Formal Physical Therapy Improves PROMIS PF for High Anxiety Patients Following Ankle ORIF.

Objective: To compare outcomes after ankle fracture fixation between those receiving formal physical therapy (PT) vs. no formal PT and those with high vs. low PROMIS anxiety score (AS), and to evaluate the effect of PT in the setting of PROMIS AS scores.

Design: Retrospective cohort study.

Setting: Level 1 trauma center.

Patient Selection Criteria: Patients aged > 18 undergoing isolated ankle fracture (OTA/AO 44A, 44B, 44C) fixation with documented PROMIS scores postoperatively.Outcome Measures and Comparisons: The post-operative PROMIS physical function (PF) and pain interference (PI) were compared between patients receiving formal PT vs. no PT and those with baseline high vs. low PROMIS AS scores. A sub-analysis was performed between patients with low anxiety and no PT (LANP) vs. low anxiety with PT (LAP) vs. high anxiety and no PT (HANP), and high anxiety with PT (HAP).

Results: A total of 161 patients, 111 females (68.9%), with an average age of 46 years (range: 72), were included in this study: 127 PT, 34 no PT, 88 low anxiety, and 73 high anxiety. PT did not yield any significant differences in PROMIS PF (44.9 PT vs 42.6 no PT, p=0.180) or PI (53.5 PT vs 54.4 no PT, p=0.656) at final follow-up. At final follow-up, high anxiety patients had similar PROMIS PF (43.0) vs. low anxiety patients (45.5, p=0.088), but significantly worse PROMIS PI scores (51.5 vs. 56.7, respectively; p=0.001). Univariate analysis demonstrated a significant difference in age between high and low anxiety patients and was thus selected as a control variable in the analysis of HANP, HAP, LANP, and LAP. After controlling for age, pairwise comparisons of estimated PROMIS PF scores at final follow-up were significantly lower for HANP (39.0) than HAP (43.9, p=0.05), LANP (45.1, p=0.05), and LAP patients (45.9, p=0.04). Final PROMIS PI scores were significantly worse for HANP (59.1) and HAP (56.5) when compared to LANP (51.3, p=0.021 vs HANP, p=0.049 vs HAP) and LAP (51.3, p=0.005 vs HANP, p=0.004 vs HAP) groups .

Conclusion: Patients with high anxiety who undergo isolated ankle fracture fixation perform worse regarding PROMIS PI irrespective of PT status. However, some patients with high anxiety may benefit from formal PT referral to maximize their functional outcomes.

Level Of Evidence: Level III, Prognostic.