Use of Compression Gloves for Distal Radius Fractures
Miller-Shahabar, I., Schreuer, N., Katsevman, H., Bernfeld, B., Cons, A., Raisman, Y., & Milman, U. (2018). Efficacy of compression gloves in the rehabilitation of distal radius fractures: Randomized controlled study. American Journal of Physical Medicine & Rehabilitation, 97(12), 904–910.
By Brittany Carrie
Distal radius fractures are a common upper extremity injury amongst all ages and account for 18% of fractures in the elderly that are most often due to a fall. Symptoms include pain, swelling, decreased ROM, and joint stiffness which can pose as a challenge to performing daily tasks. Treatment includes rehabilitative techniques such as stretching and strengthening; however, a few recent studies have looked at the effects of compression garments as a means to reduce swelling and increase functional outcomes. Prior to the study done by Miller-Shahabar et al. (2018), two studies have looked at the effects of wearing a compression glove during the recovery of a distal radius fracture (Harris et al., 2011; Schuler et al., 2011). One study looked at the effect of using a compression glove beneath the surgical dressing immediately after a distal radius surgical stabilization. The other study looked at the effects of using a compression glove during the rehabilitation phase of a distal radius fracture. Both studies concluded that swelling and function improved; however, the surgical study only measured the effects of the compression glove during the immobilization phase and the rehabilitative study did not account for pain or range of motion (ROM). Thus, the purpose of the following study is to assess the effects of wearing a made-to-measure compression glove during the rehabilitative phase of a distal radius fracture in order to achieve heightened functional outcomes with the addition of reported pain, function, and ROM.
In the Weeds
This study was a prospective randomized clinical trial taken place in Israel to assess the efficacy of the use of compression gloves for swelling after surgery (made-to-measure) fitted by an Occupational Therapist as a standard rehabilitative measure for adults recovering from a distal radius fracture. The study took place over a 1-year period and consisted of 35 participants between the ages of 30 and 86. Participants were included in the study had just completed the immobilization phase of treatment, displayed two or more symptoms of pain, limited ROM, swelling, or functional limitations, and demonstrated the ability to understand and sign an informed consent form. Participants were excluded if they were pregnant, had a history of lymphedema, a previous injury in the affected hand, or any ongoing rheumatic, neurologic, vascular, or renal pathology.
Participants were further divided into two groups—an intervention group (n=18) and a control group (n=17). The intervention group was provided with a made-to-measure compression glove provided by COMAR that applied 20-30 mm Hg of pressure and was to be worn for 10 hours a day for 6 weeks in addition to rehabilitative treatment that took place twice a week for 30-minute sessions. The control group only received rehabilitative treatment. Rehabilitative treatment consisted of active ROM hand and wrist exercises, fine motor activities, and gradual strength training.
Assessments were measured at three intervals (T1, T2, and T3). T1 was assessed 7-10 days after the immobilization removal, T2 was assessed 2 weeks after T1, and T3 was assessed a month after T2. Outcome measures assessed swelling of the fingers, hand, and wrist; ROM of the fingers and wrist; grip strength, PRWE self-reported pain and functioning, dynamic ROM using the HandTutor Physcial Therapy System (intervention group only), and the glove’s contribution (intervention group only). Figure 1 provides an image of the dynamic ROM assessment.
Fig.1 HandTutor system used to measure dynamic ROM in the intervention group.
Results indicate more significant findings between T1 and T2 for swelling and ROM between the intervention group and control group, and more significant findings throughout all assessment periods for pain, function, and participation. No significant differences were found for grip strength. In the intervention group, significant differences were achieved for dynamic ROM of the wrist and fingers at all assessment periods with the greatest difference at T1. Additionally, the intervention group reported no adverse effects which is represented in Figure 2. Tables 2 and 3 represent more explicit findings related to pain, function, and ROM between both groups.
Fig 2. Participant reports of compression glove contribution.
Bringing it Home
Based on the findings from this study, the combination of wearing compression gloves after hand surgery with rehabilitative exercises positively contributes to distal radius fracture outcomes with respect to pain, swelling, and ROM. It is suggested that surgeons, physicians, and therapists consider incorporating compression gloves into the treatment program of distal radius fractures. Furthermore, it is important to consider limitations of this study including small sample size and lack of blinding which could have impacted the results of this study.
Harris, L. C., Cole, A. L., Monroe, P. C., Chancey, J. A., & Shuler, M. S. (2011). Compression glove may reduce complications secondary to distal radius fracture. Journal of Hand Therapy, 24(4), 383–384.
Shuler, M. S., Cole, A. L., Monroe, P. C., Harris, L. C., Chancey, J. A., & Robinson, M. A. (2011). Compression glove may reduce Complications secondary to distal radius fractures: Level 1 evidence. Journal of Hand Surgery, 36(8), 31–32.
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