Impact of prolonged immobilization on functional recovery and perceived disability in older adults with proximal humerus fractures: a case study

Abstract

Introduction  Proximal humerus fractures are a significant cause of morbidity in older adults. Both conservative and surgical treatments require a period of immobilization which, although providing support and relief, may lead to stiffness and pain when maintained for a prolonged time.

Objective  This study analyzed the clinical, therapeutic, and rehabilitative factors that determine the prognosis of functional recovery in individuals with proximal humerus fractures.

Methods  This was a quantitative, descriptive, cross-sectional, non-randomized study of adults over 60 years of age with pathology of the proximal end of the humerus requiring immobilization. Outcome measures included the Shoulder Pain and Disability Index (SPADI), goniometry, and the Daniels strength scale.

Results  Five women between 65 and 83 years old were evaluated. Strong associations were found between days of immobilization and perceived disability (r = .900; p = 0.005) and strength (r = −.949; p = 0.005). Very strong associations were also found between shoulder flexion range and pain (r = −.975; p = 0.005). Currently, there is no consensus regarding the optimal immobilization period. Evidence suggests that prolonged immobilization reduces strength and joint range of motion, increases perceived disability, and that an occupation-based rehabilitation program can improve pain and reduce perceived disability.

Conclusions  It is essential to strike a balance between providing sufficient immobilization to allow injury healing while avoiding prolonged disability.

Keywords:
Humeral Fractures; Shoulder Prosthesis; Immobilization; Activities of Daily Living