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

* This study was approved by Intermountain Healthcare’s Institutional Review Board. This trial was initiated prior to 1/1/2013

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
• talus fracture
• outcomes
• rehabilitation

Notes

* This study was approved by Intermountain Healthcare’s Institutional Review Board. This trial was initiated prior to 1/1/2013