Telerehabilitation for Patients After ORIF for Ankle Fracture: A Noninferiority Randomized Controlled Trial

To determine the efficacy and cost-effectiveness of telerehabilitation compared with face-to-face rehabilitation for patients after open reduction and internal fixation (ORIF) for ankle fractures.

A randomized controlled trial was conducted.

This trial was conducted in southeast of China.

A total of 468 patients (N=468) who underwent ORIF for ankle fractures participated in the study. Participants were randomly assigned to either the telerehabilitation group (TELE group) or the face-to-face rehabilitation group (PT group), with 234 patients in each group.

The TELE group received a 12-week home-based rehabilitation program, which included video instructions on a tablet and remote coaching. The PT group received standard face-to-face rehabilitation with the assistance of a physical therapist for 12 weeks.

Effectiveness was measured using the Olerud and Molander Ankle Score (OMAS) and the EuroQol-5 Dimensions-5 Levels (EQ-5D-5L), with assessments at baseline, 12 weeks, and 24 weeks postoperatively. The incremental cost-effectiveness ratio was calculated using bootstrapping methods.

At the 12-week follow-up, the difference in OMAS scores between the TELE and PT groups was negligible, with a coefficient of -0.477 (P=.086). At 24 weeks after surgery, the OMAS difference was -0.050 (P=.857). The EQ-5D-5L utility score had a coefficient of -0.008 (P=.146), and the EQ-5D-5L visual analog scale score showed a coefficient of 0.312 (P=.058) at 12 weeks, indicating no significant difference between the groups at 12 weeks. Total 12-week costs per patient were 15% lower in the TELE group compared with the PT group.

Telerehabilitation for patients after ORIF for ankle fracture was found to be cost-effective, with no significant difference in clinical outcomes compared with face-to-face rehabilitation.