Early Neuromuscular Stimulation and Mirror Therapy Interventions to Prevent Functional Loss During Immobilization of Distal Radius Fractures
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.