Content » Vol 51, Issue 9

Review article

Evidence-based rehabilitation therapy following surgery for (peri-)articular fractures: A systematic review

Marlous L.A.P. Schnackers, Yvette Y. van Horn, Guido H. H. Meys, Peter R.G. Brink, Rob J.E.M. Smeets, Henk A.M. Seelen
Centre of Expertise in Rehabilitation and Audiology, Adelante Rehabilitation Centre, The Netherlands
DOI: 10.2340/16501977-2599


Objective: To assess the availability of explicitly reported protocols describing post-surgery rehabilitation of (peri-)articular fractures of the proximal humerus, acetabulum and/or tibial plateau, and to critically review any scientific evidence on the effectiveness of these protocols.
Data sources: MEDLINE (PubMed), Cochrane databases, CINAHL, PEDro and Embase (Ovid) were searched to November 2018. Furthermore, stakeholder internet sites, clinical guidelines and standard textbooks were searched.
Study selection: Screening was performed independently by 2 researchers based on a priori defined eligibility criteria.
Data synthesis: Five papers addressed post-surgical rehabilitation of proximal humerus fractures, 1 paper that of acetabulum fractures. No eligible information was found on stakeholder sites or in standard textbooks. Overall, the main focus of the protocols identified was on the International Classification of Functioning, Disability and Health (ICF) “Body Functions and Structures” level. In general, little information about therapy dosage was reported. None of the protocols provided scientific evidence on which the content of described rehabilitation programmes was based.
Conclusion: This review reveals a paucity of explicitly formulated protocols focussing on post-surgical rehabilitation of common (peri-)articular fractures targeting patient-centred care at all ICF levels. There is a need for more scientific evidence on which to base protocols regarding common (peri-)articular fracture rehabilitation.

Lay Abstract

The aim of this study was to review the scientific literature on the availability of explicitly reported protocols or guidelines for therapists describing rehabilitation treatment of patients with 1 or more complex fractures of the upper arm, pelvis or knee joint that needed to be operated on. Online databases, stakeholder internet sites, clinical guidelines and textbooks were searched. The papers found were critically reviewed. Five papers describing the rehabilitation of patients with an upper arm fracture and 1 paper on rehabilitation treatment after a pelvis fracture were identified, mainly describing muscle strength, joint mobility or endurance issues. Little information about therapy dosage was reported. No scientific evidence was provided on which to base the rehabilitation programmes. This review reveals a lack of explicitly formulated rehabilitation protocols focusing on improving patients’ activities of daily living and of patients’ participation in social life. More scientific evidence is needed on such protocols.


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