Self-management effective for uncomplicated ankle fractures

Self-management could replace traditional supervised exercise programs for treating uncomplicated ankle fractures if new research conducted by The George Institute for Global Health is adopted as standard practice in Australia.

Lead author Dr Anne Moseley from the Institute and the University of Sydney, said the study was published in the Journal of the American Medical Association (JAMA) and found physiotherapist-prescribed self-management provided the same benefits and similar recovery rates as supervised exercise programs.

“Uncomplicated ankle fractures are a common injury – there are more than 22,500 across Australia each year,” Dr Moseley said.

“They are particularly common among older women who are more likely to experience osteoporosis and age related injuries as well as younger men who might suffer injuries due to sport and physical activity.

“They sometimes require surgery and a period of immobilisation while the fracture heals.

“They also cost the economy more than $16 million a year in direct healthcare and out of pocket expenses, and even more for lost productivity.”

Dr Moseley said that ankle fractures are usually treated on a case-by-case basis, with supervised exercise programs being a common treatment traditionally offered to some patients.

“Contrary to accepted wisdom, we found that traditional intensive treatment of ankle fractures does not offer advantages over physiotherapist-prescribed self-management,” she said.

“Self-management comprising advice and instruction for the patient to do their own exercises provided the same outcomes over six months.

“That advice was provided in a single session by a physiotherapist in the fracture clinic, who discussed self-management, exercise and return to activity.

“On average, the provision of the traditional supervised exercise ($501 per patient) was more costly to the healthcare system than the provision of self-management ($192 per patient).

“Besides the cost benefit, this research is good news for the thousands of people who break their ankles every year and are worried about fitting a supervised exercise program into their already disrupted and busy lives or who have difficulty accessing physiotherapy as they live in a rural or remote setting.

“It’s also a plus for physiotherapists and clinicians who can focus their attention on complicated fractures where more extensive rehabilitation may be required.

“We hope the results supporting self-management are taken on board and change the standard approach to management of ankle fractures.”