The effects of a three visit supervised physiotherapy exercise programme versus a six visit supervised physiotherapy exercise programme in children with supracondylar fractures without neurovascular injuries.
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Date
2014
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Abstract
Background
From the literature that has been reviewed for this study it is evident that there is a lack of
research conducted investigating the value of early mobilization and exercise treatment of
supracondylar fractures (SCF) in children. There has been no documented research conducted
in South Africa on the frequency of physiotherapy treatment in children with SCF of the
elbow joint or compliance of the child and parent/caregiver/guardian to a physiotherapy
upper limb home exercise programme. Currently there is no set physiotherapy treatment
protocol for SCF. Therefore this study attempts to investigate the effects of a supervised
physiotherapy exercise programme in children with SCF and the compliance of the child to
the home exercise programme monitored and conducted by the parent/caregiver/guardian.
Aims and Objectives
The primary aim of this study was to compare the effects of an exercise programme
supervised by the researcher fortnightly (three visits) over a six week period to those who
attended physiotherapy once per week (six visits) over a six week period. The secondary aim
was to determine the compliance of the child supervised by the parent/caregiver/guardian at
home with a physiotherapy home exercise programme over the 6 week period when not
attending formal physiotherapy sessions at the hospital.
The objectives used in the study was to determine pain, range of motion, activities of daily
living and compliance of the physiotherapy exercise programme of flexion, extension
supination and pronation movements at the elbow joint and soft tissue mobilization over three
formal physiotherapy treatment sessions (3 visits) compared to six formal physiotherapy
treatment sessions (6 visits) over the six week period.
Study Design
A randomised experimental design with a sample size of 50 children with SCF from three
provincial hospitals in the eThekwini district was followed. The study population comprised
of children between the ages of four to thirteen years presenting with SCF of the elbow joint
in the participating hospitals. The children were randomly and equally assigned into two
groups using a computer programme either into group A (intervention group) or group B (control group). The researcher was blinded to the groupings. The researcher performed the
physiotherapy treatment programme consisting of six basic elbow exercises namely: flexion,
extension, pronation and supination movements of the elbow joint (Appendix VI). Each of
the exercises was conducted 20 times. Soft tissue mobilization was the other technique
conducted where the researcher performed a passive stretch at the biceps muscle of the
affected arm on the children during the formal physiotherapy sessions (Appendix VII). The
stretch was repeated five times. Functional activities such as washing your face, eating and
combing the hair (extension and flexion) as well as keying and un-keying a door (supination
and pronation) are some of the basic activities one requires in life. These activities are only
possible if there is 90%-100% full range of motion at the elbow joint. Group A received the
physiotherapy regimen three times over a period of six weeks (first, third and sixth week)
whereas group B received the same physiotherapy regimen of basic elbow exercises six times
(once per week) over a six week period. Group A and group B were taught and requested to
continue with the same basic elbow exercises performed in the hospital as a home programme
where each exercise was performed 20 times three times a day. The parent/caregiver/guardian
was taught how to record the relevant information on the record sheet (Appendix VI). This
information was used to assess the compliance of the child with the home exercise
programme supervised by the parent/caregiver/guardian. Data analysis
The completed questionnaires consisting of the demographic data that was coded and was
entered into an excel spreadsheet and descriptive statistics were performed using the
Statistical Package for Social Sciences IBM SPSS version 20. The significance was set at p <
0.05. Baseline characteristics were compared between the two randomised groups using
Pearson’s Chi Square Tests and the Fisher Exact Test. Data were described at each time point
by group using non parametric descriptive statistics including median and interquartile range.
Comparisons between groups were done at each time point using non parametric Mann-
Whitney tests. Results
The p value was identified to assess whether the effects of a) pain, b) range of motion, c)
functional activities and d) compliance between the intervention group (three visit supervised
physiotherapy exercise programme) and the control group (six visit supervised physiotherapy
exercise programme) differed over time. A p value <0.05 was considered statistically
significant. There was no evidence for a beneficial effect of the intervention group over the
control group in terms of the differences in pain, range of motion and activities of daily living
using the relevant assessment tools. In the intervention group there was a slight increase in
flexion values at a non - significantly faster rate than those of the control group. There was
however, significantly less compliance to the home exercise programme in the intervention
group (three visits) compared to the control group (six visits).
Conclusion
The results of this study show that the condition of the children in the intervention group
(three visit supervised physiotherapy exercise programme) improved with regards to pain,
range of motion and function at the affected elbow at approximately the same rate as the
children in the control group (six visit supervised physiotherapy exercise programme).
Perhaps a more thorough illustration, demonstration and explanation of the purpose of the
home exercises need to be communicated to the children and the caregivers in order to obtain
a more positive response of the children to their compliance to the home exercise programme.
Children presenting with supracondylar fractures without neurovascular injuries could
possibly attend fewer formal physiotherapy sessions but comply with a home exercise
programme which proved beneficial. Therefore children especially those from rural areas
may spend less time attending formal physiotherapy sessions at public hospitals.
The overall results will also be beneficial to the parent/caregiver/guardian as they will
possibly spend less time away from work and will probably cut travel time and costs to bring
the child to hospital.
Description
M. Physio. University of KwaZulu-Natal, Durban 2014.
Keywords
Physical therapy for children--South Africa., Fractures in children--Exercise therapy--South Africa., Physical therapy--Rehabilitation--South Africa., Theses--Physiotherapy.