Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Collaborative Specialization

Musculoskeletal Health Research

Supervisor

Dr. Joy MacDermid

Abstract

Introduction: Mirror therapy (MT) and neuromuscular electrical stimulation (NMES) are interventions that mitigate impairments in pain, strength, range of motion (ROM), and function. Immobilization to treat distal radius fractures (DRF) can result in similar impairments. MT and NMES can be applied during immobilization for DRF as they do not require active movement of the affected extremity. This is the study to investigate the feasibility of in-home MT, NMES, MT+NMES interventions during the immobilization period for DRF.

Methods: Literature reviews were conducted to determine how NMES and MT have been used with musculoskeletal conditions. In-home MT, NMES, and MT+NMES interventions were developed for application during immobilization for DRF. A feasibility RCT was implemented to assess recruitment, adherence to interventions, retention to on-site visits, and limited efficacy testing. Semi-structured interviews were conducted 6-weeks post-DRF to gain insight into the patients perspective, the practicality and acceptability of the interventions. Pain, ROM, dexterity, function, and strength were measured at 3-, 6-, 8-, and 12- weeks post-DRF at the on-site visits. Electromyographic recordings were collected during contractions for wrist movements at 8- and 12-weeks to investigate potential mechanisms of change.

Results: MT and NMES can help reduce pain, improve function and strength for after periods of disuse. In-home MT, NMES, and MT+NMES interventions that are 10-minute sessions, three times a day, five days a week for the last three weeks of immobilization for DRF were developed. The in-home interventions demonstrate adequate feasibility at this interim analysis with an average of 5 participants recruitment per month, >80% adherence, and >80% retention for the intervention group and 75% retention for the control group. Limited efficacy testing demonstrates trends towards improvement for the intervention groups. Patients expressed the practicality and acceptance of the interventions. Participants attributed their recovery and facilitated outcomes to their participation in the study. iii

Discussion: Engaging in early interventions for DRF during immobilization appear feasible at this interim analysis. The full feasibility sample is required to determine whether the protocol can be implemented in a full RCT as it is or requiring modifications.

Summary for Lay Audience

Fracturing the wrist usually requires a cast to be worn for at least six weeks to limit wrist movement and allow the bone to heal. The inactivity leads to loss of motor function (i.e. reduced strength and movement), which may require extensive rehabilitation and often leaves lasting impairments. Electrical stimulation activates the muscles of the arm and performing movements in front of mirror with the uninjured side are two strategies that can help recover from the resulting loss of motor function without having to move the injured arm. This research project aimed to develop interventions that can be applied during the casting period. The goal of this study was to determine if the interventions could be completed in-home after a wrist fracture. The project consists of 3-week in-home programs for three groups and standard care for the fourth group. One to activate the muscles of the arm, the other to perform movements in front of a mirror, and one group that does both together in hopes of improving recovery and shortening the time needed to heal. The in-home program was assessed for how well the protocol was followed on-site and at home, the practicality and if there was patient satisfaction with the interventions. Function, mobility, pain, fine motor skills, and strength was measured at four time points up to 12-weeks after the fracture. The recruitment and data collection for this study is ongoing. This study is the first to test these programs during casting for wrist fractures and will help decide if these programs should be used with all wrist fractures.

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