01 (11.49)
Tuberosity involvement, n (%)
Yes: 193 (77.2)
No: 57 (22.8)
Fracture types according to the Neer
classification, n (%)
Neer 1 part: undisplaced surgical neck:
18 (7.2)
Comparison
Neer 2 part: surgical neck: 119 (47.6)
Neer 2 part: greater tuberosity: 8 (3.2)
Neer 2 part: lesser tuberosity: 1 (0.4)
Neer 3 part: surgical neck+greater
tuberosity: 90 (36.0)
Outcome and results
FU
FU
FU
Increased/new shoulder-related
therapy
Medical complications during the
inpatient stay
Mortality
differences in:
IG vs CG
39.07 vs 38.32
45.64 vs 43.87
30 vs 23
11 vs 11
7 vs 4
10 vs 0
9 vs 5
Neer 3 part: surgical neck+lesser
tuberosity: 1 (0.4)
Neer 3 part: anterior dislocation+greater
tuberosity: 2 (0.8)
Neer 4 part: surgical neck+greater
tuberosity+lesser tuberosity: 11 (4.4)
ACT: activity; CG: control group; FU: body functions and structures; IG: intervention group; PART: participation.
8–10) were found, of which 5 discussed the rehabilita-
tion of proximal humerus fractures (1, 2, 8–10) and 1
the rehabilitation of acetabulum fractures (4). No paper
addressed protocols for the post-surgical rehabilitation
of tibial plateau fractures. It should be noted that 4 out
of the 6 papers identified were published in the 1990s.
However, interest in the rehabilitation of, especially,
proximal humerus fractures seems to be increasing (1,
10, 14). It is necessary to investigate protocols on their
effectiveness and report on new research and trends
to be able to improve rehabilitation of (peri-)articular
fractures. However, of the protocols selected, only
the protocol of Handoll et al. (10) was studied for its
effectiveness.
The extent to which the papers describe the therapy
varies widely. In general, little information is given
about therapy dosage. As opposed to the rehabilita-
tion programmes for proximal humerus fractures,
the post-surgical rehabilitation programme for ace-
tabulum fractures (4), identified as being relevant
for this study, targeted the whole body instead, like
prevention of pneumonia and thrombosis. In general,
the post-surgical rehabilitation protocols identified
in our review focus on the ICF body function level,
possibly since most papers have been published many
years ago. Remarkably, in none of the protocols was
scientific evidence provided on which the described
rehabilitation programmes were based.
In contrast to the literature on the rehabilitation of
some fractures after surgical treatment, more informa-
tion is available about the rehabilitation of fractures
after conservative treatment, like the papers of Limb
(15) and Wiedemann & Schweiberer (16). As the
www.medicaljournals.se/jrm
timing and approach of the rehabilitation of these
fracture types differs, distinct protocols for each type
of rehabilitation aftercare, be it after surgical or non-
surgical intervention, are needed (14).
Methodological considerations
In the present paper a descriptive analysis and metho
dological assessment could only be performed of
the paper of Handoll et al. (10). Performing either or
both of these assessments of the other papers selected
was not possible or relevant because: (i) psychome-
trically well-defined tools to assess clinical treatment
protocols regarding the aftercare treatment of (peri-)
articular fractures seem to be lacking in literature; (ii)
the effectiveness of the protocols in the papers selec-
ted was not established, disallowing the use of tools
to assess clinical trials or intervention studies like the
Van Tulder’s Quality assessment system or the PICO
principle; and (iii) the aim of the paper selected (i.e.
Moeckel et al. (9)) was not within the scope of the
present paper.
Conclusion
In conclusion, our review reveals a paucity of expli-
citly formulated rehabilitation protocols focussing on
the post-surgery treatment of some (peri-)articular
fractures. The available protocols contain only a
brief description and lack therapy-related details, e.g.
therapy dosage and criteria to evaluate adjustment of
dosage or type of training. There was a notable lack
of rehabilitation protocols targeting patient-centred
care at all ICF levels, based on scientific evidence