Forty-nine RCTs (3,366 patients) were included in the review. Sixteen trials were deemed of high quality (scoring 11 or more on the checklist), and this included all trials of lower-limb injuries. The maximum follow-up ranged from one to 60 months. The authors reported a substantial amount of clinical heterogeneity.
Patient outcomes: Following early mobilisation, significant improvements were reported for swelling and pain (13 trials) and patient satisfaction (nine trials). The high-quality trials also favoured early mobilisation in lower-limb non-fractures (two trials).
Function: Early mobilisation was associated with significant improvements in global function (including pain, stiffness, and swelling) after six months (six trials) and 12 months (one trial). This was confirmed in four high-quality trials. Significantly more patients immobilised in a cast with acute ankle sprain needed medical or physiotherapy advice in the first three weeks than those mobilised with a functional brace (one trial).
Return to work: Earlier return to work (approximately 30% to 60% earlier) resulted from early mobilisation in those with lower-limb non-fracture injuries (13 trials) and a similar pattern was noted for early return to sport (ten trials). Five of the trials reporting earlier return to work or sport were of high quality.
Range of movement: Significant improvements from early mobilisation were reported in 14 studies of upper- and lower-limb fractures, particularly in the short term following injury. A similar pattern was noted for lower-limb non-fractures (11 high-quality trials).
Deformity: Mobilisation was reported to reduce deformity for angular displacement, radial shortening in Colles' fractures, displacement of metacarpal fractures, and cosmetic deformity in radial fractures (four trials of which two were of high quality). Ten trials reported no changes in deformity or other complications.