Due to an ageing population, the number of the most common upper limb fractures – proximal humeral fractures and distal radius fractures – are expected to increase by about 10% every five years to 2036 (Sanders et al 1999). Following an upper limb fracture, patients are often referred to physiotherapy for rehabilitation to reduce pain, improve range of movement and strength, and to regain function (AIHW 2008). Even though the aims of physiotherapy are clear, the interventions used during the rehabilitation phase can vary greatly. These interventions can include thermal modalities, ultrasound,

electrical stimulation, continuous passive movement, electromyographic biofeedback, soft tissue mobilisation, mobilising and strengthening exercises, application of resting or dynamic splints, advice, and education find more (Bertoft et al 1984, Clifford, 1980, Lundberg et al 1979, Michlovitz et al 2001). Exercise is a common intervention after upper limb fracture. For example, Michlovitz et al (2001) found that exercise was prescribed to at least 90% of patients receiving rehabilitation after distal radius fracture. The application Obeticholic Acid ic50 of exercise is also consistent with the third key principle of fracture management – movement (Adams and Hamblen, 1995).

Previous research has identified that therapeutic exercise is beneficial across a broad range of health conditions (Taylor et al 2007). However, previous systematic reviews of trials of upper limb fracture management have not focused on the effect of exercise (Handoll et al 2003, Handoll et al 2006). In addition, clinical practice

guidelines for the treatment of distal radius fractures Libraries concluded that there was weak evidence to support the use of a home exercise program (Lichtman et al 2010). New trials of physiotherapy rehabilitation have been published since the two reviews were completed in 2003 and 2006. Physiotherapists need current evidence about the effectiveness of treatment techniques to help them make clinical decisions about patient care and to allocate limited therapy resources for people with upper limb fractures. Therefore, the specific research question for this systematic review was: What is the effect of exercise on reducing nearly impairment and increasing activity in the rehabilitation of people with upper limb fractures? Relevant randomised and quasi-randomised controlled trials were identified using a search strategy (See Appendix 1 on the eAddenda for full search strategy) from the earliest date possible until January 2011 in the following electronic databases: CINAHL, MEDLINE, Embase, AMED, SPORT Discus, PubMed, PEDro and the Cochrane Central Register of Controlled Trials. To ensure all relevant studies were captured, manual reference list checks and citation tracking of included studies using Web of Science were performed. One reviewer examined the study titles and abstracts to determine if they satisfied the inclusion criteria.