Skip to main content

Compliance of functional exercises in school-age children with limb fractures: implication for nursing countermeasures

Abstract

Background

Functional exercises is very essential to the recovery of patients with fracture. We aimed to evaluate the compliance of functional exercises in school-age children with limb fracture, to provide evidence to the clinical management and nursing care of children with limb fracture.

Methods

School-age children with limb fractures treated in our hospital from January 1, 2020 to June 30, 2021 were selected. The characteristics and postoperative functional exercise compliance of included children were analyzed. Pearson correlation and Logistic regression analysis were conducted to analyze the influencing factors of compliance to functional exercises.

Results

A total of 328 children with limb fracture were included, the incidence of compliance to functional exercise was only 35.98%. Pearson correlation analysis showed that age(r = 0.707), only child of family(r = 0.537), guardians(r = 0.642) and type of temperament(r = 0.635) were correlated with compliance to functional exercises in school-age children with limb fractures (all p < 0.05). Logistic regression analysis indicated that age ≤ 10y (OR2.913, 95%CI2.091 ~ 3.611), only child of family (OR2.006, 95%CI1.683 ~ 2.558), guarded by grandparents (OR1.512, 95%CI1.201 ~ 2.118), non-easy-going temperament (OR4.127, 95%CI3.811 ~ 4.902) were the influencing factors of non-compliance to functional exercises in children with limb fracture (all p < 0.05).

Conclusions

School-age children have poor compliance with functional exercises after limb fractures, and there are many influencing factors. For children with those risks, health care providers should actively intervene in nursing to improve children’s exercise compliance and the rehabilitation effect.

Peer Review reports

Background

Previous studies [1,2,3] have reported that fractures in school-age children are very common in clinical practice, with an incidence ranging from 2.04% to 11.46%. School-age children are in the stage of gradual bone ossification [4]. The bone composition contains more colloids, less calcium, and full of elasticity, but they are still not strong and are prone to fractures [5]. Fractures of the limbs are more common in school-age children, mainly due to the higher physical and psychological maturity of children during this period, and heavier curiosity about things, less self-protection ability and life experience [6, 7]. Besides, those children spend a relatively long time in school during this period, and parents’ awareness of protection is relatively relaxed, resulting in children are prone to fractures during daily activities [8, 9]. Therefore, the prevention and care of school-age children's fractures have an important influence on the prognosis of children.

School-age children are the most vigorous period of the development of various physiological functions in their lives [10]. There is a big difference in the anatomy, injury mechanism and healing characteristics of adults [11]. Fracture injuries in children are often accompanied by bone damage. Improper treatment will lead to shorter bone development and deformities such as crooked, oblique, etc. [12, 13]. Children have a high disability rate and are accompanied by varying degrees of dysfunction, but their healing speed is faster than that of adults [14]. Therefore, how to promote the functional recovery of children with fractures is particularly important. With the development and improvement of medical technology, people have higher requirements for the treatment of diseases. They are not only satisfied with curing the disease and injury itself, but also pay more attention to the long-term prognosis of the disease. Therefore, in the process of fracture treatment, the functional exercise of the affected limb is particularly important, which directly has a serious impact on the later functional recovery [15]. The latest rehabilitation concept proposes that in the acute phase, symptoms including congestion, swelling, increase in the number of fibers and collagen cells, and shedding of necrotic cells at the acute stage will cause local adhesions, which will affect the later functional exercises [16, 17]. Effective functional exercises in the early stage of the fracture will promote local blood circulation, reduce swelling, prevent compartment syndrome, and promote functional recovery [18]. Previous studies [19, 20] have shown that children with early fractures suffer from severe pain, coupled with the unfamiliarity of the environment during hospitalization, which makes them feel nervous, scared, and crying, resulting in poor exercise compliance, missing the best exercise opportunity, and directly affecting the effect of surgery and quality of life of children in later stages. Therefore, it is necessary to explore the factors affecting the compliance of functional exercises in school-age children with limb fracture, to provide evidence support for clinical treatment and care of children with limb fracture.

Methods

Ethics

In this study, all methods were performed in accordance with the relevant guidelines and regulations. This present study was a prospective cohort study design, the study had been checked and approved by the ethical committee of our hospital with approval number: (202001011–2). Furthermore, the written informed consents had all been obtained from the guardians of included children, and children’s assent to participate in the study was obtained accordingly.

Population

This study selected school-age children with limb fractures who admitted to our department from January 1, 2020 to June 30, 2021 as the research population. The inclusion criteria for children were as following: The children were school-age children aged 6 to 15 years old; The children could understand language expressions; The children could express their ideas and thought on their own; The children have accompanied guardians during their hospitalization; The guardian of the child was aware of the purpose of this study and voluntarily signed the informed consent form. Exclusion criteria for children were as following: Children with old fractures; Children with congenital diseases, such as congenital heart disease, congenital bone malformations; Children with visceral damage, such as liver rupture, spleen rupture, etc.; Children or their guardians were unwilling to participate in this study.

Definition and evaluation of functional exercise compliance

Exercise compliance was defined as the degree of consistent behavior of children performing rehabilitation exercises according to the requirements and recommendations of medical staff. We used the previously reported postoperative functional exercise compliance questionnaire [21] to analyze the children’s exercise compliance. The questionnaire involved postoperative functional exercise knowledge, doctor’s execution, daily functional exercise time, daily functional exercise times, conscious exercise and daily life behavior ability. Each item used a 5-level scoring method according to the content of the answer, corresponding to 0 ~ 4 points, the higher the score indicated the better the compliance, and scores of 3 points or above of all items indicated full compliance, otherwise it was rated as non-compliance.

Data collection

Two investigators collected following data from the communication to the guardians or children and related medical records: age, gender, body mass index(BMI), whether the child was the only child of family, place of residence, guardians, type of fracture, site of fracture, causes of fracture and type of temperament. Any disagreement was solved by further discussions.

This study used the Chinese School-age Children Temperament scale (CSTS) [22] to assess the temperament characteristics of children. The questionnaire has a total of 99 items belonging to 9 temperament dimensions, and each item is scored 1 to 6 points in 6 levels: almost never, very rare, rare, common, very common, and almost always. According to the score, the children were rated as easy-going, troublesome, initiate slow and intermediate temperament accordingly. Professionally trained nursing staff used CSTS communicating with family members or guardians who know the children’s life habits best. Family members who understand the children’s life habits have the longest contact time with the children, and observe the children’s behavior for a long and careful time, and fully understand the personality characteristics of children. The nursing staff explained the purpose of the investigation to the family members, and after obtaining their understanding and consent, we correctly guided the guardians to fill in.

Statistical analysis

In this study, SPSS 23.0 statistical software was used to process the data. The count data were expressed as percentage (%), the comparison between groups was compared by chi-square test, the continuous variables were expressed as mean ± standard deviation, and the comparison between groups was conducted by t test. We selected the statistically significant outcome variables of univariate analysis as independent variables, and took the factors that affect children's functional exercises as dependent variables, and analyzed the influencing factors of children's functional exercises by Logistic regression analysis. Besides, Pearson correlation analysis was conducted to evaluate the compliance to functional exercises and related characteristics. In this study, P < 0.05 was considered as the difference between the groups was statistically significant.

Results

The characteristics of included children

A total of 328 children with limb fracture were included, of whom 118 children had good compliance to functional exercise, the incidence of compliance to functional exercise in school-age children with limb fractures was 35.98%. As presented in Table 1, there were significant differences in the age, only child of family, guardians and type of temperament between compliance group and non-compliance group (all p < 0.05). No significant differences in the gender, BMI, place of residence, type of fracture, site of fracture and causes of fracture between compliance group and non-compliance group were found (all p > 0.05).

Table 1 The characteristics of included children

Pearson correlation analysis

As indicated in Table 2, Pearson correlation analysis showed that age(r = 0.707), only child of family(r = 0.537), guardians(r = 0.642) and type of temperament(r = 0.635) were correlated with compliance to functional exercises in school-age children with limb fractures (all p < 0.05).

Table 2 Pearson correlation analysis of compliance to functional exercises and related characteristics

Logistic regression analysis

The variable assignments of multivariate logistic regression were showed in Table 3. As indicated in Table 4, Logistic regression analysis indicated that age ≤ 10y (OR2.913, 95%CI2.091 ~ 3.611), only child of family(OR2.006, 95%CI1.683 ~ 2.558), guarded by grandparents(OR1.512, 95%CI1.201 ~ 2.118), non-easy-going temperament(OR4.127, 95%CI3.811 ~ 4.902) were the influencing factors of non-compliance to functional exercises in children with limb fracture (all p < 0.05).

Table 3 The variable assignments of multivariate logistic regression
Table 4 Logistic regression analysis on the influencing factors of non-compliance to functional exercises in children with limb fracture

Discussions

Early functional exercises for fractures are mostly within 2 weeks after surgery, mainly to exercise muscle contraction and relaxation, and mid-term functional exercises are mostly within 3 to 6 weeks after surgery [23]. The exercise intensity can be gradually strengthened and large joint activities can be attempted, but activities that are not conducive to fracture connection and stability still need to be restricted [24, 25]. Later functional exercises are mostly carried out after 6 weeks after surgery, and the limb function is gradually restored through comprehensive joint and muscle exercises [26]. It is very important to actively carry out nutritional supplements and scientific functional exercises after limb fractures. Postoperative functional exercises can not only avoid complications such as postoperative joint stiffness and muscle atrophy, but also promote the healing of the patient’s fractures [27]. However, functional exercise after surgery is more challenging in school-age children since they are lively and active, and their safety awareness and self-control ability are not strong enough [28, 29]. Currently, the status and influencing factors of compliance to functional exercise in school-age children with limb fractures remain unclear. The results of this study have found that the incidence of compliance to functional exercise in school-age children with limb fractures is 35.98%, and for children with age ≤ 10y, only child of family, guarded by grandparents, non-easy-going temperament, they may have less compliance to functional exercises after surgery, early targeted nursing care are needed for those children to improve the compliance to functional exercises of children.

Functional exercise after limb fracture operation needs to last a relatively long period of time, so functional exercise compliance is a key factor. The results of this study show that school-age children’s compliance with functional exercises after limb fractures is low, which suggests that compliance with functional exercises after school-age children’s limb fractures is affected by multiple factors. Individualized interventions can effectively improve the compliance of school-age children with limb fractures [30]. Functional exercise compliance helps children recover as soon as possible. Compliance refers to the extent to which patients accept and obey the prescribed medical and nursing measures and their behaviors [31]. This study has investigated and analyzed the compliance of school-age children with limb fractures, and has found that children under 10 years of age have poor early exercise compliance, mainly due to their relatively young age, relatively poor understanding and communication skills, and self-care ability, the importance of functional exercise cannot be fully understood for those children. Therefore, for children with age ≤ 10y, the health care providers should use simple and understandable language to communicate with them when they perform functional exercises, and integrate the exercise with games to increase the children’s interest in exercise, and then improve their compliance to functional exercise.

Children with limb fractures will still have obvious pain, swelling and movement dysfunction in the early postoperative period. The children will be disturbed by physical discomfort or emotional state of tension and fear [32, 33]. The older the school-age children can be more adapt well to the postoperative state of fractures and better cooperate with functional exercises. Children whose only children and their main caregivers are grandparents receive more attention in their daily lives, they have relatively poor tolerance to pain [34]. When they cannot maintain functional exercises, their caregivers are more likely to compromise, give up, thereby reducing the compliance [35]. Temperament characteristics are the psychological characteristics of a person's personality, and it is reported that it interacts with physical diseases and the treatment of physical diseases [36, 37]. School-age children with easy-going temperament have a weaker stress response to fractures and surgical treatments, they have strong receptivity, positive emotions, and compliance with functional exercises [38]. Therefore, in the functional exercise work of school-age children after limb fracture surgery, it is necessary to integrate the above influencing factors and pay attention to the relevant characteristics of individuals. The fun of functional exercise can be improved through methods such as children's game-style functional exercise and goal completion reward programs to help children improve their compliance.

Studies [39] have shown that the complexity of the treatment plan may influence the patients’ compliance. Although school-age children have developed cognitive abilities, they have poor understanding of things and self-control, things and treatment programs cannot be understood easily [40]. Therefore, when formulating early functional exercise programs for children with affected limbs, attention should be paid to explanations as simple as possible, focus on demonstrations, and proceed in a planned and segmented manner, so that the children can easily accept and understand. The general exercise method is from simple to complex, time from short to long, frequency from less to more, the intensity of exercise gradually increases, and the transition from passive exercise to active exercise gradually [41, 42]. It is appropriate for the child to accept and not cause severe pain, and if necessary, give appropriate analgesics in accordance with the doctor's instructions before the exercise [43, 44], so that the children can gradually adapt and not have fear of the pain caused by the functional exercise of the affected limb, and increase their compliance with the early functional exercise.

Several limitations in this present study must be considered. Firstly, participants with ≥ 12 years should be considered as adolescents in a separate group since there are important differences between these two groups that affect compliance, however, in China age ≥ 16 years is generally considered as adolescents, most of our included children are in the age range of 9–12 years old, it may underpower to detect the group between this two group. Secondly, our study is a single centered observational study, the sample size is small, and there may some other variables that affect postoperative functional exercises. Therefore, multi-centered studies with larger sample size and rigorous design in different areas are needed to further evaluate the children’s compliance with postoperative functional exercises in the future.

Conclusions

In summary, school-age children’s compliance with postoperative functional exercises for limb fractures is low, which should arouse great attentions from health care providers and related guardians. Compliance with postoperative functional exercises is affected by many factors including the age of the child, the only child, the main caregiver, and the characteristics of temperament. Those influencing factors should be considered to take targeted intervention measures to help children and their parents correctly and actively carry out postoperative functional exercises, to improve the compliance with postoperative functional exercises, thereby improving the recovery of children.

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

Abbreviations

BMI:

Body mass index

CTST:

Chinese School-age Children Temperament scale

References

  1. Hansheng D, Zhu X, Shengping T. Progress in the treatment of femoral shaft fractures in children and adolescents. Journal of Qiqihar Medical College. 2020;41(18):5–10.

    Google Scholar 

  2. Qingming L, Jiahui C, Xinping H. Epidemiological investigation and direct economic burden analysis of 1809 children with fractures in Dongguan. Journal of Guangdong Medical University. 2018;36(4):4–8.

    Google Scholar 

  3. Hongmei L, Cuiling C, Ying L. Epidemiological investigation and analysis of upper limb fractures in children. Nurs Res. 2016;30(6):735–7.

    Google Scholar 

  4. Miyamoto S, Otsuka M, Hasue F, Fujiyoshi T, Kamiya K, Kiuchi H, Odagiri T, Tanaka T, Nakamura J, Orita S, et al. Associated injury complicated by pediatric lower limb shaft fractures and clinical efficacy of flexible stainless-steel intramedullary nailing in children less than 15 years old. Orthop Rev (Pavia). 2021;13(1):8008.

    Google Scholar 

  5. Naik P. Remodelling in Children’s Fractures and Limits of Acceptability. Indian J Orthop. 2021;55(3):549–59.

    PubMed  PubMed Central  Google Scholar 

  6. Tsou PY, Ma YK, Wang YH, Gillon JT, Rafael J, Deanehan JK. Diagnostic accuracy of ultrasound for upper extremity fractures in children: A systematic review and meta-analysis. Am J Emerg Med. 2021;44:383–94.

    PubMed  Google Scholar 

  7. Albedewi H, Al-Saud N, Kashkary A, Al-Qunaibet A, AlBalawi SM, Alghnam S. Epidemiology of childhood injuries in Saudi Arabia: a scoping review. BMC Pediatr. 2021;21(1):424.

    PubMed  PubMed Central  Google Scholar 

  8. Nikander R, Sievanen H, Heinonen A, Daly RM, Uusi-Rasi K, Kannus P. Targeted exercise against osteoporosis: A systematic review and meta-analysis for optimising bone strength throughout life. BMC Med. 2010;8:47.

    PubMed  PubMed Central  Google Scholar 

  9. Binkley TL, Parupsky EC, Kleinsasser BA, Weidauer LA, Speckerr BL. Feasibility, compliance, and efficacy of a randomized controlled trial using vibration in pre-pubertal children. J Musculoskelet Neuronal Interact. 2014;14(3):294–302.

    CAS  PubMed  Google Scholar 

  10. Grgic O, Chung K, Shevroja E, Trajanoska K, Uitterlinden AG, Wolvius EB, Rivadeneira F, Medina-Gomez C. Fractures in school age children in relation to sex and ethnic background: The Generation R Study. Bone. 2019;121:227–31.

    PubMed  Google Scholar 

  11. Phelan I, Furness PJ, Dunn HD, Carrion-Plaza A, Matsangidou M, Dimitri P, Lindley S. Immersive virtual reality in children with upper limb injuries: Findings from a feasibility study. J Pediatr Rehabil Med. 2021;14(3):401–14.

    PubMed  Google Scholar 

  12. Mohsenzade P, Amirhakimi A, Honar N, Saki F, Omrani GHR, Dabbaghmanesh M. Bone density, fractures and the associated factors in iranian children and adolescent with Osteogenesis Imperfecta. BMC Pediatr. 2021;21(1):37.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Ferrer FS, Castell EC, Marco FC, Ruiz MJ, Rico JAQ, Roca APN. Influence of weight status on bone mineral content measured by DXA in children. BMC Pediatr. 2021;21(1):185.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Grgic O, Shevroja E, Dhamo B, Uitterlinden AG, Wolvius EB, Rivadeneira F, Medina-Gomez C: Skeletal maturation in relation to ethnic background in children of school age: The Generation R Study. Bone 2020, 132:115180.

    PubMed  Google Scholar 

  15. Chaoqi D, Zhenghua S, Yong W. Investigation of compliance with functional exercise and analysis of influencing factors in school-age children with limb fracture surgery. China Maternal and Child Health Care. 2021;36(3):3–6.

    Google Scholar 

  16. Ponzano M, Rodrigues IB, Hosseini Z, Ashe MC, Butt DA, Chilibeck PD, Stapleton J, Thabane L, Wark JD, Giangregorio LM. Progressive resistance training for improving health-related outcomes in people at risk of fracture: a systematic review and meta-analysis of randomized controlled trials. Phys Ther. 2021;101(2):pzaa221.

    PubMed  Google Scholar 

  17. Zhang X, Butts WJ, You T. Exercise interventions, physical function, and mobility after hip fracture: a systematic review and meta-analysis. Disabil Rehabil. 2021;8:1–11.

    Google Scholar 

  18. Harding AT, Weeks BK, Lambert C, Watson SL, Weis LJ, Beck BR. Exploring thoracic kyphosis and incident fracture from vertebral morphology with high-intensity exercise in middle-aged and older men with osteopenia and osteoporosis: a secondary analysis of the LIFTMOR-M trial. Osteoporos Int. 2021;32(3):451–65.

    CAS  PubMed  Google Scholar 

  19. Weiwei T, Zhenlan S, Guirong S. The influence of temperament characteristics of school-age children with fractures on early functional exercise compliance. Journal of Qingdao University Medical College. 2013;11(5):3–6.

    Google Scholar 

  20. Linlin G, Yakun L, Baihua L. The effect of game-style functional exercises on postoperative rehabilitation of school-age children with supracondylar fractures of the humerus. Nursing Practice and Research. 2020;17(8):3–8.

    Google Scholar 

  21. Xiaoyan Z, Yan Z, Jingfen Z. Survey of factors affecting early postoperative functional exercise compliance of patients with tibial plateau fractures. General Nursing. 2018;16(9):1132–4.

    Google Scholar 

  22. Qi H, Kainan Y, Ling L. Revision and standardization of the temperament scale for children aged 6–16 year old. Chinese Journal of Children’s Health. 1996;4(3):128–31.

    Google Scholar 

  23. Ostergaard HK, Mechlenburg I, Launonen AP, Vestermark MT, Mattila VM, Ponkilainen VT. The Benefits and Harms of Early Mobilization and Supervised Exercise Therapy after Non-surgically Treated Proximal Humerus or Distal Radius fracture: A systematic Review and Meta-analysis. Curr Rev Musculoskelet Med. 2021;14(2):107–29.

    PubMed  PubMed Central  Google Scholar 

  24. Cresswell EN, Ruspi BD, Wollman CW, Peal BT, Deng S, Toler AB, McDonough SP, Palmer SE, Reesink HL. Determination of correlation of proximal sesamoid bone osteoarthritis with high-speed furlong exercise and catastrophic sesamoid bone fracture in Thoroughbred racehorses. Am J Vet Res. 2021;82(6):467–77.

    PubMed  Google Scholar 

  25. Binder EF, Christensen JC, Stevens-Lapsley J, Bartley J, Berry SD, Dobs AS, Fortinsky RH, Hildreth KL, Kiel DP, Kuchel GA et al: A multi-center trial of exercise and testosterone therapy in women after hip fracture: Design, methods and impact of the COVID-19 pandemic. Contemp Clin Trials 2021, 104:106356.

    PubMed  Google Scholar 

  26. Beckmann M, Bruun-Olsen V, Pripp AH, Bergland A, Smith T, Heiberg KE: Effect of an additional health-professional-led exercise programme on clinical health outcomes after hip fracture. Physiother Res Int 2021, 26(2):e1896.

    PubMed  Google Scholar 

  27. Tan C, Depiazzi J, Bear N, Blennerhassett L, Page R, Gibson N: Exercise handout and one-on-one hand therapy for management of stiffness after plaster cast immobilization of simple phalangeal and metacarpal fractures in children: A randomized, noninferiority trial. J Hand Ther 2021, 34(3):423-432 e427.

    Google Scholar 

  28. Ailan C. The influence of school-age children’s temperament characteristics on the occurrence of fractures. General Nursing. 2020;18(9):111–3.

    Google Scholar 

  29. Changqin L, Wenqiong X, Jin L. Current status and influencing factors of postoperative panic disorder in school-aged children. Chinese Journal of Practical Nursing. 2020;36(18):5–9.

    Google Scholar 

  30. Xiang F, Li B, Xiao S, Liu H, Wen J, Li X, Fang K, Zeng M, Tang Z, Cao S, et al. The midterm outcomes of ankle Dias-Tachdjian pronation-eversion external rotation physeal fracture in children treated by open reduction internal fixation with one-stage medial-lateral combined incision. J Pediatr Orthop B. 2021;30(5):438–42.

    PubMed  Google Scholar 

  31. Fei X, Biao Z, Lei W. Early postoperative functional exercise compliance survey and influencing factors analysis of patients with tibial plateau fractures. Chinese Journal of Modern Nursing. 2016;22(33):4802–5.

    Google Scholar 

  32. Delshad M, Beck KL, Conlon CA, Mugridge O, Kruger MC, von Hurst PR: Fracture risk factors among children living in New Zealand. J Steroid Biochem Mol Biol 2020, 200:105655.

    CAS  PubMed  Google Scholar 

  33. Conley RB, Adib G, Adler RA, Akesson KE, Alexander IM, Amenta KC, Blank RD, Brox WT, Carmody EE, Chapman-Novakofski K, et al. Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition. J Orthop Trauma. 2020;34(4):e125–41.

    PubMed  Google Scholar 

  34. Azzam W, Catagni MA, Ayoub MA, El-Sayed M, Thabet AM. Early correction of malunited supracondylar humerus fractures in young children. Injury. 2020;51(11):2574–80.

    PubMed  Google Scholar 

  35. Ariza-Vega P, Ortiz-Pina M, Kristensen MT, Castellote-Caballero Y, Jimenez-Moleon JJ. High perceived caregiver burden for relatives of patients following hip fracture surgery. Disabil Rehabil. 2019;41(3):311–8.

    PubMed  Google Scholar 

  36. Kohler-Forsberg O, Keers R, Uher R, Hauser J, Maier W, Rietschel M, McGuffin P, Farmer AE, Aitchison KJ, Mors O. Dimensions of temperament and character as predictors of antidepressant discontinuation, response and adverse reactions during treatment with nortriptyline and escitalopram. Psychol Med. 2021;10:1–9.

    Google Scholar 

  37. Chow CHT, Rizwan A, Xu R, Poulin L, Bhardwaj V. Association of temperament with preoperative anxiety in pediatric patients undergoing surgery: a systematic review and meta-analysis. JAMA Netw Open. 2019;2(6):e195614.

    PubMed  PubMed Central  Google Scholar 

  38. Peixia W, Yaming T, Weihong Z. Study on the relationship between postoperative exercise compliance and self-efficacy and coping style in patients with traumatic limb fractures. Chinese Journal of Clinical Nursing. 2019;11(6):464–7.

    Google Scholar 

  39. Linlin G, Yakun L, Baihua L. The effect of game-style functional exercise on postoperative rehabilitation of school-age children with supracondylar fractures of the humerus. Nursing Practice and Research. 2020;17(8):99–101.

    Google Scholar 

  40. Saeed M, Malik RN, Kamal A. Fluorosis and cognitive development among children (6–14 years of age) in the endemic areas of the world: a review and critical analysis. Environ Sci Pollut Res Int. 2020;27(3):2566–79.

    CAS  PubMed  Google Scholar 

  41. Clayton RP, Wurzer P, Andersen CR, Mlcak RP, Herndon DN, Suman OE. Effects of different duration exercise programs in children with severe burns. Burns. 2017;43(4):796–803.

    PubMed  Google Scholar 

  42. Zhang W, Wang Q, Liu L, Yang W, Liu H. Effects of physical therapy on lung function in children with asthma: a systematic review and meta-analysis. Pediatr Res. 2021;89(6):1343–51.

    PubMed  Google Scholar 

  43. Zaqout M, Vandekerckhove K, De Wolf D, Panzer J, Bove T, Francois K, De Henauw S, Michels N. Determinants of Physical Fitness in Children with Repaired Congenital Heart Disease. Pediatr Cardiol. 2021;42(4):857–65.

    PubMed  Google Scholar 

  44. Li J, Yuan X, Cao Y, Liu T, Gou P, Li X, Li M, Liu X. The effects of home confinement on pediatric fractures during the COVID 19 outbreak. Ital J Pediatr. 2021;47(1):142.

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

None.

Funding

None.

Author information

Authors and Affiliations

Authors

Contributions

D C, Y T designed research; H L, Y W, M L, D C, Y T conducted research; H L, Y W analyzed data; D C, Y T wrote the first draft of manuscript; H L, D C, Y T had primary responsibility for final content. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Dan Chen or Yuping Tang.

Ethics declarations

Ethics approval and consent to participate

In this study, all methods were performed in accordance with the relevant guidelines and regulations. This present study was a prospective cohort study design, the study had been checked and approved by the ethical committee of Children's Hospital of Nanjing Medical University with approval number: (202001011–2). Furthermore, the informed consents had all been obtained from the guardians of included children.

Consent for publication

Not applicable.

Competing interests

The all authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Liu, H., Wang, Y., Li, M. et al. Compliance of functional exercises in school-age children with limb fractures: implication for nursing countermeasures. BMC Pediatr 22, 133 (2022). https://doi.org/10.1186/s12887-022-03193-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12887-022-03193-6

Keywords

  • Compliance
  • Functional exercises
  • Children
  • Fractures
  • Care
  • Nursing