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Supervised physical therapy not linked with improved outcomes after ankle fracture
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ORLANDO, Fla. — Patients who underwent supervised physical therapy following surgical treatment of ankle fracture showed no differences in outcome scores compared with patients who had surgeon-directed rehabilitation, according to results presented here.
“We were not able to identify specific factors which did yield a better benefit with formalized physical therapy, and we think this represents an area for further research,” Chad Ferguson, MD, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
Eighty patients with either bimalleolar or trimalleolar fractures with or without dislocation and underwent operative treatment were prescribed either formal physical therapy directed by a physical therapist or self-directed exercise instruction from the physician (no formal physical therapy) for 6 weeks to 6 months. Researchers assessed patient-reported outcome scores, as well as injury characteristics, patient demographics and pre-post fixation and follow-up radiographs.
Patients who received physical therapy were more likely to have private insurance than patients who were not prescribed formal physical therapy, according to Ferguson. He also noted 84% of patients who received formal physical therapy were referred from a private practice vs. 19% from an academic institution. Results showed no differences between groups in outcome scores at 6-months or in complication rates. However, Ferguson noted a 30% higher complication rate compared with previously published results.
Of the 38 patients prescribed formal physical therapy, 85% attended at least one session, with 36 visits in 6 months as the maximum number of sessions for one patient, according to results.
“With the cost of $125 per session, the maximum cost was $4,500 for one patient with a total cost for the cohort of $62,000,” Ferguson said. – by Casey Tingle
Reference:
Ferguson C, et al. Paper #744. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 1-5, 2016; Orlando, Fla.
Disclosure: Ferguson reports no relevant financial disclosures.
Perspective
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Carol Frey, MD
After an ankle fracture, the recovery rate and impairment correlate with the severity of injury and accuracy of reduction. Regardless of rehabilitation, fractures that do not involve the joint have a better outcome. The most common complaints after fracture union are stiffness and loss of dorsiflexion. Early motion exercises can help prevent this problem.
With good bone density and secure fixation, the patient may begin protected weight-bearing with crutches and a cast equivalent when tolerated. The device may be removed several times a day for active range of motion after suture removal. Gentle passive dorsiflexion stretching is added as tolerated.
Aggressive stretching with formal physical therapy is only added if fracture union is secure and patients cannot achieve satisfactory dorsiflexion on their own.
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