AFTER – Ankle Fracture Treatment: Enhancing Rehabilitation trial
Research type
Research Study
Full title
Effectiveness of supervised versus self-directed rehabilitation for people aged 50 years and over with ankle fractures: the AFTER trial
IRAS ID
308989
Contact name
David Keene
Contact email
Sponsor organisation
University of Oxford / Research Governance, Ethics & Assurance Team
ISRCTN Number
ISRCTN11830323
Duration of Study in the UK
2 years, 1 months, 31 days
Research summary
Around 1 in 10 of all people attending hospital with a broken bone have injured their ankle joint. Most of these injuries occur in people aged 50 years and over as a result of a fall from a standing height. After a broken ankle is treated with or without surgery, the ankle is kept still in a boot or cast for around six weeks. Keeping the ankle still protects it as it heals but causes stiffness and weakness. Putting weight through the ankle after the boot or cast is removed is difficult. People often feel unsteady and lack confidence. At this time, health care professionals are recommended to provide advice on early ankle exercises and on how to gradually return to daily life.
After this initial advice, there is no national guidance on whether further rehabilitation under the supervision of a physiotherapist should be provided. Previous research in younger adults found additional physiotherapy did not improve recovery, but it is not clear whether older adults would benefit. Extra sessions of physiotherapy can be difficult for patients to attend and are costly to the health service.
Our study will find out if referral for physiotherapy appointments after a person aged 50 years or older has suffered a broken ankle helps them recover quicker and better when compared to good quality advice on self-management.
To compare the two treatments properly 344 people will be recruited to take part. Participants will be placed by chance into one of two groups by a computer program, this will make sure that the groups are similar and the comparison is fair. Over a 6-month period participants will be asked about their health, walking ability and other daily activities, as well as any complications and specific costs.
Lay summary of study results: Around 1 in 10 of all people attending hospital with a broken bone have injured their ankle. Most of these injuries occur in people aged 50 years and over after a fall from a standing height. After a broken ankle is treated with or without surgery, there is no national guidance on whether rehabilitation under the supervision of a physiotherapist should be provided.
This study aimed to find out if referral for physiotherapy appointments to have supervised rehabilitation improves recovery when compared to good quality advice on self-directed rehabilitation. The cost of providing these treatments to patients by the NHS was also assessed.
To compare the two ways of providing rehabilitation for people with an ankle fracture, 377 people joined the study from 28 hospitals across the UK. Three quarters of the participants were female and the average age was 62 years. Just under half of participants had received surgery for their fracture. Participants were placed at random into one of the two rehabilitation groups. Over a 6-month period participants were asked about their ankle function recovery and quality of life, as well as any costs.
No difference was found in the recovery between people getting supervised rehabilitation or those following self-directed rehabilitation. Supervised rehabilitation would not be value for money for the NHS compared to self-directed rehabilitation.
Findings of the research will be shared widely. Further work will now be needed to help support use of the self-directed rehabilitation programme in the NHS.
REC name
North West - Liverpool Central Research Ethics Committee
REC reference
22/NW/0131
Date of REC Opinion
6 May 2022
REC opinion
Favourable Opinion