{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T01:54:13Z","timestamp":1791597253484,"version":"4.3.4"},"reference-count":37,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T00:00:00Z","timestamp":1710201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives. This overview of Cochrane systematic reviews (CSRs) reports on current evidence on the effectiveness of rehabilitation interventions for persons with upper limb fractures (ULFs), and the quality of the evidence. Materials and Methods. Following the inclusion criteria defined by the World Health Organization, all CSRs tagged in the Cochrane Rehabilitation database that were relevant for persons with ULFs were included. A mapping synthesis was used to group outcomes and comparisons of included CSRs, indicating the effect of rehabilitation interventions and the certainty of evidence. Results. A total of three CSRs were included in the evidence map. The certainty of evidence was judged as low to very low. Early occupational and hand therapy, cyclic pneumatic soft tissue compression, and cross-education, when started during immobilization, may improve grip strength and wrist range of motion, with results maintained up to 12 weeks from the cast removal, compared to no intervention. Approaches such as occupational therapy and passive mobilisation, started post-immobilization, are probably safe in terms of secondary complications. However, the overall evidence of rehabilitative interventions related to proximal humeral fractures has been judged insufficient for all the outcomes considered. A paucity of primary studies and CSRs for elbow fractures was noted. Conclusions. This overview provided the effect and the certainty of evidence of rehabilitation interventions available after ULFs using a mapping synthesis. To date, there is a need to further the effectiveness and safety of these interventions for persons with ULFs, improving methodological quality of the research in the field.<\/jats:p>","DOI":"10.3390\/medicina60030469","type":"journal-article","created":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T12:17:16Z","timestamp":1710245836000},"page":"469","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Overview of Cochrane Systematic Reviews for Rehabilitation Interventions in Individuals with Upper Limb Fractures: A Mapping Synthesis"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8707-2482","authenticated-orcid":false,"given":"Sara","family":"Liguori","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Specialties and Dentistry, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"},{"name":"Department of Mental and Physical Health and Preventive Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4598-2891","authenticated-orcid":false,"given":"Antimo","family":"Moretti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Specialties and Dentistry, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8560-721X","authenticated-orcid":false,"given":"Giuseppe","family":"Toro","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Specialties and Dentistry, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Arienti","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Patrini","sequence":"additional","affiliation":[{"name":"IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8500-7751","authenticated-orcid":false,"given":"Carlotte","family":"Kiekens","sequence":"additional","affiliation":[{"name":"IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1878-2747","authenticated-orcid":false,"given":"Stefano","family":"Negrini","sequence":"additional","affiliation":[{"name":"IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy"},{"name":"Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 \u201cLa Statale\u201d, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0976-925X","authenticated-orcid":false,"given":"Giovanni","family":"Iolascon","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Specialties and Dentistry, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1905-6405","authenticated-orcid":false,"given":"Francesca","family":"Gimigliano","sequence":"additional","affiliation":[{"name":"Department of Mental and Physical Health and Preventive Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"155","DOI":"10.23736\/S1973-9087.17.04746-3","article-title":"The World Health Organization \u201cRehabilitation 2030: A call for action\u201d","volume":"53","author":"Gimigliano","year":"2017","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2205","DOI":"10.1016\/j.apmr.2019.06.002","article-title":"Toward Strengthening Rehabilitation in Health Systems: Methods Used to Develop a WHO Package of Rehabilitation Interventions","volume":"100","author":"Rauch","year":"2019","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2006","DOI":"10.1016\/S0140-6736(20)32340-0","article-title":"Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Cieza","year":"2021","journal-title":"Lancet"},{"key":"ref_4","unstructured":"GBD 2019 Fracture Collaborators (2021). Global, regional, and national burden of bone fractures in 204 countries and territories, 1990\u20132019: A systematic analysis from the Global Burden of Disease Study 2019. Lancet Healthy Longev., 2, e580\u2013e592."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Bergh, C., Wennergren, D., M\u00f6ller, M., and Brisby, H. (2020). Fracture incidence in adults in relation to age and gender: A study of 27,169 fractures in the Swedish Fracture Register in a well-defined catchment area. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0244291"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/BOT.0000000000000768","article-title":"Management of Closed Diaphyseal Humerus Fractures in Patients with Injury Severity Score \u226517","volume":"31","author":"Dielwart","year":"2017","journal-title":"J. Orthop. Trauma"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1007\/s00590-020-02626-1","article-title":"Management of distal humerus fractures","volume":"30","author":"Lauder","year":"2020","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Schierenbeck, M., Gr\u00f6zinger, M., Reichardt, B., Jansen, O., Kauczor, H.U., Campbell, G.M., and Sedaghat, S. (2023). Detecting Bone Marrow Edema of the Extremities on Spectral Computed Tomography Using a Three-Material Decomposition. Diagnostics, 13.","DOI":"10.3390\/diagnostics13172745"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Mellstrand Navarro, C., Brolund, A., Ekholm, C., Heintz, E., Hoxha Ekstr\u00f6m, E., Josefsson, P.O., Leander, L., Nordstr\u00f6m, P., Zid\u00e9n, L., and Stenstr\u00f6m, K. (2019). Treatment of radius or ulna fractures in the elderly: A systematic review covering effectiveness, safety, economic aspects and current practice. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0214362"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1302\/2046-3758.510.BJR-2016-0138","article-title":"The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection","volume":"5","author":"Mills","year":"2016","journal-title":"Bone Jt. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s10195-020-00560-w","article-title":"Systematic review of clinical practice guidelines for adults with fractures: Identification of best evidence for rehabilitation to develop the WHO\u2019s Package of Interventions for Rehabilitation","volume":"21","author":"Gimigliano","year":"2020","journal-title":"J. Orthop. Traumatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"236","DOI":"10.23736\/S1973-9087.21.06916-1","article-title":"A systematic review of Clinical Practice Guidelines for the management of fractures in the pediatric population: Identification of best evidence for rehabilitation to develop the WHO\u2019s Package of Interventions for Rehabilitation","volume":"58","author":"Gimigliano","year":"2022","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_13","first-page":"ED000142","article-title":"Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions","volume":"10","author":"Cumpston","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V.A. (2019). Cochrane Handbook for Systematic Reviews of Interventions, Wiley. [2nd ed.].","DOI":"10.1002\/9781119536604"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1111\/j.1365-2753.2008.01112.x","article-title":"Evidence mapping: Illustrating an emerging methodology to improve evidence-based practice in youth mental health","volume":"16","author":"Hetrick","year":"2010","journal-title":"J. Eval. Clin. Pract."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1111\/dmcn.15572","article-title":"Overview of Cochrane systematic reviews for rehabilitation interventions in individuals with cerebral palsy: A mapping synthesis","volume":"65","author":"Liguori","year":"2023","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.jclinepi.2021.03.001","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"134","author":"Page","year":"2021","journal-title":"J. Clin. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1016\/j.apmr.2019.01.021","article-title":"One in 11 Cochrane Reviews Are on Rehabilitation Interventions, According to Pragmatic Inclusion Criteria Developed by Cochrane Rehabilitation","volume":"100","author":"Levack","year":"2019","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"j4008","DOI":"10.1136\/bmj.j4008","article-title":"AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both","volume":"358","author":"Shea","year":"2017","journal-title":"BMJ"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: An emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.jclinepi.2010.04.026","article-title":"GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables","volume":"64","author":"Guyatt","year":"2011","journal-title":"J. Clin. Epidemiol."},{"key":"ref_22","first-page":"CD000434","article-title":"Interventions for treating proximal humeral fractures in adults","volume":"6","author":"Handoll","year":"2022","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_23","first-page":"CD008130","article-title":"Early mobilisation for elbow fractures in adults","volume":"2011","author":"Harding","year":"2011","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_24","first-page":"CD003324","article-title":"Rehabilitation for distal radial fractures in adults","volume":"2015","author":"Handoll","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1177\/2151458516669202","article-title":"Distal Radius Fracture Outcomes and Rehabilitation","volume":"7","author":"Ikpeze","year":"2016","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_26","first-page":"157","article-title":"Distal and\/or Proximal Joint Stiffness Among Post-Fracture Patients Treated in University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia","volume":"14","author":"Gashaw","year":"2022","journal-title":"Orthop. Res. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1197\/j.jht.2007.06.001","article-title":"Patient-perceived outcome after displaced distal radius fractures. A comparison between radiological parameters, objective physical variables, and the DASH score","volume":"20","author":"Wilcke","year":"2007","journal-title":"J. Hand Ther."},{"key":"ref_28","unstructured":"American Academy of Orthopaedic Surgeons (2023, February 28). The Treatment of Distal Radius Fractures. Available online: https:\/\/www.aaos.org\/globalassets\/quality-and-practice-resources\/distal-radius\/distal-radius-fractures-clinical-practice-guideline.pdf."},{"key":"ref_29","unstructured":"Danish Health Authority (2023, February 28). National Clinical Guideline on the Treatment of Distal Radial Fractures. Available online: https:\/\/www.sst.dk\/da\/udgivelser\/2014\/~\/media\/22E568AA633C49A9A0A128D5FDC4D8B7.ashx."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e042629","DOI":"10.1136\/bmjopen-2020-042629","article-title":"Serious game versus standard care for rehabilitation after distal radius fractures: A protocol for a multicentre randomised controlled trial","volume":"11","author":"Meijer","year":"2021","journal-title":"BMJ Open"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s11678-017-0425-1","article-title":"Rehabilitation of elbow fractures and dislocations","volume":"12","author":"Hackl","year":"2017","journal-title":"Obere Extrem."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/0020-1383(94)90154-6","article-title":"The non-operative management of radial head fractures: A randomized trial of three treatments","volume":"25","author":"Koka","year":"1994","journal-title":"Injury"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"429","DOI":"10.2174\/1874325001206010429","article-title":"A survey of practice patterns for rehabilitation post elbow fracture","volume":"6","author":"Macdermid","year":"2012","journal-title":"Open Orthop. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1186\/s13018-021-02551-x","article-title":"Epidemiology of proximal humerus fractures","volume":"16","year":"2021","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s12306-017-0483-y","article-title":"Immediate intensive mobilization compared with immediate conventional mobilization for the impacted osteoporotic conservatively treated proximal humeral fracture: A randomized controlled trial","volume":"101","author":"Carbone","year":"2017","journal-title":"Musculoskelet. Surg."},{"key":"ref_36","first-page":"129","article-title":"Optimal Treatment of Proximal Humeral Fractures in the Elderly: Risks and Management Challenges","volume":"15","author":"Baker","year":"2023","journal-title":"Orthop. Res. Rev."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Baker, H.P., Gutbrod, J., Strelzow, J.A., Maassen, N.H., and Shi, L. (2022). Management of Proximal Humerus Fractures in Adults\u2014A Scoping Review. J. Clin. Med., 11.","DOI":"10.3390\/jcm11206140"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/3\/469\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:12:31Z","timestamp":1760105551000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/3\/469"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,12]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["medicina60030469"],"URL":"https:\/\/doi.org\/10.3390\/medicina60030469","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,12]]}}}