Randomised evaluation of rehabilitation after acute proximal humerus (shoulder) fracture: the REACH study

Plain English Summary

Background and study aims
A break (fracture) to the bone of the upper arm at the shoulder (proximal humerus) is a painful injury. It results in a sudden loss of use of the arm with recovery taking many months. Most injuries occur in people over 50 years of age after a fall, due to reduced bone strength, and are usually treated with a sling, although some fractures may need surgery.
At the moment, people are asked to see a physiotherapist a number of times to help with recovery after a proximal humerus fracture. Attending physiotherapy appointments can however be very difficult, especially for people who live alone or have poor social support networks. Driving is not possible and public transport is a struggle due to low confidence after a fall. A one-off advice session, with clear verbal and written instructions and videos of exercises patients can do at home, could be an alternative to attending a physiotherapy clinic for multiple sessions. Providing high-quality advice so people can manage their own recovery could be less of a burden for patients and their carers who might use fewer healthcare resources.
Before widely using an alternative advice approach, it is important to know that people receiving a one-off advice session would not be disadvantaged in their recovery compared with people having a series of physiotherapy appointments.
The REACH trial aims to find out the best way to support recovery and will compare the recovery of patients who receive a single advice session with a health professional and access to a workbook and videos to use at home, with the recovery of patients who are referred to see a physiotherapist

Who can participate?
People aged 16 years or above with a broken shoulder.

What does the study involve?
The two rehabilitation programmes in this study are referral for physiotherapist-supervised rehabilitation or self-directed rehabilitation. Participants allocated to self-directed rehabilitation will get detailed advice from a trained health professional in the hospital and will be provided with a workbook and access to a website with exercises that can be completed at home. Participants will be asked to complete follow-up questionnaires 2, 4 and 6 months after joining the study.

What are the possible benefits and risks of participating?
People are unlikely to be harmed by the rehabilitation programmes. The NHS already uses these types of advice and exercises for people with broken bones. Patients may feel some soreness in their shoulder after exercises but will be given advice on how to manage it. Participants may not benefit just from taking part in the study, but the results will help people who break their shoulder have a clear best pathway to recovery. Doctors and physiotherapists will use the information from this study to help treat people with broken shoulders in the future.

Where is the study run from?
The study is sponsored by the University of Exeter and run by the University of Oxford (UK)

When is the study starting and how long is it expected to run for?
October 2023 to August 2027

Who is funding the study?
National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (UK)

Who is the main contact?
Kylea Draper, reach@ndorms.ox.ac.uk

Contact information

Dr David Keene
Scientific

Medical School Building, St Luke’s Campus, Heavitree Road
Exeter
EX1 2LU
United Kingdom

ORCID ID	0000-0001-7249-6496
Phone	+44 (0)1865 223126
Email	d.keene@exeter.ac.uk

Mrs Kylea Draper
Public

University of Oxford - NDORMS
Kadoorie Centre
Level 3, John Radcliffe Hospital
Oxford
OX3 9DU
United Kingdom

Phone	+44 (0)1865 223126
Email	reach@ndorms.ox.ac.uk

Study information

Eligibility

Locations

Countries of recruitment

• England
• Scotland
• United Kingdom
• Wales

Study participating centres

Sponsor information

University of Exeter
University/education

Stocker Road
Exeter
EX4 4PY
England
United Kingdom

Phone	+44 (0)1392 726621
Email	res-sponsor@exeter.ac.uk
Website	http://www.exeter.ac.uk/
"ROR"	https://ror.org/03yghzc09

Funders

Funder type

Government

Results and Publications

Editorial Notes

01/04/2025: The study participating centres were updated to remove South Tees NHS Foundation Trust and add Princess Alexandra Hospital, Wrexham Maelor Hospital, King's College Hospital, and Royal Albert Edward Infirmary.
Royal Albert Edward Infirmary
09/09/2024: Trial's existence confirmed by the National Institute for Health and Care Research (NIHR) (UK).