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BFR DISTRAD NON OP: Blood Flow Restricted Training During Rehabilitation Following Distal Radius Fracture

Primary Purpose

Distal Radius Fracture, Rehabilitation

Status
Unknown status
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
DELFI PTS ii portable tourniquet
Sponsored by
Brooke Army Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Distal Radius Fracture focused on measuring Blood Flow Restriciton, Occlusion training, Distal radius fracture

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Status post distal radius fracture (non-operative treated with cast immobilization)
  • Males and females 18-65 years of age
  • Eligible to receive care at Military Treatment Facility (DEERS eligible)
  • Must be able to read and write in English in order to consent

Exclusion Criteria:

  • Contralateral upper extremity involvement resulting in less than normal range of motion, muscle strength, or daily pain greater than 1/10.
  • Status post distal radius fractured treated operatively (k-wires, ORIF, etc)
  • Pregnancy - per patient self-report. Due the expected small number of pregnant individuals and resulting inability to account for its effect on resulting outcomes, these patients will not be included in the study.
  • Recent history of deep vein thrombosis, within the 12 months or on active treatment with anticoagulants
  • History of upper quadrant lymph node dissection
  • History of endothelial dysfunction
  • Patient endorsement of easy bruising
  • Active Infection in the injured arm
  • Cancer (current diagnosis per medical record)

Sites / Locations

  • Brooke Army Medical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

No Intervention

Active Comparator

Arm Label

non-oclusion training group

occlusion traingn with tourniquet

Arm Description

The control (non-occlusion training) group will follow the standard s/p distal radius fracture rehabilitation protocol. Treatment will include passive, active assistive,active range of motion (P/AA/AROM) to wrist, forearm and hand; desensitization as needed; edema control as needed; heat/cold modalities as needed; and strengthening exercises.

The occlusion training group will follow the same protocol as described above but will utilize occlusion training with the strengthening exercises. Investigators will use an established occlusion training protocol already being used. Intervention: Occlusion training with tourniquet (DELFI PTS ii portable tourniquet system)

Outcomes

Primary Outcome Measures

grip strength
grip strength will be assessed using the JAMAR Hand Dynamometer

Secondary Outcome Measures

pinch strength
Pinch strength will be assessed using the PG-60 Pinch Gauge. The mean of three successive trials will be recorded for each pinch position (tip, key and palmar)
joint range of motion
Joint range of motion (ROM) will be assessed using a plastic goniometer

Full Information

First Posted
February 15, 2017
Last Updated
February 16, 2017
Sponsor
Brooke Army Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT03056950
Brief Title
BFR DISTRAD NON OP: Blood Flow Restricted Training During Rehabilitation Following Distal Radius Fracture
Official Title
BFR DISTRAD NON OP: Blood Flow Restricted Training During Rehabilitation Following Distal Radius Fracture
Study Type
Interventional

2. Study Status

Record Verification Date
February 2017
Overall Recruitment Status
Unknown status
Study Start Date
March 2016 (undefined)
Primary Completion Date
March 2019 (Anticipated)
Study Completion Date
March 2019 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Brooke Army Medical Center

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Occlusion training, resistance exercise performed with a specialized venous tourniquet, leads to beneficial changes in muscle strength at low resistance and minimal stress on the nearby joint. This novel resistance training has the potential to greatly improve muscle strength gains in individuals who are unable, for medical reasons, to perform the high resistance exercises typically required to improve strength. Our study will examine the effect of this technique on strength recovery following distal radius fracture treated with cast immobilization (non-operatively). The primary objective of the intervention is to achieve accelerated recovery of forearm, wrist and hand function as assessed using measures such as grip/pinch strength, validated questionnaires, and functional outcome testing. Occlusion training can potentially serve as a specialty intervention for rehabilitation patients, reduce the cost of care, and improve the treatment options for both patients and providers.
Detailed Description
Investigator's will perform a prospective, randomized, controlled study. All subjects in this group will be adults who have sustained a distal radius fractured treated with cast immobilization (non-operative) at San Antonio Military Medical Center (SAMMC) clinic system. Participants will be provided information about the study and inclusion/exclusion criteria, and upon conclusion of the formal consenting process, and signature of the consent document, will be considered enrolled in the study. Prior to intiation of any study procedures each patient must be cleared for participation in treatment by his or her surgeon as per standard post-fracture protocol. Medical clearance will be documented on the Enrollment form (Appendix A) and the Medical History form (Appendix K). This will be verified by accessing the medical record to confirm that a referral was made for post-fracture rehabilitation. Before initiation of treatment, the enrolled subjects will be randomized to either a standard rehabilitation group or an occlusion training rehabilitation group. Randomization with be performed with a random number generator. Treatment will be initiated approxmiately 6 weeks s/p fracture (when cleared by the orthopedic surgeon). Participantswill undergo approximetely 8-12 weeks of treatment with therapy sessions two to three days a week (consistent with standard of care), and will have re-assessments completed at approximately 4 weeks, 8 weeks, and 12 weeks after initiating the training protocol. The 12-week time point (after initiation of therapy) will be at approximately the same time that patients are released for full activity per standard of care. The control (non-occlusion training) group will follow the standard s/p distal radius fracture rehabilitation protocol. Treatment will include passive, active assistive,active range of motion (P/AA/AROM) to wrist, forearm and hand; desensitization as needed; edema control as needed; heat/cold modalities as needed; and strengthening exercises. Specific strengthening exercises will include wrist flexion/extension over a foam wedge, forearm pronation/supination with arm positioned at side and elbow at 90 degrees, thumb opposition (pinch strength) as well as grip strengthening. The amount of resistance used with be determined by patient tolerance and post operative precautions. The occlusion training group will follow the same protocol as described above but will utilize occlusion training with the strengthening exercises. We will use an established occlusion training protocol already being used at the CFI. The resistance for strength training will be determined based on the individual participants tolerance. A cuff will be wrapped around the most proximal portion of the arm of the involved extremity. In order to individualize the pressure for each subject, the limb occlusion pressure will be measured (with dopplar ultrasound over the radial artery at the wrist level) at the first scheduled therapy visit. Limb occlusion pressure is the pressure necessary to completely occlude arterial blood flow. The cuff pressure utilized during the post-operative exercises will be set at 50% of the limb occlusion pressure. Repetions will be 30, 15, 15 and 15 for each of the four sets. A 30-second rest will be given between sets. The tourniquet will stay inflated throughout the entire exercise and rest sessions, and no longer than 30 minutes consecutively for any time that the tourniquet is inflated. After completion of the 4 sets the tourniquet pressure will be deflated. The subjects' strength will be re-assessed approximately every 2-4 weeks and the load will be increased as tolerated.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Distal Radius Fracture, Rehabilitation
Keywords
Blood Flow Restriciton, Occlusion training, Distal radius fracture

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
52 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
non-oclusion training group
Arm Type
No Intervention
Arm Description
The control (non-occlusion training) group will follow the standard s/p distal radius fracture rehabilitation protocol. Treatment will include passive, active assistive,active range of motion (P/AA/AROM) to wrist, forearm and hand; desensitization as needed; edema control as needed; heat/cold modalities as needed; and strengthening exercises.
Arm Title
occlusion traingn with tourniquet
Arm Type
Active Comparator
Arm Description
The occlusion training group will follow the same protocol as described above but will utilize occlusion training with the strengthening exercises. Investigators will use an established occlusion training protocol already being used. Intervention: Occlusion training with tourniquet (DELFI PTS ii portable tourniquet system)
Intervention Type
Device
Intervention Name(s)
DELFI PTS ii portable tourniquet
Intervention Description
A cuff will be wrapped around the most proximal portion of the arm of the involved extremity. In order to individualize the pressure for each subject, the limb occlusion pressure will be measured (with doppler ultrasound over the radial artery at the wrist level) at the first scheduled therapy visit. The cuff pressure utilized during the post-operative exercises will be set at 50% of the limb occlusion pressure. The subjects' strength will be re-assessed approximately every 2-4 weeks and the load will be increased as tolerated.
Primary Outcome Measure Information:
Title
grip strength
Description
grip strength will be assessed using the JAMAR Hand Dynamometer
Time Frame
18 weeks
Secondary Outcome Measure Information:
Title
pinch strength
Description
Pinch strength will be assessed using the PG-60 Pinch Gauge. The mean of three successive trials will be recorded for each pinch position (tip, key and palmar)
Time Frame
18 weeks
Title
joint range of motion
Description
Joint range of motion (ROM) will be assessed using a plastic goniometer
Time Frame
18 weeks
Other Pre-specified Outcome Measures:
Title
Performance measure DASH
Description
a 30-item self-report measure that assesses a subject's perceived ability to complete twenty-one upper extremity functional activities using a 5-point Likert scale. The cumulative DASH score is scaled from 0 to 100, with higher scores indicating increased disability
Time Frame
18 weeks
Title
Performance measure PRWE
Description
a 15-item questionnaire that assesses wrist pain (5 items) and disability (10 items) in activities of daily living.
Time Frame
18 weeks
Title
Performance measure JTHFT
Description
is a seven part test that evaluates the time needed to perform seven hand-related tasks
Time Frame
18 weeks
Title
Performance measure PSFS
Description
a patient-specific outcome measure to assess functional status[49]. The patient is asked to identify three to five activities that he or she has difficulty performing due to his or her condition. The patient then rates the amount of limitation he or she has in performing each of these activities on an 11-point scale with 0 being unable to perform the activity and 10 being able to perform the activity with no problem. An average score for the activities gives an ability score out of 10.
Time Frame
18 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Status post distal radius fracture (non-operative treated with cast immobilization) Males and females 18-65 years of age Eligible to receive care at Military Treatment Facility (DEERS eligible) Must be able to read and write in English in order to consent Exclusion Criteria: Contralateral upper extremity involvement resulting in less than normal range of motion, muscle strength, or daily pain greater than 1/10. Status post distal radius fractured treated operatively (k-wires, ORIF, etc) Pregnancy - per patient self-report. Due the expected small number of pregnant individuals and resulting inability to account for its effect on resulting outcomes, these patients will not be included in the study. Recent history of deep vein thrombosis, within the 12 months or on active treatment with anticoagulants History of upper quadrant lymph node dissection History of endothelial dysfunction Patient endorsement of easy bruising Active Infection in the injured arm Cancer (current diagnosis per medical record)
Facility Information:
Facility Name
Brooke Army Medical Center
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78234
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Simon A Brown, MBA
Phone
210-965-8634
Email
simon.a.brown.ctr@mail.mil
First Name & Middle Initial & Last Name & Degree
Jason M Wilken, PhD
Phone
210-916-1478
Email
jason.m.wilken.civ@mail.mil
First Name & Middle Initial & Last Name & Degree
Jill Cancio, OTD

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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BFR DISTRAD NON OP: Blood Flow Restricted Training During Rehabilitation Following Distal Radius Fracture

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