Priority 15 from the Broken Bones of the Upper Limb in People over 50

UNCERTAINTY: Does the way in which rehabilitation is delivered (e.g. individual sessions, group sessions, hydrotherapy) to people over 50 with an upper limb fracture affect outcomes? (JLA PSP Priority 15)
Overall ranking 15
JLA question ID 0093/15
Explanatory note Rehabilitation is important to ensure a patient achieves their best possible outcome following an upper limb fracture. However, does the way we deliver this rehabilitation affect the level of recovery for patients? This question looks to determine the best way to deliver rehabilitation to patients to optimise their recovery. Uncertainties included individual versus group sessions; use of hydrotherapy; formal physiotherapy versus information leaflets; use of virtual physiotherapy; effectiveness of home exercises programmes; use of paper leaflets versus online videos versus apps; and the use of other forms of rehabilitation such as Pilates.
Evidence

Bruder AM, Shields N, Dodd KJ, et al.; Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation: a systematic review. J Physiother. 2017 Oct;63(4):205-220.

Handoll HHG & Elliott J.; Rehabilitation for distal radial fractures in adults. Cochrane Database of Systematic Reviews 2015, Issue 9
Health Research Classification System category Injuries and Accidents
Extra information provided by this PSP
Original uncertainty examples How effective is group physio compared with individual physio sessions for upper limb rehab? ~ Is group based rehab appropriate for conservatively managed proximal humerus fractures over 1:1 treatment? ~ Physiotherapy is vital. The hand class is very useful and provides some camaraderie. ~ In person physio vs information sheet only for all upper limb fractures ~ Is there a role for virtual physio therapy in the rehab of shoulder injuries?
Submitted by 40 x Healthcare Professionals, 21 x Patients, 3 x Carers / Relatives, 2 x Not stated
PSP information
PSP unique ID 0093
PSP name Broken Bones of the Upper Limb in People over 50 PSP
Total number of uncertainties identified by this PSP. 50 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 3 December 2018