Evidence map›Paper›PMID 42896847›Full record

ArticleBone & joint open2026

Development of a therapist-supervised flexibility and resistance exercise intervention for adults aged 50 years and over with a distal radius fracture in the Wrist Injury Strengthening Exercise (WISE) trial.

Warren Sheehan, Sarah E Lamb, Colin P Forde, Cynthia Srikesavan, Phillipa J A Nicolson, Elizabeth Tutton, Jenny Gould, Richard Grant, Juul Achten, Duncan Appelbe and 2 more

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Article in Bone & joint open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Warren SheehanOxford University Hospitals NHS Foundation Trust, Oxford, UK.
Sarah E LambPublic Health and Sport Sciences, University of Exeter, Exeter, UK.
Colin P FordeKadoorie Institute of Trauma, Emergency and Critical Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.ORCID 0000-0003-0749-1298
Cynthia SrikesavanPublic Health and Sport Sciences, University of Exeter, Exeter, UK.
Phillipa J A NicolsonBotnar Institute for Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Elizabeth TuttonKadoorie Institute of Trauma, Emergency and Critical Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.ORCID 0000-0003-3973-360X
Jenny GouldKadoorie Institute of Trauma, Emergency and Critical Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Richard GrantKadoorie Institute of Trauma, Emergency and Critical Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Juul AchtenKadoorie Institute of Trauma, Emergency and Critical Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Duncan AppelbeKadoorie Institute of Trauma, Emergency and Critical Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Matthew L CostaKadoorie Institute of Trauma, Emergency and Critical Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
David J KeeneKadoorie Institute of Trauma, Emergency and Critical Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.

Funding

Wellcome Trust
6 · The paper itself

Abstract

Aims: The definitive Wrist Injury Strengthening Exercise (WISE) trial is a multicentre superiority randomized controlled trial (RCT) evaluating usual care advice plus a therapist-supervised flexibility and resistance exercise intervention versus usual care advice alone for adults aged ≥ 50 years with a distal radius fracture (DRF). This paper describes the development and delivery of the therapist-supervised exercise intervention evaluated in the definitive WISE RCT. Methods: The intervention was developed iteratively in accordance with Medical Research Council (MRC) guidance for complex interventions. UK DRF clinical guidelines, published rehabilitation RCTs, UK NHS patient information leaflets, common post-injury impairments, and exercise and behavioural theory were reviewed to inform candidate intervention components. Feedback from UK therapists and patient and public involvement partners then informed the design of the initial intervention. Two methods of intervention delivery were then evaluated in a multicentre feasibility RCT and embedded qualitative study involving 117 participants aged ≥ 50 years with a distal radius fracture. Results: Review of guidelines and previous research highlighted uncertainty regarding the optimal rehabilitation after DRF and limited reporting of progressive exercise interventions. NHS patient information leaflets largely focused on flexibility exercises and self-management advice. Therapist and patient feedback informed the intervention content, progression, and participant materials. Findings from the feasibility RCT and embedded qualitative study supported a therapist-supervised delivery model with three sessions, rather than a single-session independent exercise approach. The final intervention comprised usual care advice plus up to three one-to-one sessions with a physiotherapist or occupational therapist over 12 weeks. Participants also received a workbook containing self-management advice, progressive flexibility and resistance exercises with resistance bands and therapeutic putty, and behaviour change strategies to support exercise adherence. Conclusion: Using an iterative MRC-informed process, a therapist-supervised rehabilitation intervention was developed and refined prior to definitive evaluation. Transparent reporting of intervention development and content should support interpretation, replication, and implementation.

Identifiers

PMID42896847
PMCPMC13680054

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.