SLR - November 2017 - Viraj Rathnayake
Reference: Jansen H, Jordan M, Frey S, Holscher-Doht S, Meffert R, Heintel T. Active Controlled Motion in Early Rehabilitation Improves Outcome After Ankle Fractures: A Randomized Control Trial. Clinical Rehabilitation. 2017 Aug 1:269215517724192Scientific Literature Review
Reviewed By: Viraj Rathnayake, DPM
Residency Program: Westside Regional Medical Center, Plantation, Florida
Podiatric Relevance: Ankle fractures are commonplace in the world of podiatric medicine with podiatrists performing conservative and nonconservative treatment. After nonconservative treatment, there have been debates and no unifying consensus on proprioceptive deficit rehabilitation and at which time to best perform this form of rehabilitation. This study of 50 patients looks at the possible beneficial rehabilitation of the use of active controlled motion (ACM) device versus physiotherapy (PT) solely.
Methods: A level two prospective randomized controlled study was performed on participants who underwent sole operative unstable Weber B and C ankle fractures and their ability to perform physiotherapy and ACM with no deficiencies in ambulation prior to injury. A total of 50 participants were included with 44 patients left for examination at 12 weeks who were randomized into physiotherapy alone and ACM groups. Prospective outcomes were evaluated by visual analog scale for foot and ankle (VAS FA), the Phillips score, the Mazur score and the AOFAS score with clinical follow-up at six and 12 weeks. Secondary outcomes of dynamic pedography were tested as well.
Results: After six weeks, ROM fully returned for 54 percent (13 participants) in the PT group and 88 percent (22 participants) in the ACM group. Better motion at the ankle joint at six weeks, VAS FA, Mazur score, AOFAS score, Philip score and return to work (10.5 weeks vs. 14.7 weeks) were all statistically significant in the ACM group over the PT group, respectively. No difference in pedobarography was noted after six weeks, but a decrease in pressure in the ACM group at 12 weeks in the midfoot region was noted.
Conclusion: Despite fast initial recovery, regaining function decelerates over time and can take upwards of two years, raising costs and dissatisfaction of patients. Early range of motion has been shown in this study to reduce functional delay with ACM treatment early postsurgically showing statistically significant results. Inherent limitations in the study included participants not being blinded and whether reduced lack of proprioception causes better functional results. Overall, the use of ACM started soon after treatment was found to have better range of motion and functional outcomes as compared to physiotherapy alone.