title: Lack of Benefit of Physical Therapy on Function Following Supracondylar Humeral Fracture: A Randomized Controlled Trial.
abstract: BACKGROUND
  The goal of the study was to evaluate the efficacy of physical therapy in restoring function and mobility after a pediatric supracondylar humeral fracture.
  
  
  METHODS
  The study included sixty-one patients from five to twelve years of age with a supracondylar humeral fracture that was treated with casting or with closed reduction and pinning followed by casting. Patients were randomized to receive either no further treatment (no-PT group) or six sessions of a standardized hospital-based physical therapy program (PT group). The ASK-p (Activities Scale for Kids-performance version) and self-assessments of activity were used to assess function at one, nine, fifteen, and twenty-seven weeks after injury. Motion was measured at nine and fifteen weeks after injury by a blinded therapist. Anxiety was measured at one and nine weeks after injury with a self-assessment. Differences in ASK-p scores and anxiety level were analyzed with use of multivariate generalized estimating equations.
  
  
  RESULTS
  ASK-p scores were significantly better in the no-PT group at nine and fifteen weeks after injury (p = 0.02 and 0.01, respectively) but the difference at twenty-seven weeks was not significant. There were no differences between groups with respect to performance of activities of daily living or time to return to sports. Anxiety at nine weeks was associated with worse ASK-p scores at nine and fifteen weeks in the PT group and with better ASK-p scores in the no-PT group at these time points (p = 0.01 and 0.02, respectively). There were no differences between the groups with respect to elbow motion in the injured arm at any time. Severity of injury had no impact on function or elbow motion in either the PT or the no-PT group.
  
  
  CONCLUSIONS
  Children undergoing closed treatment of a supracondylar humeral fracture that was limited to approximately three weeks of cast immobilization received no benefit involving either return of function or elbow motion from a short course of physical therapy.
  
  
  METHODS
  Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedics and Sports Medicine (G.A.S. and V.B.) and Department of Emergency Medicine (S.M.), Seattle Children's Hospital, 4800 Sand Point Way, Seattle, WA 98105. E-mail address for G.A. Schmale: gregory.schmale@seattlechildrens.org.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Schmale
authors.affiliation: Department of Orthopedics and Sports Medicine (G.A.S. and V.B.) and Department of Emergency Medicine (S.M.), Seattle Children's Hospital, 4800 Sand Point Way, Seattle, WA 98105. E-mail address for G.A. Schmale: gregory.schmale@seattlechildrens.org.
authors.forename: Suzan
authors.initials: S
authors.lastname: Mazor
authors.affiliation: Children's Core for Biomedical Statistics, Seattle Children's Hospital, 2001 8th Avenue, CW8-5B, Seattle, WA 98121.
authors.forename: Laina D
authors.initials: LD
authors.lastname: Mercer
authors.affiliation: Department of Orthopedics and Sports Medicine (G.A.S. and V.B.) and Department of Emergency Medicine (S.M.), Seattle Children's Hospital, 4800 Sand Point Way, Seattle, WA 98105. E-mail address for G.A. Schmale: gregory.schmale@seattlechildrens.org.
authors.forename: Viviana
authors.initials: V
authors.lastname: Bompadre
mesh_terms: D000203:Activities of Daily Living; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006810:Humeral Fractures / Q000628:therapy*; D008297:Male; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012647:Self-Assessment; D016896:Treatment Outcome