Clinical Question: Which is better for acute limb injuries, rest or early mobilization?

Setting: Various (meta-analysis)

Study Design: Systematic review

Allocation: Unconcealed

Synopsis: The authors of this study performed a thorough search of the literature to identify all studies of rest versus early mobilization for acute limb injuries, including fractures, strains, sprains, and other soft tissue injuries. Included were randomized controlled trials with less than 20 percent loss to follow-up (or an intention-to-treat analysis), trials that studied mostly adults, and those with adequate data reporting. The authors identified 187 potential articles, of which 49 met the inclusion criteria. The quality of the studies was rated on a scale from 0 to 16; most were of low quality, and the recommendations for this study were based in large part on the higher quality studies. The definition of early mobilization varied among studies and often involved comparison with splinting or immobilization.

Regarding pain and swelling, 13 studies demonstrated an improvement with early mobilization and nine showed improved patient satisfaction, while no studies reported an improvement with rest. The better quality studies found no difference or favored early mobilization. Overall function scores also were more likely to be improved by early mobilization than by rest, and return to work was hastened in 13 of 14 studies of this outcome. However, patient preferences, perhaps because of their expectations, tended to favor braces or casting following acute injuries. Cost was not studied.

Bottom Line: Early mobilization following acute limb injuries generally improves function, reduces pain and swelling, and speeds return to work and sports. With proper supervision and education, early mobilization is preferred over rest for an array of injuries. Unfortunately, this report does not provide highly specific guidance for mobilization of individual injuries. (Level of Evidence: 2a)