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. 2018 Jul;26(3):147-156.
doi: 10.1080/10669817.2018.1432542. Epub 2018 Feb 12.

Timing of initiating manual therapy and therapeutic exercises in the management of patients after hindfoot fractures: a randomized controlled trial

Stephanie R Albin  1   2 , Shane L Koppenhaver  3 , Drew H Van Boerum  4 , Thomas G McPoil  1 , James Morgan  4 , Julie M Fritz  5
Affiliations

Timing of initiating manual therapy and therapeutic exercises in the management of patients after hindfoot fractures: a randomized controlled trial

Stephanie R Albin et al. J Man Manip Ther. 2018 Jul.

Abstract

Study design: Randomized clinical trial.

Background: Patients with fractures to the talus and calcaneus report decreased functional outcomes and develop long-term functional limitations. Although physical therapy is typically not initiated until six weeks after fixation, there's little research on the optimal time to initiate a formal physical therapy program.

Objectives: To assess whether initiating physical therapy including range of motion (ROM) and manual therapy two weeks post-operatively (EARLY) vs. six weeks post-operatively (LATE) in patients with fixation for hindfoot fractures results in different clinical outcomes.

Methods: Fifty consecutive participants undergoing operative fixation of a hindfoot fracture were randomized to either EARLY or LATE physical therapy. Outcomes, including the American Orthopedic Foot and Ankle Society Hindfoot Scale (AOFAS), the Lower Extremity Functional Scale (LEFS), active ROM, swelling, and pain, were collected at three and six months and analyzed using linear mixed-modeling to examine change over time. Adverse events were tracked for 12 months after surgery.

Results: The EARLY group demonstrated significantly larger improvements for the AOFAS (p = .01) and the LEFS (p = .01) compared to the LATE group. Pairwise comparison of the LEFS favors the EARLY group at 6 months [7.5 (95%CI -.01 to 15.0), p = .05]. There were no differences between the groups with regard to ROM, pain, and swelling. The LATE group incurred increased adverse events in this study.

Conclusion: Initiating early physical therapy may improve long-term outcomes and mitigate complications in patients after hindfoot fractures.

Level of evidence: Therapy, level 2b.

Keywords: Calcaneus Fracture; outcomes; rehabilitation; talus fracture.

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Figures

Figure 1.
Figure 1.
Flow diagram of study treatment.
Figure 2.
Figure 2.
Patient self-reported AOFAS hindfoot scale adjusted mean scores.
Figure 3.
Figure 3.
Patient self-reported LEFS adjusted mean scores for EARLY and LATE groups.
Figure 4.
Figure 4.
Side-to-side differences in talocrural joint range of motion between EARLY and LATE groups.
See this image and copyright information in PMC

References

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