Early motion and directed exercise (EMADE) post ankle fracture fixation - a pragmatic randomised control trial

Ankle fractures are very common, comprising up to 20% of all leg fractures. The best type and timing of rehabilitation for this condition remains unclear. For those who need to have surgery to fix their ankle fracture it is normal for them to remain in a leg cast and not put the foot to the floor for 6-weeks. 

However, early exercise, outside of a cast, could be a viable option. We have devised an Early Motion And Directed Exercise (EMADE) rehabilitation programme. This will be used from the 2nd to the 6th week after surgery. After 6 weeks, both groups will then receive the same care - i.e. no cast, taking weight through the leg, plus physiotherapy if needed.

 

The aim is to establish if physiotherapy rehabilitation, when started early, provides more rapid and complete recovery and return to work for patients who have had surgery to fix an ankle fracture. 

The primary outcome measure will be questionnaires for the patients to report how well their function is returning following their ankle fracture.  Other measures cover general health and wellbeing, plus physical measures.  Data will be collected at time points after surgery; 2 and 6-weeks and then at 3, 6 and 12 months.

The study is being conducted within a busy NHS fracture clinic. This means that the study experience, including limitations on clinician’s time and other resources, are same if the EMADE approach were to be adopted by the wider NHS.  This is important as it will facilitate rapid translation from research innovation into actual patient care.