Effectiveness of progressive exercise versus best practice advice for people aged 50 years and over with ankle fractures: the AFTER trial

Around 1 in 10 people attending hospital with a broken bone have injured their ankle joint. Most of these injuries occur in people aged 50 years and over as a result of a fall from a standing height. Recovery is slow due to prolonged pain, disability, and anxiety. Currently, about two thirds of people with an ankle fracture are referred to see a physiotherapist for a number of appointments, which typically involves an exercise programme and ongoing advice, costing about £350 for each patient.

After a broken ankle is treated with or without surgery, the ankle is kept still in a boot or cast for around six weeks. Keeping the ankle still protects it as it heals but causes stiffness and weakness. Putting weight through the ankle after the boot or cast is removed is difficult, and people often feel unsteady and lack confidence. At this time, health care professionals are recommended to provide advice on early ankle exercises and on how to gradually return to daily life.

After this initial advice, there is no national guidance on whether or not further rehabilitation under the supervision of a physiotherapist should be provided. Previous research in younger adults found additional physiotherapy did not improve recovery but it is not clear whether older adults would benefit. Extra sessions of physiotherapy are often difficult for patients to attend and are costly to the health service.

AFTER is a randomised controlled trial that investigates the clinical and cost-effectiveness of progressive exercise versus best practice advice for people aged 50 years and over with ankle fractures.