![]() An efficient return-to-work time is also recommended to decrease individual and company costs. Subsequently, non-operative treatments are recommended, usually based on immobilization and then on rehabilitation. When dealing with adult working patients it is common to firstly introduce joint-saving procedures, including minimally invasive reduction and intramedullary fixation, open reduction and internal plates fixation. PHFs advocate frequent demand for subsequent surgical and rehabilitation treatments. Despite exact estimates of indirect costs not being available, presumably long-term loss of earnings, vocational rehabilitation expenditures, pensions and wage-replacement costs, production slowdowns, accident investigations, and finally, the recruiting and training of workers to replace those injured are also expected. ![]() In addition, PHFs produce relevant direct costs including medical costs: the hospitalization cost is the most important factor in total healthcare cost of PHFs, being 55% of the total healthcare costs. Proximal humeral fractures (PHFs) induce pain and limitations in activities of daily living (ADL), and reduce quality of life (QoL). The most common site for fracture is proximal humerus accounting for 50% of them, with higher rates in females (78 visits with humeral fractures/100,000 people) than in males (36 visits with humeral fractures/100,000 people), and with a larger number in the 45–64 years age group. Upper limb fractures are continuously increasing in industrialized western countries: about 370,000 visits to the emergency departments are expected to occur every year in the United States. On, the trial was retrospectively registered in the ISRCTN registry with the ID number 17996552. Improvements lasted for at least 12 months. ConclusionsĪ rehabilitation program based on task-oriented exercises was useful in improving disability, pain, and quality of life in working patients after PHFs. As for SF-36, there were between-group differences ranging from 17.9 to 37.0 at follow-up. The NRS achieved a between-group difference of 2.9 (95% C.I. The DASH and the DASH work achieved clinically important between-group differences of 16.0 points (95% confidence interval 7.3 to 24.7) and 19.7 (95% C.I. Time, group and time by group showed significant effects for all outcome measures in favour of the experimental group. A linear mixed model analysis for repeated measures was carried out for each outcome measure ( p < 0.05). Participants were evaluated before surgery, before and after rehabilitation (primary endpoint), and at the one-year follow-up (secondary endpoint). The Disability Arm Shoulder Hand questionnaire (DASH scores range from 0 to 100 primary outcome), a Pain intensity Numerical Rating Scale (scores range 0 to 10 secondary outcomes), and the Short-Form Health Survey (scores range from 0 to 100 secondary outcomes) assessed the interventions. Both groups individually followed programs of 60-min session three times per week for 12 weeks in the outpatient setting. The second group underwent general physiotherapy, including supervised mobility, strengthening and stretching exercises. The first group underwent a supervised rehabilitation program of task-oriented exercises based on patients’ specific job activities, and occupational therapy. There was a permuted-block randomization plan, and a list of program codes was previously created subsequently, an automatic assignment system was used to conceal the allocation. Methodsīy means of a randomized controlled trial with one-year follow-up, 70 working patients (mean age of 49 ± 11 years 41 females), who were selected for open reduction and internal fixation with plates caused by PHF, were randomized to be included in an experimental ( n = 35) or control group (n = 35). Better-targeted exercises seem worthy of investigation and the aim of this study was to assess the efficacy of a rehabilitation program including task-oriented exercises in improving disability, pain, and quality of life in patients after a PHF. General physiotherapy is a common means of rehabilitation after surgery for proximal humeral fracture (PHF).
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