Development and delivery of the rehabilitation interventions for older adults with an ankle fracture in the AFTER (Ankle Fracture Treatment Enhancing Rehabilitation) trial
Year: 2025
Type: article
Abstract: Objectives Describe the development and delivery of the interventions in the Ankle Fracture Treatment Enhancing Rehabilitation (AFTER) trial, a randomised controlled trial comparing the effectiveness of supervised versus self-directed rehabilitation for adults aged ≥50 years with an ankle fracture. Design Intervention development. Setting UK National Health Service (NHS) hospitals. Method We developed the interventions in stages. First, we reviewed two UK clinical guidelines and the existing research evidence. We then conducted a clinical practice survey ( n = 59 physiotherapists) to inform a stakeholder meeting which identified key intervention components. Subsequently, we designed the interventions, tested them in a pilot trial ( n = 61 participants), then refined them for the definitive AFTER trial. Results/findings The definitive AFTER trial interventions start after randomisation, which occurs when the participant's cast/boot is removed and weightbearing and ankle movement restrictions are lifted. Participants allocated to self-directed rehabilitation receive a high-quality advice workbook, a progressively challenging self-directed exercise programme that they follow to self-manage their recovery, and strategies to encourage exercise adherence. Supervised rehabilitation participants receive a high-quality workbook, then 4 to 6 one-to-one face-to-face/remote sessions with a physiotherapist. The physiotherapist provides specific advice, home exercises, and uses strategies to facilitate adherence to prescribed exercises. The supervised rehabilitation intervention is tailored to individual participants during review sessions. Conclusions The definitive AFTER trial will provide high-quality evidence to guide rehabilitation provision for older adults with an ankle fracture. Results are anticipated in 2025. Trial Registration Number ISRCTN registry (identifier: ISRCTN11830323). Contribution of the Paper •Although ankle fractures commonly affect older adults and their recovery is usually incomplete, the most effective rehabilitation for these patients remains unknown. •The Ankle Fracture Treatment Enhancing Rehabilitation (AFTER) trial is a large multicentre randomised controlled trial comparing supervised versus self-directed rehabilitation for older adults. •In accordance with current complex intervention development guidance, this paper describes how we developed the AFTER trial interventions and how they are delivered. •This transparent reporting will enable readers to understand the evidence and theory underpinning the AFTER interventions and aid future implementation of the intervention shown to be most effective.
Source: Physiotherapy
Language: English
Topic: Foot and Ankle Surgery
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,480
Awards: Effectiveness of progressive exercise versus best practice advice for people aged 50years and over with ankle fractures: the AFTER trial, Optimising rehabilitation after ankle fracture in older adults: physiotherapy intervention refinement and a randomised, multicentre, feasibility study, NIHR Development and Skills Enhancement Award, G4959849045, G8635623250
OpenAlex ID: W4408782012