الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 254 |  |  |
| | | from | 254 | | |
Abstract
Bone fractures are a global health issue that continues to impose a considerable burden on communities around the world, as they are considered the most common cause of hospitalization. One of the most common fractures in the emergency department is DRFs, which affects all age groups and genders and represents approximately 17% of all orthopedic fractures in the western world, as well as accounting for around 75% of forearm fractures. Moreover, the prevalence of DRFs in Hadara Orthopedic and Traumatology University Hospital, Alexandria, Egypt, represents about 20 % of all orthopedic fractures in 2020, and these numbers are expected to continue to increase globally as life expectancy increases.
Distal radius fractures surgeries are a serious health condition that has a significant impact on patients’ functional ability. Moreover, DRFs surgeries are associated with numerous postoperative complications and poor functional outcomes, resulting in increased mortality and morbidity rates, decreased work productivity, loss of independence, poor quality of life, and even permanent disability. Therefore, global attention is required for DRFs surgeries care and rehabilitation to reduce these complications and disability. For this, practicing postoperative physical exercises therapy is extremely beneficial and should be initiated immediately as soon as possible post DRFs surgeries and continued during the early and late postoperative periods up to best functional recovery and societal participation are achieved. Exercise therapy after DRFs surgery is generally used for the prevention of complications and unsatisfactory surgical outcomes in an attempt to accelerate the regaining of functional ability. Hence; this study was carried out to compare the effect of activation of shoulder girdle muscles exercises versus hand on wrist joint mechanics of patients post intraarticular DRFs surgeries.
Aim of this study:
The aim of the study is to compare the effect of activation of shoulder girdle muscles exercises versus hand on wrist joint mechanics of patients post intraarticular distal radius fracture surgeries.
Research design:
A comparative quasi experimental research design was utilized to attain the aim of the present study.
Setting:
This study was carried out at the inpatient units and hand surgery outpatient clinics of Hadara Orthopedic and Traumatology University Hospital, Alexandria, Egypt. Subjects:
A convenience sample of fifty adult patients (81-60 years) with intraarticular DRF who were scheduled for surgeries from the above mentioned setting, were included and assigned randomly and alternatively into two equal groups of 25 patients each.
The study group (I): was exposed to shoulder girdle, and hand exercises, which were carried out by the researcher as approved by an orthopedic treating surgeon.
The study group (II): was exposed to hand exercises only, which were carried out by the researcher as approved by orthopedic treating surgeon.
Tools:
Three tools were used for data collection and to attain the aim of the current study:
Tool I: Wrist Functional Abilities Index; Interview Schedule
This tool was measured through the Patient-Rated Wrist Evaluation (PRWE), which was adapted from MacDermid et al. (1998) by the researcher. However, it is a fifteen item questionnaire designed to measure wrist pain and functional abilities of the affected wrist joint.
In addition, the ”Patient’s Sociodemographic and Clinical Data Sheet” was attached to tool I.
Tool II: Mobility Index of the Wrist Joint
This tool was used to collect baseline data about wrist joint mobility, regarding both wrist ROM and hand grip strength. It was divided into two parts as follows:
Part I: Range of Motion of the Wrist
This part was adapted by the researcher from Washington State Department of Social and Health Service [DSHS] (2014) ; Reese and Bandy (2016) and Donaldson (2019) where the researcher utilized the goniometer to evaluate ROM of the affected wrist joint.
Part II: Grip Strength of the Affected Hand
This part was adapted by the researcher from (National Health and Nutrition Examination Survey [NHANES], 2011) and (Roberts et al., 2011). The grip strength was measured by the researcher using a handheld dynamometer to evaluate hand muscles strength.
Tool III: Complications of Intraarticular Distal Radius Fracture Checklist
This tool was developed by the researcher based on a review of relevant literature to collect pertinent data about intraarticular DRF postoperative complications. This tool was divided into two parts, as shown:
Part I: Intraarticular Distal Radius Fracture Postoperative Complications
The researcher obtained data related to intraarticular DRF postoperative complications from patients’ medical records. It consisted of two sub parts related to early complications and late complications.
Part II: Distal Radius Plain X- Ray
This part was used to assess the fracture healing process, where it was evaluated by the assistance of an orthopedic surgeon through plain radiography of the affected distal radius. Each patient’s x ray result data was then recorded by the researcher.
Method The current study was accomplished as follows: An official permission was obtained from the Ethical Research Committee of the Faculty of Nursing, Alexandria University, for carrying out this study. An official permission was obtained from the Faculty of Nursing, Alexandria University, to obtain the approval of the responsible authorities of the selected setting to collect data after explanation of the study’s aim. The study tools as well as the developed educational booklet utilized during data collection were tested for content validity by three experts in Medical Surgical Nursing and two experts in Orthopedic Surgery fields; then the necessary modifications were made accordingly. The reliability of all tools was tested by means of Cronbach’s alpha. Reliability coefficient for tool I in English and Arabic language, II, and III were 0.871, 0.821, 0.842, and 0.881, respectively, indicating that all tools were reliable.
Data collection
The collection of data was started and continued for a period of 12 months, from May 2020 to May 2021.
Data were collected from the study group (I), followed by the study group (II).
The purpose of the study was explained to the patients in both groups after the researcher introduced herself to them individually.
The study was carried out through four phases, as follows:
I. Assessment phase
Initial assessment was carried out for both groups’ patients in orthopedic units by the researcher immediately on admission, utilizing the three study tools to collect baseline data about sociodemographic and clinical data, pain level, functional ability, wrist ROM, hand grip strength, and the initial x-ray result.
II. Planning Phase
The researcher created individualized exercises sessions plans for each patient in each group based on the data collected from the first evaluation and the recent review of relevant literature. Moreover, two illustrated colored booklets were developed by the researcher where booklet I was provided to each patient in the study group I, and booklet II was distributed to each patient in the study group II during the implementation phase. However, booklet I covered both active shoulder girdle and hand exercises, while booklet II exclusively covered hand exercises only.
III. Implementation phase
The developed colored booklets were handed to each study group’s patient from the beginning of the first session; however, face to face discussion, demonstration, and redemonstration were used.
The researcher’s exercises instructions were implemented individually for each patient in both study groups in two sessions. The first session was carried out preoperatively (the day before surgery), while the second session was performed in the 1st postoperative day in the inpatient units.
IV. Evaluation Phase
The researcher evaluated all patients in both groups three times using the three study tools in both the inpatient units and outpatient clinics to assess their pain level, functional ability, ROM, hand grip strength, and intraarticular DRFs complications. While the affected wrist’s bone healing was evaluated four times. Comparisons were done between both study groups using the appropriate statistical tests to compare the effect of activation of shoulder girdle muscles exercises versus hand on wrist joint mechanics of patients post intraarticular distal radius fracture surgeries.
Ethical Consideration
Written informed patients’ consents were obtained prior to data collection and after explanation of the study aim. Also, the patients were informed that their participation in the study was voluntary, and they could withdraw at any time without having an impact on their hospital care. Privacy was assured.
Statistical analysis of the data
Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. (Armonk, NY: IBM Corp). Qualitative data were described using numbers and percent. The Shapiro-Wilk test was used to verify the normality of the distribution. Quantitative data were described using range (minimum and maximum), mean, standard deviation, and median. Significance of the obtained results was judged at the 0.05% level.
The main findings of this study
The results showed that, more than one third (36.0%) of both groups were less than 30 years, while an equal proportion was noted for those whose age ranged from 50 to less than 60 years, constituting 32.0% each. Concerning occupation, the largest percentage (52.0%) within group I were employees, while (40.0%) in group II were manual workers. Additionally, more than three quarters (76.0%) and more than two thirds (68.0%) of groups I and II, respectively, were from urban areas.
The current study revealed that the most common mechanism of injury in groups I and II was a simple fall, as reported by 28.0% and 44.0% of them, respectively. Additionally, the highest percentage of both groups were treated by volar ORIF as mentioned by 64.0% and 84.0% of them, respectively.
With respect to pain assessment, statistically significant differences were noted between group I and group II post exercises in the 6th week (U=163.00, p=0.003), and in the 8th week (U=188.50, p=0.014). Concerning the functional ability assessment, the differences between group I and group II were statistically significant at the pre exercises interval (U=221.0, p=0.054), in the 6th week post exercises performance (U=144.0, p=0.001), and in the 8th week post exercises performance (U=119.00, p=0.001). Moreover, there was a statistically significant difference between groups I and II regarding the total PRWE mean score pre exercises interval (U=191.50, p=0.014), post exercises in the 6th week (U=146.50, p=0.001), and post exercises performance in the 8th week (U=144.50, p=0.001).
Furthermore, with respect to the total ROM mean score, statistically significant differences were noted between group I and group II in the 6th week (U=155.50, p=0.001), and the 8th week (U=165.00, p=0.001) post exercises performance. The current findings also revealed a highly statistically significant difference between the two studied groups’ hand grip strength in the 6th and 8th week post exercises performance (χ2=8.264, p=0.043, and χ2=11.769, p=0.013; respectively).
The results showed that compartment syndrome represents the most common problem among the early complications in both groups, in which more than one quarter (28.0%) of them had compartment syndrome immediately postoperatively compared to none (0.0%) of them after the 6th week and 3 months’ post exercises performance. Additionally, none (0.0%) of the patients in both groups complained from malunion, nonunion, and tendon complications at the three assessment intervals.
Additionally, the current results illustrated that less than one third of patients in study group II experienced late complications, namely: wrist joint stiffness and complex regional pain syndrome 3 months post exercises. In comparison, a minorities of patients in group I complained of these complications in the same assessment interval. Additionally, only 4.0% of patients in group I developed delayed union at the 6th week post exercises, compared to 24.0% of patients in study group II at the 6th week post exercises performance; while regarding pin site infection, it wasn’t reported by any of group I patients, compared to 12.0% of group II patients in the 6th week post exercises, which wasn’t revealed 3 months thereafter.
The results demonstrated that, there was a statistically significant difference between groups I and II with regard to the total complications score in the 6th week and 3 months post exercises (2=3.947, P=0.047, 2=4.5, p=0.043; respectively).
Concerning wrist joint union, the vast majority of group I patients had wrist joint union at the 6th week and 3 months’ post exercises (92.0% and 96.0%, respectively). On the other hand, during the 6th week assessment interval 68.0% of group II had wrist joint union, which raised to 72.0% after 3 months. Moreover, highly statistically significant differences were noted between preoperative, immediate postoperative, 6th week, and 3 months intervals, where (P=0.001) related to the wrist joint plain x-ray results.
Conclusion
Based on the results of the current study, it was concluded that patients in study group (I) who had received shoulder girdle and hand exercises showed a significant improvement in their mean scores of functional abilities, ROM, muscle strength, bone healing, and complications compared to those patients in study group (II) who received hand exercises only.
Recommendations
The following are the main recommendations based on the current study’s findings:
The developed booklet about therapeutic shoulder girdle and hand exercises should be available and distributed to all patients undergoing intraarticular DRFs surgeries.
Replication of the study using a larger sample from different geographical areas is important to help generalize the results.