FOOT & ANKLE
Weight-Bearing and Mobilization in the Postoperative Care of Ankle Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Cohort Studies
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2015;3(8):9PLoS One. 2015 Feb 19;10(2):e0118320.
A total of 25 studies (randomized controlled trials and cohort studies) were included in this systematic review and meta-analysis investigating mobilization and weight-bearing following open reduction and internal fixation of ankle fractures. The purpose of this study was to examine the effectiveness of different postoperative rehabilitation protocols. The results of this review found that early weight-bearing and active mobilization did not cause a significant increase in incidence of complications and accelerated patients’ return to work and daily activities.
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Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
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報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
Ankle fractures account for a number of visits to orthopaedic and fracture clinics, commonly occurring in sporting activities. A number of these injuries are treated surgically, particularly open reduction and internal fixation (ORIF), though there has been debate about optimal postoperative rehabilitation in these cases, with no conclusive standard of postoperative care. As a result, this systematic review and meta-analysis aimed to compare the efficacy and safety of current rehabilitative interventions used in patients who undergo ORIF for ankle fractures.
主な研究課題は何ですか？
How effective and safe are current rehabilitative interventions following open reduction and internal fixation of ankle fractures?
重要な知見は？
- In total, 19 studies provided comparison between mobilization (ie. exercises) versus immobilization after ORIF, and 11 studies provided comparison between early weight-bearing and delayed weight-bearing after ORIF.
- In comparing mobilization versus immobilization postoperatively, no statically significant differences were noted in functional outcome through Olerud Molander score in the short- and long-term (9 studies: Short-term MD -6.88 [95%CI: -17.66, 3.91]; Long-term MD -1.05 [95% CI: -4.11, 2.00]) or incidence of complications (12 studies: RR 1.22 [95%CI: 0.60, 2.45]). Mobilization demonstrated significantly earlier return to work/ daily activities (7 studies: MD -20.76 days [95%CI -40.02, -1.50]).
- In comparing early weight-bearing versus delayed weight-bearing, early weight-bearing groups demonstrated a mean 20.62-day earlier to work/daily activities as compared with delayed weight-bearing, though the difference did not reach statistical significance (3 studies: [95%CI -42.46, 1.22]; p=0.06). The incidence of complications did not significantly differ between early and delayed weight-bearing (8 studies: RR 1.26 [95%CI 0.56, 2.85]).
- Sub-group analysis of studies which featured immediate weight-bearing as tolerated as the early weight-bearing group also demonstrated no significant differences in complication risk (2 studies: RR 0.69 [95%CI 0.28, 1.73]).
最も覚えておくべきことは？
In rehabilitation after open reduction and internal fixation (ORIF) for ankle fracture, earlier return to work and daily activities was noted with exercise versus immobilization, as well as early weight-bearing versus delayed weight-bearing, though the latter did not reach statistical significance. No protocol demonstrated a significantly higher incidence of complications than its comparator. Short- and long-term functional outcome also appeared similar between exercise and immobilization protocols.
それが私の患者ケアにどのように影響するか？
The results this study suggest that exercise therapy, as opposed to immobilization, after ankle fixation surgery may facilitate an earlier return to activities without increasing the risk of complications. Early weight-bearing also does not appear to increase risk for complications when compared to delayed weight-bearing, with a trend toward to earlier return to activities. Given the ongoing trials currently being performed with respect to postoperative rehabilitation after ankle fracture fixation, a re-evaluation in the near future with the addition of ongoing and planned randomized controlled trials may further define the roles of different postoperative care methods as they pertain to patient outcome.
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