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THE COCHRANE CORNER
Lin C.-W. C. 1, Moseley A. M. 1, Refshauge K. M. 2
1 George Institute for International Health, University of Sydney, NSW, Australia
2 Research and Innovation, Faculty of Health Sciences, University of Sydney, NSW, Australia
Background. Ankle fracture is one of the most common lower limb fractures. People experience limitations in activities after ankle fracture.
Objectives. The aim of this review was to evaluate the effects of rehabilitation interventions after ankle fracture in adults.
Methods. Electronic databases, reference lists of included studies and relevant systematic reviews, and clinical trials registers were searched for randomised and quasi-randomised controlled trials with adults undergoing any interventions for rehabilitation after ankle fracture. The primary outcomes were activity limitation and adverse events. Two reviewers independently screened search results, assessed methodological quality, and extracted data.
Results. Thirty-one studies were included. Clinical and statistical heterogeneity, or the low number of studies in the comparison, prevented meta-analyses in most instances. After surgical fixation, commencing exercise in a removable brace or splint significantly improved activity limitation but also led to a higher rate of adverse events (relative risk 2.61, 95% CI 1.72 to 3.97). Most other rehabilitation interventions did not show an effect in improving activity limitation.
Conclusions. There is limited evidence supporting the use of a removable type of immobilisation and exercise during the immobilisation period for improving activity limitation. Because of the potential increased risk, the patient’s ability to comply with this treatment regimen is essential. More clinical trials that are well-designed and adequately-powered are required to strengthen current evidence.