Rehabilitation after immobilization for ankle fracture: The EXACT trial

1. This randomized control study found that, after removing immobilization, patients with isolated ankle fractures did not benefit more from a combined exercise and advice program compared to advice alone.

2. Treatment effects were not moderated by fracture severity, age, or sex.

Evidence Rating Level: 1 (Excellent)

Study Rundown: While ankle fractures are a common injury, the role of rehabilitation in the treatment of ankle fracture is unclear. The authors of this study investigated the benefits of a combined exercise and advice program compared with advice given alone in patients with isolated and uncomplicated ankle fractures. Using measures in the form of activity limitation and mean quality of life, this study found that rehabilitation did not provide a significant benefit over advice.

Strengths of this study include its blinded nature, randomized controlled design, and high follow-up rates. The results of this study are limited by early termination of the trial due to a lack of funding. Overall, however, the evidence procured from this trial does not support the regular use of supervised exercise programs after removal of immobilization in patients with isolated ankle fractures.

Click to read the study in JAMA

Relevant Reading: The trAPP-study: cost-effectiveness of an unsupervised e-health supported neuromuscular training program for the treatment of acute ankle sprains in general practice: design of a randomized controlled trial

In-Depth [randomized controlled trial]: A total of 214 subjects from 7 hospitals in Australia were enrolled in this double-blinded, randomized controlled trial and randomized to either the rehabilitation group (i.e., supervised exercise and advice, n = 106) or the advice group (i.e., advice alone, n = 108), all delivered by a physical therapist. The main outcomes measured included the Assessment of Quality of Life (score 0-1) and the Lower Extremity Functional Scale (score 0-80). There was no significant difference in Assessment of Quality of Life scores (difference -0.01; 95%CI -0.06 to 0.04) or the Lower Extremity Functional Scale scores (difference 0.2; 95%CI -3.4 to 3.9) between the rehabilitation and advice groups.

Image: CC/Wiki

©2015 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.