A Survey of Practice Patterns for Rehabilitation Post Elbow Fracture
Joy C MacDermid*, 1, Joshua I Vincent2, Leah Kieffer3, Ashley Kieffer3, Jennifer Demaiter3, Stephanie MacIntosh3
1 Rehabilitation Science, McMaster University, School of Rehabilitation Science, Hamilton, Ontario, Canada and Hand and Upper Limb Center, St. Joseph’s Health Center, London, Ontario, Canada
2 University of Western Ontario, Health and Rehabilitation Sciences, London, Ontario, Canada
3 University of Western Ontario, School of Physical Therapy, London, Ontario, Canada
Background and Purpose:
Elbow fractures amount to 4.3% of all the fractures. The elbow is prone to stiffness after injury and fractures can often lead to significant functional impairment. Rehabilitation is commonly used to restore range of motion (ROM) and function. Practice patterns in elbow fracture rehabilitation have not been defined. The purpose of this study was to describe current elbow fracture rehabilitation practices; and compare those to the existing evidence base.
Hand therapists (n=315) from the USA (92%) and Canada (8%) completed a web-based survey on their practice patterns and beliefs related to the acute (0-6 weeks) and functional (6-12 weeks) phases of elbow fracture rehabilitation.
More than 99% of respondents agreed that fracture severity, co-morbidities, time since fracture, compliance with an exercise program, psychological factors, and occupational demands are important prognostic indicators for optimal function. Strong agreement was found with the use of patient education (95%) and active ROM (86%) in the acute stage while, home exercise programs (99%), active ROM (99%), stretching (97%), strengthening (97%), functional activities (ADLs and routine tasks) (97%), passive ROM (95%), and active assisted ROM (95%) were generally used in the functional stage. The most commonly used impairment measures were goniometry (99%), Jamar dynamometry (97%), and hand held dynamometry (97%). Agreement on the use of patient-reported outcome measures was very minimal (1.3%- 35.6%).
Exercise, education, and functional activity have high consensus as components of elbo fracture rehabilitation. Future research should focus on defining the optimal dosage and type of exercise/activity, and establish core measures to monitor outcomes of these interventions.
open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
* Address correspondence to this author at the Hand and Upper Limb Centre, St. Joseph’s Health Centre, 268 Grosvenor Street, London, Ontario, N6A 4L6, Canada; Tel: 519-646-6100, Ext. 64636; Fax: 519-646-6049;