Abstract
BackgroundPassive joint mobilisation is a technique frequently used by physiotherapists to reduce pain, improve joint movement and facilitate a return to activities after injury, but its use after ankle fracture is currently based on limited evidence. The primary aim of this trial is to determine if adding joint mobilisation to a standard exercise programme is effective and cost-effective after cast immobilisation for ankle fracture in adults.Methods/DesignNinety participants will be recruited from the physiotherapy departments of three teaching hospitals and randomly allocated to treatment or control groups using a concealed procedure. All participants will perform an exercise programme. Participants in the treatment group will also receive joint mobilisation twice a week for four weeks. Blinded follow-up assessments will be conducted four, 12 and 24 weeks after randomisation. The primary outcome measures will be the Lower Extremity Functional Scale and the Assessment of Quality of Life. Secondary outcomes will include measures of impairments, activity limitation and participation. Data on the use of physiotherapy services and participants' out-of-pocket costs will be collected for the cost-effective and cost-utility analyses. To test the effects of treatment, between-group differences will be examined with analysis of covariance using a regression approach. The primary conclusions will be based on the four-week follow-up data.DiscussionThis trial incorporates features known to minimise bias. It uses a pragmatic design to reflect clinical practice and maximise generalisability. Results from this trial will contribute to an evidence-based approach for rehabilitation after ankle fracture.
Highlights
Passive joint mobilisation is a technique frequently used by physiotherapists to reduce pain, improve joint movement and facilitate a return to activities after injury, but its use after ankle fracture is currently based on limited evidence
It uses a pragmatic design to reflect clinical practice and maximise generalisability. Results from this trial will contribute to an evidence-based approach for rehabilitation after ankle fracture
Orthopaedic management in adults with ankle fracture may involve reduction, surgical fixation, and immobilisation for six to 12 weeks depending on the severity of the fracture [3,4,11,12,13]
Summary
Ankle fracture refers to fracture of the medial or lateral malleolus or the distal tibia or fibula [1,2,3,4]. Due to effects of the fracture and the subsequent immobilisation, most people experience pain, swelling, stiffness, muscle atrophy and decreased muscle torque at the ankle following cast removal [1619]. They complain of limitations in activities involving the lower limb, such as stair climbing and walking [18], and reduced participation in work and recreation [20,21,22]. Joint mobilisation led to increased ankle movement, improved gait patterns, reduced pain and the number of treatment sessions required, and hastened return to activities when compared with the usual rest, ice, compression and elevation protocol [35]. A secondary aim is to determine if treatment effects are influenced by fracture severity
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