1. Patients in the early weight-bearing group showed better recovery than those in the delayed weight-bearing group at 4 months post-randomization.
2. Early weight-bearing was more cost-effective with comparable adverse outcomes.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Patients recovering from ankle surgery have traditionally been advised to avoid walking for 6 weeks, a strategy known as delayed weight-bearing. An alternative approach, early weight-bearing, allows walking 2 weeks post-surgery and may offer better rehabilitation outcomes. This randomized controlled trial aimed to evaluate the clinical and cost-effectiveness of early weight-bearing compared to delayed weight-bearing. The primary outcome of this study was ankle function measured using the Olerud and Molander Ankle Score (OMAS) at 4 months, while a key secondary outcome was cost from the National Health Service (NHS) hospitals. According to study results, early weight-bearing was non-inferior and had a high likelihood of being cost-effective compared to delayed weight-bearing. Although this study was well done, the clinicians were not blinded to the patient-intervention pairings, which may introduce bias.
Click to read the study in The Lancet
In-depth [randomized controlled trial]: Between Jan 13, 2020, and Oct 29, 2021, 2218 patients were screened for eligibility across 23 UK hospitals. Included were patients ≥ 18 years old who underwent surgery for an unstable ankle fracture. Altogether, 480 patients (243 in early weight-bearing and 237 in delayed weight-bearing) were included in the final analysis. The primary outcome of ankle function at 4 months was non-inferior, and potentially superior, in the early weight-bearing group than in the delayed weight-bearing group (65.9 vs. 61.2, mean difference 4.47, 95% confidence interval [CI] 0.58-8.37, p=0.024). The secondary outcome revealed that early weight-bearing was likely to be more cost-effective (mean cost £725 for early weight-bearing vs. £785 for late weight-bearing). Complications in both groups were comparable. Overall, findings from this study suggest that early weight-bearing is a clinically effective and cost-efficient rehabilitation strategy for patients recovering from ankle surgery.
Image: PD
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