Rehabilitation for ankle fractures in adults

Background Ankle fracture is one of the most common lower limb fractures. Whilst immobilisation of the ankle can support and protect the fracture site during early healing, this also increases the risk of ankle weakness, stiffness, and residual pain. Rehabilitation aims to address the after‐effects of this injury, to improve ankle function and quality of life. Approaches are wide‐ranging and include strategies to improve ankle joint movement, muscle strength, or both. This is an update of a Cochrane review last published in 2012. Objectives To assess the effects of rehabilitation interventions following surgical or non‐surgical management of ankle fractures in adults. Search methods We searched CENTRAL, MEDLINE, Embase, three other databases, and two clinical trials registers in May 2022, and conducted additional searches of CENTRAL, MEDLINE, and Embase in March 2023. We also searched reference lists of included studies and relevant systematic reviews. Selection criteria We included randomised controlled trials (RCTs) and quasi‐RCTs comparing any rehabilitation intervention delivered to adults with ankle fracture. Interventions could have been given during or after the initial fracture management period (typically the first six weeks after injury), which may or may not have included surgical fixation. We excluded participants with multi‐trauma, pathological fracture, or with established complications secondary to ankle fracture. Data collection and analysis We used standard methodological procedures expected by Cochrane. We collected data for five outcomes: activity limitation (ankle function), health‐related quality of life (HRQoL), participant satisfaction with treatment, pain, and adverse events (we focused on re‐operation, defined as unplanned return to theatre). We report the findings up to six months after injury. Main results We included 53 studies (45 RCTs, 8 quasi‐RCTs) with 4489 adults with ankle fracture. In most studies, orthopaedic management included surgical fixation but was non‐surgical in five studies, and either surgical or non‐surgical in six studies. Here, we summarise the findings for three common rehabilitation comparisons; these included the most data and were the most clinically relevant. Because of different intervention approaches, we sometimes included a study in more than one comparison. Data for other less common comparisons were also available but often included few participants and were imprecise. All studies were unavoidably