title: Manual Physical Therapy Following Immobilization for Stable Ankle Fracture: A Case Series.
abstract: METHODS
  Case series.
  
  
  BACKGROUND
  Ankle fractures commonly result in persistent pain, stiffness, and functional impairments. There is insufficient evidence to favor any particular rehabilitation approach after ankle fracture. The purpose of this case series was to describe an impairment-based manual physical therapy approach to treating patients with conservatively managed ankle fractures.
  
  
  METHODS
  Patients with stable ankle fractures postimmobilization were treated with manual physical therapy and exercise targeted at associated impairments in the lower limb. The primary outcome measure was the Lower Extremity Functional Scale. Secondary outcome measures included the ankle lunge test, numeric pain-rating scale, and global rating of change. Outcome measures were collected at baseline (performed within 7 days of immobilization removal) and at 4 and 12 weeks postbaseline.
  
  
  RESULTS
  Eleven patients (mean age, 39.6 years; range, 18-64 years; 2 male), after ankle fracture-related immobilization (mean duration, 48 days; range, 21-75 days), were treated for an average of 6.6 sessions (range, 3-10 sessions) over a mean of 46.1 days (range, 13-81 days). Compared to baseline, statistically significant and clinically meaningful improvements were observed in Lower Extremity Functional Scale score (P = .001; mean change, 21.9 points; 95% confidence interval: 10.4, 33.4) and in the ankle lunge test (P = .001; mean change, 7.8 cm; 95% confidence interval: 3.9, 11.7) at 4 weeks. These changes persisted at 12 weeks.
  
  
  CONCLUSIONS
  Statistically significant and clinically meaningful improvements in self-reported function and ankle range of motion were observed at 4 and 12 weeks following treatment with impairment-based manual physical therapy. All patients tolerated treatment well. Results suggest that this approach may have efficacy in this population.
  
  
  METHODS
  Therapy, level 4.
authors.affiliation: Brooke Army Medical Center, Army-Baylor University Doctoral Fellowship in Orthopaedic Manual Physical Therapy, Fort Sam Houston, TX.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Painter
authors.forename: Gail D
authors.initials: GD
authors.lastname: Deyle
authors.forename: Christopher
authors.initials: C
authors.lastname: Allen
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Petersen
authors.forename: Theodore
authors.initials: T
authors.lastname: Croy
authors.forename: Kenneth P
authors.initials: KP
authors.lastname: Rivera
mesh_terms: D000293:Adolescent; D000328:Adult; D064386:Ankle Fractures / Q000534:rehabilitation* / Q000628:therapy; D018771:Arthralgia / Q000517:prevention & control; D002370:Casts, Surgical; D005260:Female; D005592:Fracture Fixation; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000379:methods*; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D055815:Young Adult
keywords: clinical reasoning; lower extremity; manipulation; mobilization