Development of a therapist-supervised flexibility and resistance exercise intervention for adults aged 50 years and over with a distal radius fracture in the Wrist Injury Strengthening Exercise (WISE) trial

Aims The definitive Wrist Injury Strengthening Exercise (WISE) trial is a multicentre superiority randomized controlled trial (RCT) evaluating usual care advice plus a therapist-supervised flexibility and resistance exercise intervention versus usual care advice alone for adults aged ≥ 50 years with a distal radius fracture (DRF). This paper describes the development and delivery of the therapist-supervised exercise intervention evaluated in the definitive WISE RCT. Methods The intervention was developed iteratively in accordance with Medical Research Council (MRC) guidance for complex interventions. UK DRF clinical guidelines, published rehabilitation RCTs, UK NHS patient information leaflets, common post-injury impairments, and exercise and behavioural theory were reviewed to inform candidate intervention components. Feedback from UK therapists and patient and public involvement partners then informed the design of the initial intervention. Two methods of intervention delivery were then evaluated in a multicentre feasibility RCT and embedded qualitative study involving 117 participants aged ≥ 50 years with a distal radius fracture. Results Review of guidelines and previous research highlighted uncertainty regarding the optimal rehabilitation after DRF and limited reporting of progressive exercise interventions. NHS patient information leaflets largely focused on flexibility exercises and self-management advice. Therapist and patient feedback informed the intervention content, progression, and participant materials. Findings from the feasibility RCT and embedded qualitative study supported a therapist-supervised delivery model with three sessions, rather than a single-session independent exercise approach. The final intervention comprised usual care advice plus up to three one-to-one sessions with a physiotherapist or occupational therapist over 12 weeks. Participants also received a workbook containing self-management advice, progressive flexibility and resistance exercises with resistance bands and therapeutic putty, and behaviour change strategies to support exercise adherence. Conclusion Using an iterative MRC-informed process, a therapist-supervised rehabilitation intervention was developed and refined prior to definitive evaluation. Transparent reporting of intervention development and content should support interpretation, replication, and implementation. Cite this article: Bone Jt Open 2026;7(10):1352–1364.