AFTER study
Research type
Research Study
Full title
Optimising mobility after ankle fracture in older adults: a multi-centre pilot randomised controlled trial
IRAS ID
245538
Contact name
David Keene
Contact email
Sponsor organisation
University of Oxford / Clinical Trials and Research Governance
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
AFTER – Ankle Fracture Treatment: Enhancing Rehabilitation
Broken ankles represent a high proportion of injuries treated in the National Health Service (NHS). The most severe injuries require surgery or casting to align the bones until healing has occurred. An increasing number of these injuries are in adults over 50 years old as the age of the population is rising. For older adults, an ankle injury can be the start of a decline in their ability to move around confidently as the limb can feel weak, walking is difficult, balance worsens and a fear of falling is common. We recently conducted a study which found that, on average, older adults lost around 30% of their ankle function at 6 months after breaking their ankle.2,3In the NHS, physiotherapy provision after acute fracture treatment with a surgery or a cast varies from hospital to hospital. Some patients may not get any physiotherapy, although most do, and usual care is generally a session of advice with occasionally the option of a further one or two sessions follow-up. In clinical trials to date longer courses of supervised physiotherapy have not shown advantages for patients, compared with a single session of advice. However, these studies have not focussed specifically on the needs of older adults, who may have more complex needs.
Aim of the research
The aim of the AFTER (Ankle Fracture Treatment: Enhancing Rehabilitation) study is to assess the feasibility of conducting a large randomised controlled trial to test whether a new approach to physiotherapy provision or best practice advice is the best and most affordable approach to treating ankle fractures in older adults in the NHS.Research plan
The pilot trial will be conducted in at least three NHS hospitals. Forty-eight consented adults aged 50 years and over with an ankle fracture will be randomly allocated to one of two different types of physiotherapy regimes. One type of physiotherapy regime will be best-practice advice, which includes guidance on self-management and a home-based exercise programme, and access to an information booklet. There will be one or two optional extra contacts with the physiotherapist to reinforce advice for people who are struggling to manage. The second type of physiotherapy regime will include up to six sessions with a physiotherapist. The additional sessions will involve functional progressive exercises to be practised and progressed under supervision. The physiotherapist will facilitate self-management and independent exercise practice at home. The objectives of the pilot trial will be to estimate rates of recruitment and follow-up, and the adherence to the physiotherapy regimes. The feasibility of collecting outcome measures for a future RCT will also be assessed.
We will interview ten participants to better understand their experience of taking part in the study and of the interventions (physiotherapy regimes).REC name
South Central - Hampshire B Research Ethics Committee
REC reference
18/SC/0281
Date of REC Opinion
2 Jul 2018
REC opinion
Further Information Favourable Opinion