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. 2015 Sep;45(9):665-74.
doi: 10.2519/jospt.2015.5981. Epub 2015 Jul 10.

Manual Physical Therapy Following Immobilization for Stable Ankle Fracture: A Case Series

Elizabeth E Painter  1 , Gail D Deyle, Christopher Allen, Evan J Petersen, Theodore Croy, Kenneth P Rivera
Affiliations

Manual Physical Therapy Following Immobilization for Stable Ankle Fracture: A Case Series

Elizabeth E Painter et al. J Orthop Sports Phys Ther. 2015 Sep.

Abstract

Study design: Case series.

Background: Ankle fractures commonly result in persistent pain, stiffness, and functional impairments. There is insufficient evidence to favor 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 postimmobilization 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. Secondary outcome measures included the ankle lunge test, numeric pain-rating scale, and global rating of change. Outcome measures were collected at baseline (performed within 7 days of immobilization removal) and at 4 and 12 weeks postbaseline.

Outcomes: Eleven patients (mean age, 39.6 years; range, 18-64 years; 2 male), after ankle fracture-related immobilization (mean duration, 48 days; range, 21-75 days), were treated for an average of 6.6 sessions (range, 3-10 sessions) over a mean of 46.1 days (range, 13-81 days). Compared to baseline, statistically significant and clinically meaningful improvements were observed in Lower Extremity Functional Scale score (P = .001; mean change, 21.9 points; 95% confidence interval: 10.4, 33.4) and in the ankle lunge test (P = .001; mean change, 7.8 cm; 95% confidence interval: 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 with impairment-based manual physical therapy. All patients tolerated treatment well. Results suggest that this approach may have efficacy in this population.

Level of evidence: Therapy, level 4.

Keywords: clinical reasoning; lower extremity; manipulation; mobilization.

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