Feasibility of the PERFormance guided fracture Rehabilitation Method (PERFoRM) protocol for upper extremity fractures

Abstract

Purpose: Upper extremity fractures are increasingly common in Western Europe due to an aging population and rising osteoporosis rates. Treatment approaches vary significantly, influenced by fracture type, bone quality, and patient-surgeon preferences, with limited consensus on optimal rehabilitation. A key challenge is identifying when to initiate safe, early functional rehabilitation, as guidelines lack clarity on progressive mobilization. Materials & Methods: A prospective observational study of operatively treated proximal humeral and distal radius fractures was performed. Feasibility was assessed through clinical observation of patient progress using patient-reported outcome measures and feedback from both medical and paramedical professionals. Results: Twenty patients and 10 professionals participated. Feasibility questionnaires indicated high protocol usability, though suggestions included simplifying it into a pocket card. Rapid functional improvement was observed within six weeks, with one complication (material failure) noted. Conclusion: The PERFoRM protocol is safe and feasible, though larger-scale studies are needed. Future research should examine its applicability to a broader patient population, potentially extending to all upper extremity fractures except hand fractures.