Authors: Elizabeth E. Painter, PT, DSc1, Gail D. Deyle, PT, DSc1, Christopher Allen, PT, DSc1, Evan J. Petersen, PT, DSc2, Theodore Croy, PT, PhD3, Kenneth P. Rivera, PA-C, DSc4
Study Design
Case series.
Background
Ankle fractures commonly result in persistent pain, stiffness, and functional impairments. There is insufficient evidence for any particular rehabilitation approach after ankle fracture. The purpose of this case series was to describe an impairment-based manual physical therapy approach to treating patients with conservatively managed ankle fractures.
Case Description
Patients with stable ankle fractures post immobilization were treated with manual physical therapy and exercise targeted at associated impairments in the lower limb. The primary outcome measure was the Lower Extremity Functional Scale (LEFS). Secondary outcome measures included the Ankle Lunge Test (ALT), Numeric Pain Rating Scale, and Global Rating of Change. Outcomes measures were collected at baseline (performed within 7 days of immobilization removal), and 4 and 12 weeks post-baseline.
Outcomes
Eleven patients (mean age 39.6 years, range 18-64; 2 male), post ankle fracture related immobilization (mean duration 48 days, range 21-75) were treated for an average of 6.6 sessions (range 3-10) over a mean of 46.1 days (range 13-81). Compared to baseline, statistically significant and clinically meaningful improvement were observed in the LEFS (P=.001; mean change, 21.9 points; 95% confidence interval [CI] 10.4, 33.4) and ALT (P=.001; mean change 7.8 cm; 95% CI: 3.9, 11.7) at 4 weeks. These changes persisted at 12 weeks.
Discussion
Statistically significant and clinically meaningful improvements in self-reported function and ankle range of motion were observed at 4 and 12 weeks following treatment based on impairment-based manual physical therapy. All patients tolerated treatment well. Results suggest this approach may have efficacy in this population.
Level of Evidence
Therapy, level 4. J Orthop Sports Phys Ther, Epub 10 Jul 2015. doi:10.2519/jospt.2015.5981