Plain English Summary
Background and study aims
Although programmes based on exercises may be recommended after surgery for proximal humeral fractures, there is a lack of evidence about their clinical impact as well as their long-term effects in working adults as most studies are conducted in older ages. Evidence is also required when defining characteristics (general physiotherapy, mainly including strengthening, stretching, and mobilization exercises, or task-oriented exercises, primarily aimed at early functional recovery and independence in ADL), intensity, frequency and duration of exercise-based programmes. The aim of this study is to find out whether a 12-week rehabilitation programme of functional exercises improves disability, pain, and quality of life, and whether these positive effects are maintained up to at least one year later.
Who can participate?
Patients aged 20-65 undergoing surgical treatment of proximal humeral fractures
What does the study involve?
Participants are randomly allocated to one of two treatment programmes: either an enriched programme incorporating task-oriented exercises, or general physiotherapy alone. The treatment programmes last 12 weeks, the rehab sessions are performed three times a week and the duration is 1 hour. The follow-up is for 1 year.
What are the possible benefits and risks of participating?
Possible benefits are clinically significant improvements in disability, pain, and quality of life. No side effects are expected.
Where is the study run from?
Operative Unit of the Scientific Institute of Lissone, Monza Brianza (Italy)
When is the study starting and how long is it expected to run for?
May 2012 to June 2017
Who is funding the study?
University of Cagliari, UNICA (Italy)
Who is the main contact?
Task-oriented exercises improve disability of working adults with surgically treated proximal humeral fractures: a randomized controlled trial with one-year follow-up
A 12-week rehabilitation programme of functional exercises would produce clinically significant improvements in disability, pain, and quality of life (QoL) in these subjects vs. general physiotherapy, and that these positive effects would have maintained up to at least one year later.
Approved 04/05/2012, Ethical Committee Salvatore Maugeri Foundation (Via Monsignor Ennio
Bernasconi, 16, 20851 Lissone MB, Italy; Tel: +39 (0)39 4657277), ref: 4
Randomised parallel-group superiority-controlled trial
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use contact details to request a participant information sheet.
Proximal humeral fracture, following surgery
Experimental group. Task-oriented exercises and occupational therapy.
Control group. Passive humeral and upper limb mobilisation, strengthening, muscle segmentary stretching, and
Randomization: the biostatistician randomized the subjects to one of the two treatment programmes using a permuted-block randomization procedure. The list of treatment codes was previously generated and stored in Matlab and an automatic assignment system, also developed in Matlab, was used to conceal the allocation.
The treatment programme took place at the outpatient rehabilitative gym at the hospital and was led by two physiatrists, an occupational therapist, and two equally-experienced physiotherapists. The interventions lasted 12 weeks, the rehab sessions were performed three times a week and the duration was of 1 hour. The follow-up was of 1 year. During the treatment period, the questionnaires were administered by secretarial staff who checked them and returned any uncompleted part to the subjects for completion. At follow-up, the patients were contacted personally by the same secretarial staff in order to ensure that the questionnaires were properly completed.
Primary outcome measure
Disability assessed using the validated Italian version of the self-reported Disability Arm Shoulder Hand questionnaire before treatment, at the end (12 weeks) and at follow-up (one year after the end of treatment).
Secondary outcome measures
1. Pain intensity assessed using an 11-point numerical rating scale at baseline, 12 weeks and 12 months
2. Quality of life assessed using the Italian version of the self-report Short-Form Health Survey (SF-36) at baseline, 12 weeks and 12 months
3. Patient-rated efficacy of treatment assessed using the Global Perceived Effect scale (GPE) at end of treatment
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
1. Subjects undergoing surgical treatment of PHFs classified as Arbeitsgemeinschaft Osteosynthese (AO) Foundation for the Study of Internal Fixation type 11 (2)
2. A good understanding of Italian
3. Working age (20-65 years old)
Target number of participants
Participant exclusion criteria
1. Cognitive impairment (Mini-Mental State Examination Score of<24), unstable cardiovascular and pulmonary diseases, and systemic or neuromuscular diseases, ruled out by means of case histories and imaging
2. Subjects with isolated tuberculum majus fracture (AO 11, A1), or fractures with involvement of the glenoid cavity, double fractures or injury of the plexus or the axillary nerve
3. Subjects who had workers’ compensation
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Scientific Institute of Lissone
Via Monsignor Bernasconi, 16
Lissone (Monza Brianza)
Università degli Studi di Cagliari
Dept. Medical Science and Public Health - Faculty of Medicine
Cittadella Universitaria S.S. 554 Bivio Monserrato - Sestu
Università degli Studi di Cagliari
University of Cagliari, UNICA
Funding Body Type
private sector organisation
Funding Body Subtype
Universities (academic only)
Results and Publications
Publication and dissemination plan
Peer-reviewed journals with special interest to spinal disorders. No additional documents are available.
IPD sharing statement:
The datasets generated during and/or analysed during the current study are available from Marco Monticone (firstname.lastname@example.org) on reasonable request on publication and from that day on; no access criteria; all of the analyses; consent was obtained; no comments on data anonymisation; no ethical or legal restrictions; no other comments.
Intention to publish date
Participant level data
Available on request
Basic results (scientific)