标题：Effectiveness of the active physical therapy in restoring wrist and hand functional ability in patients with immobility-induced contracture of the wrist joint complicated by median nerve entrapment owing to distal forearm fracture
摘要：The high prevalence of complex upper extremity injuries, intricate anatomy, and high demand on fine motor skills require a novel approach to restore their function. Objective:To determine the effectiveness of the developed physical therapy program by evaluating the forearm and wrist functional outcomes in patients with immobility-induced contractures of the wrist joint complicated by median nerve entrapment. Method:We examined 56 patients with immobility-induced contracture of the wrist joint complicated by median nerve entrapment owing to distal forearm fracture. The patients were divided into two groups, i.e., the control group (received outpatient rehabilitation program with theprevailing use of passive methods such as manual techniques and, preformed physical factors) and the treatment group (received developed ICF-based physical therapy program with the prevailing use of active methods such as functional training, massage, moist warm compress combined with postisometric muscle relaxation, positional release therapy, and kinesiotaping). The effectiveness of the developed program was assessed in terms ofthe presence and degree of pain (VAS and DN4), goniometry results, signs of median nerve irritation (Hoffman–Tinnel sign, Phalen's test, and Durkan's test), Frenchay Arm Test, ABILIHAND, DASH, Boston Carpal Tunnel Questionnaire, and HADS. Results: After receiving rehabilitation, all of the patients showed a decrease in the intensity of pain at rest and duringmovement(VAS). There was an improvement in wrist joint motion (goniometry results) and a decrease in median nerve entrapment (pain intensity in DN4, prevalence of specific symptoms, and Boston Carpal Tunnel Questionnaire). There was also an improvement in the upper extremity function inABILIHAND, DASH, and Frenchay Arm Test. The psycho-emotional stress (HADS) was reduced to subclinical level and normal level in the control and treatment groups, respectively. Based on the studied outcome indicators, the patients fromboth groups showed a statistically significant improvement compared to the baseline values (p< 0.05); however, the treatment group demonstrated better outcomes compared tothe control group (p< 0.05). Conclusions:The developed physical therapy program with the prevailing use of active rehabilitation methods showed a statistically significant improvement in thefunctional ability of distal upper extremity, a reduced severity of median nerve irritation signs, and an improved psycho-emotional state compared tothe outpatient rehabilitation program.
