Action observation intervention using three - dimensional movies improves the usability of hands with distal radius fractures in daily life: a nonrandomized controlled trial in women

Prolonged immobilization of joints after distal radius fracture (DRF) leads to cerebral disuse-dependent plasticity (DDP) and deterioration of upper extremity function. Action observation therapy (AOT) can improve DDP. This nonrandomized controlled trial (UMIN 000039973) tested the hypothesis that AOT improves hand-use difficulties during activities of daily living in patients with DRF. Right-handed women with volar locking plate fixation for DRF were divided into AOT and Non-AOT groups for a 12-week intervention. The primary outcome was the difficulty in using the fractured hand, as examined by the Japanese version of the Patient-Related Wrist Evaluation (PRWE). Secondary outcomes were (1) range of motion (ROM) of the injured side and (2) difference between the measured and patient-estimated ROM. The survey was conducted immediately postoperatively and at 4, 8, and 12 weeks postoperatively. The AOT groups used a head-mounted display and three-dimensional video during ROM exercises, whereas the Non-AOT group used active ROM exercises alone. A generalized linear model (GLM) was used to confirm interactions and main effects by group and time period, and multiple comparisons were performed. In total, 35 patients were assigned to the AOT (n=18, median age 74 years) and Non-AOT (n=17, 70 years) groups. In the GLM, PRWE Total, PRWE Specific, and PRWE Usual scores showed interactions between groups and periods. A post-hoc test showed that the PRWE Specific (z=3.43, p=0.02) and PRWE Usual (z=7.53, p<0.01) scores w ere significantly lower in the AOT group than in the Non-AOT group at 4 weeks postoperatively, whereas PRWE Total s cores (z=3.29, p=0.04) were lower at 8 weeks postoperatively. These results suggest that AOT can improve hand-use difficulties in right-handed women after DRF surgery. AOT positively affects the motor imagery of patients with DRF and can reverse the patient’s perceived difficulty of using the fractured hand during rehabilitation.