OTA International (Jun 2019)

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

  • Chad M. Ferguson, MD,
  • Luke Harmer, MD,
  • Rachel B. Seymour, PhD,
  • John Kent Ellington, MD,
  • Michael J. Bosse, MD,
  • the CMC-OC Ankle Fracture Study Group,
  • Joseph R. Hsu, MD,
  • Madhav Karunakar, MD,
  • Stephen Sims, MD,
  • Michael Ruffolo, MD,
  • Christine Churchill, MA,
  • Robert Anderson, MD,
  • Bruce Cohen, MD,
  • Hodges Davis, MD,
  • Carroll Jones, MD,
  • Amy Roznowski, MBA

DOI
https://doi.org/10.1097/OI9.0000000000000039
Journal volume & issue
Vol. 2, no. 2
p. e039

Abstract

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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.