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

• Published in: OTA international : the open access journal of orthopaedic trauma 2019-06, Vol.2 (2), p.e039
• Main Authors: Ferguson, Chad M, Harmer, Luke, Seymour, Rachel B, Ellington, John Kent, Bosse, Michael J, Hsu, Joseph R, Karunakar, Madhav, Sims, Stephen, Ruffolo, Michael, Churchill, Christine, Anderson, Robert, Cohen, Bruce, Davis, Hodges, Jones, Carroll, Roznowski, Amy
• Format: Article
• Language: English
• Subjects: Clinical/Basic Science
• ISSN: 2574-2167; 2574-2167
• DOI: 10.1097/OI9.0000000000000039

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). 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. 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 (  = .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;  = .868, .454, respectively). Postoperative complications were rare and equivalent between groups. 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.