Cross-Education for Improving Strength and Mobility After Distal Radius Fractures: A Randomized Controlled Trial

Objective: To evaluate the effects of cross-education (contralateral effect of unilateral strength training) during recovery from unilateral distal radius fractures on muscle strength, range of motion (ROM), and function. Design: Randomized controlled trial (26-wk follow-up). Setting: Hospital, orthopedic fracture clinic. Participants: Women older than 50 years with a unilateral distal radius fracture. Fifty-one participants were randomized and 39 participants were included in the final data analysis. Interventions: Participants were randomized to standard rehabilitation (Control) or standard rehabilitation plus strength training (Train). Standard rehabilitation included forearm casting for 40.4 +/- 6.2 days and hand exercises for the fractured extremity. Nonfractured hand strength training for the training group began immediately postfracture and was conducted at home 3 times/week for 26 weeks. Main Outcome Measures: The primary outcome measure was peak force (handgrip dynamometer). Secondary outcomes were ROM (flexion/extension; supination/pronation) via goniometer and the Patient Rated Wrist Evaluation questionnaire score for the fractured arm. Results: For the fractured hand, the training group (17.3 +/- 7.4kg) was significantly stronger than the control group (11.8 +/- 5.8kg) at 12 weeks postfracture (P<.017). There were no significant strength differences between the training and control groups at 9 (12.5 +/- 8.2kg; 11.3 +/- 6.9kg) or 26 weeks (23.0 +/- 7.6kg; 19.6 +/- 5.5kg) postfracture, respectively. Fractured hand ROM showed that the training group had significantly improved wrist flexion/extension (100.5 degrees +/- 19.2 degrees) than the control group (80.2 degrees +/- 18.7 degrees) at 12 weeks postfracture (P<017). There were no significant differences between the training and control groups for flexion/extension ROM at 9 (78.0 degrees +/- 20.7 degrees; 81.7 degrees +/- 25.7 degrees) or 26 weeks (104.4 degrees +/- 15.5 degrees; 106.0 degrees +/- 26.5 degrees) or supination/pronation ROM at 9 (153.9 degrees +/- 23.9 degrees; 151.8 degrees +/- 33.0 degrees), 12 (170.9 degrees +/- 9.3 degrees; 156.7 degrees +/- 20.8 degrees) or 26 weeks (169.4 degrees +/- 11.9 degrees; 162.8 degrees +/- 18.1 degrees), respectively. There were no significant differences in Patient Rated Wrist Evaluation questionnaire scores between the training and control groups at 9 (54.2 +/- 39.0; 65.2 +/- 28.9), 12 (36.4 +/- 37.2; 46.2 +/- 35.3), or 26 weeks (23.6 +/- 25.6; 19.4 +/- 16.5), respectively. Conclusions: Strength training for the nonfractured limb after a distal radius fracture was associated with improved strength and ROM in the fractured limb at 12 weeks postfracture. These results have important implications for rehabilitation strategies after unilateral injuries. (C) 2013 by the American Congress of Rehabilitation Medicine