title: Effectiveness of joint mobilisation after cast immobilisation for ankle fracture: a protocol for a randomised controlled trial [ACTRN012605000143628].
abstract: BACKGROUND
  Passive joint mobilisation is a technique frequently used by physiotherapists to reduce pain, improve joint movement and facilitate a return to activities after injury, but its use after ankle fracture is currently based on limited evidence. The primary aim of this trial is to determine if adding joint mobilisation to a standard exercise programme is effective and cost-effective after cast immobilisation for ankle fracture in adults.
  
  
  METHODS
  Ninety participants will be recruited from the physiotherapy departments of three teaching hospitals and randomly allocated to treatment or control groups using a concealed procedure. All participants will perform an exercise programme. Participants in the treatment group will also receive joint mobilisation twice a week for four weeks. Blinded follow-up assessments will be conducted four, 12 and 24 weeks after randomisation. The primary outcome measures will be the Lower Extremity Functional Scale and the Assessment of Quality of Life. Secondary outcomes will include measures of impairments, activity limitation and participation. Data on the use of physiotherapy services and participants' out-of-pocket costs will be collected for the cost-effective and cost-utility analyses. To test the effects of treatment, between-group differences will be examined with analysis of covariance using a regression approach. The primary conclusions will be based on the four-week follow-up data.
  
  
  CONCLUSIONS
  This trial incorporates features known to minimise bias. It uses a pragmatic design to reflect clinical practice and maximise generalisability. Results from this trial will contribute to an evidence-based approach for rehabilitation after ankle fracture.
authors.affiliation: School of Physiotherapy, the University of Sydney, PO Box 170, Lidcombe, New South Wales 1825, Australia. c.lin@usyd.edu.au
authors.forename: C Christine
authors.initials: CC
authors.lastname: Lin
authors.forename: Anne M
authors.initials: AM
authors.lastname: Moseley
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Refshauge
authors.forename: Marion
authors.initials: M
authors.lastname: Haas
authors.forename: Robert D
authors.initials: RD
authors.lastname: Herbert
mesh_terms: D016512:Ankle Injuries / Q000503:physiopathology / Q000628:therapy*; D000843:Ankle Joint / Q000503:physiopathology*; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D003627:Data Interpretation, Statistical; D004434:Early Ambulation / Q000379:methods; D005081:Exercise Therapy / Q000191:economics / Q000379:methods*; D005592:Fracture Fixation / Q000534:rehabilitation*; D050723:Fractures, Bone / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D011788:Quality of Life; D016896:Treatment Outcome