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The effect of mirror therapy and neuromuscular electrical stimulation interventions during immobilization of distal radius fractures on grip strength
Stephanie Reischl, RMT, PT, PhD Candidate
Western University, London, ON, Canada
Introduction: Mirror therapy (MT), neuromuscular stimulation (NMES), and MT+NMES are feasible in-home interventions during the casting period for distal radius fracture (DRF). The aim of this pilot randomized controlled trial is to determine if MT, NMES, and MT+NMES interventions are effective at mitigating reductions in grip strength at 8- and 12-weeks post-DRF and facilitate recovery timelines. Methods: Participants were recruited if they had sustained a DRF in the last three weeks, were being managed conservatively, 18–80 years old, able to understand instructions in English, and able to provide informed consent. Individuals were excluded if they had cognitive disorders and/or visual impairments that limited their ability to follow instructions and engage in the home interventions, superficial metal implants in the injured arm, active cancer, severe peripheral vascular disease, or thrombophlebitis in the injured arm. Three weeks post-DRF participants were randomized to the MT, NMES, MT+NMES, or control group. Intervention groups performed the interventions in-home for 10 minutes, three times a day, 5 days a week for the last three weeks of immobilization. Grip strength was assessed at 8-, and 12-weeks post-DRF. Results: This interim analysis reports on grip strength for 19 participants between 22 and 78 years of age (mean = 58 ±14.3). All participants are right hand dominant. Nine participants fractured their dominant hand, and ten participants fractured their left hand. Grip strength is presented as a percentage of the unaffected side. At 8-weeks post-DRF, the relative grip strength was 56 ± 30.2% for MT, 56 ± 55.8% for NMES, 51 ± 24.5% for MT+NMES and 31 ± 8.9% for the control group. At 12-weeks post-DRF, the relative grip strength was 80 ± 23.9% for MT, 71 ± 28.6% for NMES, 70 ±18.6% for MT+NMES and 56 ± 21.2% for the control group. Discussion: Statistical analyses were limited due to the sample size for this interim analysis. The grip strength achieved by the early intervention groups at 8-weeks was comparable to reports at 12-weeks, while the control group matched the 12-week values reported at 12-week post-DRF (Bobos et al. 2018). For the early intervention groups, the 12-week grip strength values were comparable to reports at one year post-DRF (Olech
et al. 2022).
Conclusion: The interim results provide promising evidence that NMES, MT, and MT+NMES interventions could mitigate losses in grip strength during immobilization for DRF and facilitate recovery timelines, but a larger sample is required to confirm with statistical analyses.
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