Development and feasibility of PROWRIST: a 12-week home-based progressive exercise and patient education program for individuals with post-traumatic wrist pain
Post-traumatic wrist pain
The PROWRIST program will be developed through a multi-stage co-creative process involving the research group and additional clinical experts. Clinical experts will be engaged at an early stage via a workshop and will subsequently be invited to review and provide feedback on the program. The participants will engage in a home-based, 12-week PROWRIST program combining progressive exercises and structured patient education with self-management strategies, with follow-up appointments every 2 to 3 weeks, which can be conducted in person or replaced by digital sessions if needed. A member of the research team, together with experienced physiotherapists at the Hand Surgery Department in Malmö, will be responsible for delivering and supervising the program. Prior to starting PROWRIST, each participant will have a consultation with the treating physiotherapist to discuss the treatment plan, set individual goals, and receive detailed instruction on the exercises. During this session, participants will also be guided through the educational content and taught how to apply self-management strategies, such as pacing, goal-setting, and problem-solving. During the follow-up sessions, the therapist will provide ongoing feedback to ensure correct exercise performance and to reinforce self-management strategies, with the aim of enhancing wrist function, reducing pain, and facilitating the transfer of exercises to daily activities. The program includes two main types of exercises, organized in three phases: 1) daily exercises performed once a day, focusing on wrist-specific movements, and 2) weekly exercises performed three times a week, consisting of a more comprehensive set of multi-joint exercises targeting the proximal muscles and core strength. The educational content and self-management strategies are integrated throughout the program to support adherence, facilitate recovery, and enhance the transfer of improvements to daily activities.
1. Diagnosed partial wrist ligament injuries, distortions, or other post-traumatic and symptomatic wrist conditions with no structural carpal malalignment 2. Wrist pain ≥3 months
1. Total wrist ligament injuries, carpal malalignment such as dorsal intercalated segment instability (DISI) and volar intercalated segment instability (VISI), surgically treated or acute wrist ligament injuries 2. Previous surgery to the wrist 3. Intra-articular wrist cortisone injection within the last 3 months 4. Wrist fractures, or ongoing upper extremity fracture healing 5. Radiocarpal osteoarthritis ≥ grade 2 6. Inability to understand and follow test instructions due to communicative, mental, or cognitive impairments.