Priority 6 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) whilst it needs to be kept still (e.g. in a cast or sling)?  (JLA PSP Priority 6)
Overall ranking 6
JLA question ID 0093/6
Explanatory note Rehabilitation is important to ensure a patient achieves their best possible outcome following an upper limb fracture. There is often a period of time that patients are not allowed to move their injured arm whilst it is healing. We currently do not know what the ideal rehabilitation programme should be during this period of time. This question looks at ways that we can prevent stiffness and weakness in both the affect limb and unaffected limbs, as well as maintaining a patient's general fitness.
Evidence

Nash CE, Mickan SM, Del Mar CB, Glasziou PR. Resting injured limbs delays recovery: a systematic review. Journal of Family Practice 2004; 53(9): 706-712

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 Is information provided regarding keeping other joints in the upper limb mobile whilst in a cast to prevent stiffness? ~ Can working the other side to the injury or visual imagery be beneficial in instances where immobilisation is necessary? ~ Do we have a reliable way to avoid elbow stiffness after simple fractures? ~ More info would of been useful about movement while in cast and splint to help reduce problems afterwards. Perhaps would be helpful to see a physio at this stage.
Submitted by  6 x Healthcare Professionals, 6 Patients, 1 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