A Cochrane review [Abstract] 1 included 15 studies with a total of 746 mainly female and older subjects. Initial treatment was conservative, involving plaster cast immobilisation, in all but 27 patients whose fractures were fixed surgically. Though some trials were well conducted, others were methodologically compromised.
For interventions started during immobilisation, there was weak evidence of improved hand function for hand therapy in the days after plaster cast removal, with some beneficial effects continuing one month later (one trial). For early occupational therapy, there was weak evidence of improved hand function in the short term, but not in the longer term (three months; one trial). Supervised and unsupervised exercises showed no difference (one trial).
For interventions started post-immobilisation, there was weak evidence of a lack of clinically significant differences in outcome in patients receiving formal rehabilitation therapy (four trials), passive mobilisation (two trials), ice or pulsed electromagnetic field (one trial), or whirlpool immersion (one trial) compared with no intervention. There was weak evidence of a short-term benefit of continuous passive motion (post external fixation; one trial), intermittent pneumatic compression (one trial) and ultrasound (one trial). There was weak evidence of better short-term hand function in participants given physiotherapy than in those given instructions for home exercises by a surgeon (one trial).
Comment: The quality of evidence was downgraded by limitations in study quality and by imprecise results (few patients and wide confidence intervals).
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