Priority 3 from the Broken Bones of the Upper Limb in People over 50

UNCERTAINTY: What is the best physical rehabilitation programme for people over 50 with an upper limb fracture (with or without surgery) when it NO LONGER needs to be kept still?  (JLA PSP Priority 3)
Overall ranking 3
JLA question ID 0093/3
Explanatory note Rehabilitation is important to ensure a patient achieves their best possible outcome following an upper limb fracture. However, we do not know what the ideal rehabilitation programme should be once a patient is allowed to start moving their injured arm. This question aims to determine the ideal rehabilitation programme for both surgically and non-surgically managed upper limb fractures. Uncertainties included the ideal rehabilitation programme for specific fractures, such as the proximal humerus, wrist and clavicle. Respondents asked about different aspects of rehabilitation such as timing / intensity / duration of physiotherapy; use of manual therapy, isometric exercises, weight bearing exercises and home exercise programmes; functional use of the arm; as well as the cost-effectiveness of physiotherapy.
Evidence

Handoll H & Brorson, S; Interventions for treating proximal humeral fractures in adults. Cochrane Systematic Review - Intervention Version published: 11 November 2015 

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 long would a planned rehabilitation programme last? ~ Explain balance between rehabilitation treatment given and self-management. ~ How often should I do exercises? ~ How can you standardise my rehab? ~ What is the optimum rehab regimen for wrist, elbow and humerus fractures? ~ What is the optimal rehabilitation after a clavicle fracture? ~ When to start resistance work after wrist operation?
Submitted by  7 x Healthcare professionals, 71 x Patients, 9 x Carers/relatives, 7 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