Can Postural Instability in Individuals with Distal Radius Fractures Be Alleviated by Concurrent Cognitive Tasks?

Abstract

Background Although impaired postural control may be a risk factor for distal radius fractures (wrist fractures), which often are caused by falls, little attention has been given thus far to the various performance and neurophysiologic aspects involved. Although studies suggest that external focus and cognitive tasks can improve postural control, it remains unclear whether these benefits are observed in individuals with a history of distal radius fracture and to what extent.Each author certifies that neither he or she, nor any member of his or her immediate family, have funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Lower limb muscle strength and balance in older adults with a distal radius fracture: a systematic review

“…11 (27%) cases referred to community physiotherapy ¶ 2/41 (5%) controls received balance exercises and physiotherapy sessions. 2/41 (5%) controls were referred to community physiotherapy Knee extension strength Knee flexion strength Ankle dorsiflexion strength MCToSIoB Ringsberg et al, [ 20 ] 1993 Sweden 184 Cases: 61 Con: 123 Cases: Women, aged 54–75 years, DRF 6 weeks-3 months or 11–13 months before Con: Healthy, age-matched women, no DRF NR Cases 6 weeks-3 months post DRF: 64 (6) Cases 11–13 months post DRF: 66 (5) Con: 64 (6) 100% women (184) NR N/A Single leg balance Sakai et al, [ 27 ] 2010 Japan 106 Cases: 54 Con: 52 Cases: Women, aged ≥ 50 years, DRF following fall from standing height, surgically treated with volar locking plate and no cast Con: Community dwelling, aged ≥ 50 years, no DRF NR Cases: 69.3 (9.9) Con: 67 (8.7) 100% women (106) NR N/A Single leg balance eyes open Sharabiani et al, [ 16 ] 2019 Iran 80 Cases: 40 Con: 40 Cases: 6–24 months after DRF following a fall Con: No history of DRF, age- and sex-matched In previous 1 year Cases: 1 (1) Con: 0 (0) Cases: 56 (4) Con: 55 (7) 83% female (66) NR N/A Postural sway RCTs Armstrong et al, [ 13 ] 1996 UK 116 Int: 57 Con: 59 Post-menopausal women, aged 45–70 years, ≤ 7 weeks after DRF, no contraindications to HRT NR …”

“…Full methodological quality assessments of included studies are presented in Additional file 4 . Two of 10 (20%) case-control studies [ 26 , 27 ] scored the maximum of eight stars on the modified Newcastle-Ottawa scale, two studies (20%) [ 14 , 28 ] scored seven stars, three studies (30%) [ 19 – 21 ] scored six stars, and one study (10%) scored five stars [ 16 ], four stars [ 17 ] and three stars [ 18 ]. Seven case-control studies lost a star for ‘representativeness of cases’ [ 14 , 16 – 21 ].…”

“…Two of 10 (20%) case-control studies [ 26 , 27 ] scored the maximum of eight stars on the modified Newcastle-Ottawa scale, two studies (20%) [ 14 , 28 ] scored seven stars, three studies (30%) [ 19 – 21 ] scored six stars, and one study (10%) scored five stars [ 16 ], four stars [ 17 ] and three stars [ 18 ]. Seven case-control studies lost a star for ‘representativeness of cases’ [ 14 , 16 – 21 ]. Two of the five (40%) case series [ 29 , 30 ] scored the maximum five stars on the modified Newcastle-Ottawa scale, two case series (40%) [ 15 , 31 ] scored four stars, and one (20%) [ 32 ] scored three stars.…”

“…Cases had no recent falls in three case-control studies that assessed balance [ 16 , 26 , 28 ]. Cho et al, [ 26 ] found no difference in performance of the balance component of the short physical performance battery between women six months after distal radius fracture and age- and gender-matched controls with a unilateral upper-limb condition.…”

“…During full-text screening, it became apparent that some studies included participants aged < 50 years, but participants’ mean age minus two standard deviations indicated ≥ 90% were aged ≥ 50 years [ 13 – 16 ]. Several studies did not specify if participants were enrolled within one year after distal radius fracture, instead they reported participants’ duration after distal radius fracture as a range, for example 6–24 months [ 16 – 20 ]. One study included a mixture of participants enrolled within, and more than, one year after distal radius fracture [ 21 ].…”