Does formal vs home-based physical therapy predict outcomes after ankle fracture or ankle fracture-dislocation?

Abstract

Background: Ankle fractures are among the most common injuries treated by orthopaedic surgeons. Various postoperative rehabilitation strategies have been promoted, but the ability to improve patient-reported functional outcome has not been clearly demonstrated. We aim to evaluate outcomes associated with clinic-based, physical therapist-supervised rehabilitation (Formal-PT) compared to surgeon-directed rehabilitation (Home-PT). Methods: This prospective observational study included patients with operative bimalleolar or trimalleolar ankle fractures with or without dislocation (n = 80) at a Level I trauma center. Patients were prescribed PT per the surgeon's practice pattern. Patient-reported functional outcomes at 6 months and complication rates were compared between groups. Results: Of the 80 patients, 38 (47.5%) patients received Formal-PT; the remaining received Home-PT. Thirty-four patients (89.5%) attended ≥1 PT session. Number of sessions attended ranged from 1 to 36 (mean = 16). Receipt of Formal-PT did not differ by injury characteristics or demographics. Of patients with private insurance, 57% were prescribed Formal-PT vs 7% of uninsured patients (P = .033). FAAM and Combination SMFA scores at 6 months were similar between groups (Formal-PT: 69.7, 20.1; Home-PT: 70.9, 24.4; P = .868, .454, respectively). Postoperative complications were rare and equivalent between groups. Conclusions: Comparison of outcomes between patients with operatively treated displaced ankle fractures/dislocations with Formal-PT vs Home-PT showed no difference in SMFA and FAAM scores. These findings suggest patients receiving supervised PT produced a similar outcome to those under routine physician-directed rehabilitation at 6 months. The cost for therapy averaged $2012.96 per patient receiving Formal-PT.

Effectiveness of Postoperative Physiotherapy Compared to Postoperative Instructions by Treating Specialist Only in Patients With an Ankle Fracture: A Systematic Review

“…Although various aspects of pain were analyzed (eg, pain during (im)mobilization, impact on daily life), no statistically significant difference for pain between the PT group and the ITS group was found. 6,24 10,25 did not find a significant difference in the number of complications between the 2 rehabilitation groups.…”

“…Five studies were considered suitable and subsequently included in this systematic review. 6 , 10 , 16 , 24 , 25 …”

“…Other studies included patients with various types of ankle fractures (uni-, bi-, and/or trimalleolar) ( Table 1 ). 6 , 10 , 25 Four studies included operatively treated patients only. 6 , 10 , 16 , 25 Moseley et al 24 included both operated and nonoperatively treated patients.…”

Characteristics and Effectiveness of Postoperative Rehabilitation Strategies in Ankle Fractures: A Systematic Review

“…Of all studies, 40 23–61 described their postoperative rehabilitation strategy but did not evaluate effectiveness and 15 20–22,62–73 focused on evaluating the effectiveness of the postoperative rehabilitation strategy. This section reports only those 40 studies that described their postoperative rehabilitation strategy, focusing on weight-bearing, immobilization, and other therapy administered.…”

Patients’ perception of physical therapy after shoulder surgery

“…However, our data find that patients have a perceived preference toward having PT sessions at a rehab center as well as perceiving formal PT over IBPT programs. 1 , 10 , 24 Thus, education for patients on the similar efficacy of formal PT and IBPT programs should be provided.…”