Manual therapy in addition to physiotherapy does not improve clinical or economic outcomes after ankle fracture.
OBJECTIVE
The primary aim of this study was to determine the effectiveness and cost-effectiveness of adding manual therapy to a physiotherapy programme for ankle fracture.


METHODS
Assessor-blinded randomized controlled trial.


METHODS
Ninety-four adults were recruited within one week of cast removal for isolated ankle fracture. Inclusion criteria were: they were able to weight-bear as tolerated or partial weight-bear, were referred for physiotherapy, and experienced pain. Ninety-one participants completed the study.


METHODS
Participants were randomly allocated to receive manual therapy (anterior-posterior joint mobilization over the talus) plus a standard physiotherapy programme (experimental), or the standard physiotherapy programme only (control). They were assessed by a blinded assessor at baseline, and at 4, 12 and 24 weeks. The main outcomes were activity limitation and quality of life. Information on costs and healthcare utilization was collected every 4 weeks up to 24 weeks.


RESULTS
There were no clinically worthwhile differences in activity limitation or quality of life between groups at any time-point. There was also no between-group difference in quality-adjusted life-years, but the experimental group incurred higher out-of-pocket costs (mean between-group difference = AU$200, 95% confidence interval 26-432).


CONCLUSIONS
When provided in addition to a physiotherapy programme, manual therapy did not enhance outcome in adults after ankle fracture.
Centre for Evidence-Based Physiotherapy, The University of Sydney, Lidcombe, NSW 1825, Australia.
Chung-Wei Christine
CW
Lin
Anne M
AM
Moseley
Marion
M
Haas
Kathryn M
KM
Refshauge
Robert D
RD
Herbert
D000328:Adult; D016512:Ankle Injuries / Q000191:economics / Q000523:psychology / Q000534:rehabilitation*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000191:economics / Q000523:psychology / Q000534:rehabilitation*; D017048:Health Care Costs; D006801:Humans; D026201:Musculoskeletal Manipulations / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011788:Quality of Life; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome