TY - JOUR
T1 - Short-term effects of manual therapy in patients after surgical fixation of ankle and/or hindfoot fracture
T2 - A randomized clinical trial
AU - Albin, Stephanie R.
AU - Koppenhaver, Shane L.
AU - Marcus, Robin
AU - Dibble, Lee
AU - Cornwall, Mark
AU - Fritz, Julie M.
N1 - Funding Information:
1School of Physical Therapy, Regis University, Denver, CO. 2Doctor of Physical Therapy Program, Baylor University, Waco TX. 3Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT. 4Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ. Intermountain Healthcare and Womack Army Medical Center’s Institutional Review Boards approved this study. This randomized clinical trial was registered with ClinicalTrials.gov (NCT02609347). This work was supported by the Defense Health Program at the US Army Medical Research and Materiel Command-Department of Defense Joint Program Committee 5. Opinions, interpretations, conclusions, and recommendations are those of the author (S.K.) and are not necessarily endorsed by the US Army. The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. Address correspondence to Dr Stephanie R. Albin, Regis University, 3333 Regis Boulevard, Denver, CO 80221-1099. E-mail: albin149@regis.edu U Copyright 2019 Journal of Orthopaedic & Sports Physical Therapy®
Publisher Copyright:
Copyright © 2019 Journal of Orthopaedic & Sports Physical Therapy.
PY - 2019/5
Y1 - 2019/5
N2 - U BACKGROUND: Patients with surgical fixation of ankle and/or hindfoot fractures often experience decreased range of motion and loss of function following surgery and postsurgical immobilization, yet there is minimal evidence to guide care for these patients. U OBJECTIVES: To assess whether manual therapy may provide short-term improvements in range of motion, muscle stiffness, gait, and balance in patients who undergo operative fixation of an ankle and/or hindfoot fracture. U METHODS: In this multisite, double-blind randomized clinical trial, 72 consecutive patients who underwent open reduction internal fixation of an ankle and/or hindfoot fracture and were receiving physical therapy treatment of exercise and gait training were randomized to receive either impairment-based manual therapy (manual therapy group) or a sham manual therapy treatment of light soft tissue mobilization and proximal tibiofibular joint mobilizations (control group). Participants in both groups received 3 treatment sessions over 7 to 10 days, and outcomes were assessed immediately post intervention. Outcomes included ankle joint range of motion, muscle stiffness, gait characteristics, and balance measures. Group-by-time effects were compared using linear mixed modeling. U RESULTS: There were no significant differences between the manual therapy and control groups for range of motion, gait, or balance outcomes. There was a significant difference from baseline to the final follow-up in resting gastrocnemius muscle stiffness between the manual therapy and control groups (–47.9 N/m; 95% confidence interval: –86.1, –9.8; P = .01). There was no change in muscle stiffness for the manual therapy group between baseline and final follow-up, whereas muscle stiffness increased in the control group by 6.4%. U CONCLUSION: A brief course of manual therapy consisting of 3 treatment sessions over 7 to 10 days did not lead to better short-term improvement than the application of sham manual therapy for most clinical outcomes in patients after ankle and/or hindfoot fracture who were already being treated with exercise and gait training. Our results, however, suggest that manual therapy might decrease aberrant resting muscle stiffness after ankle and/or hindfoot surgical fixation.
AB - U BACKGROUND: Patients with surgical fixation of ankle and/or hindfoot fractures often experience decreased range of motion and loss of function following surgery and postsurgical immobilization, yet there is minimal evidence to guide care for these patients. U OBJECTIVES: To assess whether manual therapy may provide short-term improvements in range of motion, muscle stiffness, gait, and balance in patients who undergo operative fixation of an ankle and/or hindfoot fracture. U METHODS: In this multisite, double-blind randomized clinical trial, 72 consecutive patients who underwent open reduction internal fixation of an ankle and/or hindfoot fracture and were receiving physical therapy treatment of exercise and gait training were randomized to receive either impairment-based manual therapy (manual therapy group) or a sham manual therapy treatment of light soft tissue mobilization and proximal tibiofibular joint mobilizations (control group). Participants in both groups received 3 treatment sessions over 7 to 10 days, and outcomes were assessed immediately post intervention. Outcomes included ankle joint range of motion, muscle stiffness, gait characteristics, and balance measures. Group-by-time effects were compared using linear mixed modeling. U RESULTS: There were no significant differences between the manual therapy and control groups for range of motion, gait, or balance outcomes. There was a significant difference from baseline to the final follow-up in resting gastrocnemius muscle stiffness between the manual therapy and control groups (–47.9 N/m; 95% confidence interval: –86.1, –9.8; P = .01). There was no change in muscle stiffness for the manual therapy group between baseline and final follow-up, whereas muscle stiffness increased in the control group by 6.4%. U CONCLUSION: A brief course of manual therapy consisting of 3 treatment sessions over 7 to 10 days did not lead to better short-term improvement than the application of sham manual therapy for most clinical outcomes in patients after ankle and/or hindfoot fracture who were already being treated with exercise and gait training. Our results, however, suggest that manual therapy might decrease aberrant resting muscle stiffness after ankle and/or hindfoot surgical fixation.
KW - Ankle
KW - Balance
KW - Calcaneus
KW - Fracture
KW - Gait
KW - Manual therapy
KW - Talus
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U2 - 10.2519/jospt.2019.8864
DO - 10.2519/jospt.2019.8864
M3 - Article
C2 - 30759357
AN - SCOPUS:85065173134
SN - 0190-6011
VL - 49
SP - 310
EP - 319
JO - Journal of Orthopaedic and Sports Physical Therapy
JF - Journal of Orthopaedic and Sports Physical Therapy
IS - 5
ER -