Is a Structured Rehabilitation Program Useful After Ankle Fracture?

Thomas L. Schwenk, MD reviewing Moseley AM et al. JAMA 2015 Oct 6.

A 4-week supervised exercise program provided no benefit over usual advice.

Treating patients with ankle fractures, whether by open or closed reduction, always requires immobilization, and recovery from immobilization can be slow or incomplete. In this Australian study of 214 adults (mean age, 41) with ankle fractures, researchers assessed the value of a structured exercise program versus usual advice following immobilization; mean immobilization was almost 7 weeks, and about half the patients underwent open reduction and internal fixation. Patients were randomized either to an exercise program supervised by physical therapists (1–2 times weekly for 4 weeks, emphasizing ankle mobility, strength, and balance) or to a single session of self-management advice (general encouragement to walk as tolerated with ankle dorsiflexion and plantar flexion on a step).

In blinded assessments at 1, 3, and 6 months, no significant differences were noted in improvement of function or mean overall quality of life between the two groups. None of 17 secondary outcomes showed between-group differences; fracture severity, age, and sex of patients did not influence outcomes.

CITATION(S):

Moseley AM et al. Rehabilitation after immobilization for ankle fracture: The EXACT randomized clinical trial. JAMA 2015 Oct 6; 314:1376.