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Objectives and questions: This systematic review and meta-analysis evaluated the effectiveness of traditional face-to-face physiotherapy (supervised [SP]) compared with home exercise programs supported by paper handouts, instructional videos, or smartphone applications (unsupervised [UP]) in the postoperative rehabilitation of patients with surgically treated distal radius fractures. The primary aim of this study is to determine whether unsupervised or supervised physiotherapy after operative treatment of distal radius fractures yields more favorable results in terms of Patient-Rated Wrist Evaluation (PRWE) scores, pain, and range of motion (ROM). Secondary outcomes include complications and other functional measures such as grip strength and the Disabilities of the Arm, Shoulder and Hand (qDASH) score at short-, mid-, and long-term follow-up.

Material and methods: A comprehensive search of PubMed, Embase, and the Cochrane Library identified randomized controlled trials comparing supervised and unsupervised physiotherapy following osteosynthesis of distal radius fractures. The primary outcome was wrist function and pain assessed by the Patient-Rated Wrist Evaluation (PRWE). Secondary outcomes included the Disabilities of the Arm, Shoulder and Hand score (qDASH), range of motion (ROM), grip strength, and postoperative complications.

Results: Nine trials comprising 470 patients met the inclusion criteria. Across all time points, no significant differences were observed between the SP and UP groups, except for the PRWE score at 12 weeks, which slightly favoured the SP group (12.2 [95% CI: 9.8–14.7] vs. 16.0 [95% CI: 13.8–18.1]). However, this difference did not exceed the minimal clinically important difference (MCID) of 11.5 points. Aftercare-related complications occurred in 1.1% of patients in both groups, with complex regional pain syndrome (CRPS) being the most common (SP 3.4% vs. UP 4.9%). Subgroup analysis indicated a non-significant but clinically relevant trend toward worse PRWE scores at six weeks among patients aged over 60 years (–11.98 [95% CI: –24.77 to 0.82] vs. 4.94 [95% CI: –10.11 to 19.99]).

Discussion and conclusions: Supervised and unsupervised physiotherapy yielded comparable outcomes in wrist function, pain, and complications after distal radius fracture surgery. Although the SP group demonstrated a statistically significant advantage in PRWE at 12 weeks, this difference is unlikely to be clinically meaningful. Older patients, however, may experience inferior functional recovery with unsupervised programs. Overall, unsupervised physiotherapy appears safe for most patients, though older individuals may benefit more from supervised care.