Evaluation of the effects of a rehabilitation program of pain management on discomforts, joint function, basic stamina, health-based quality of life and occupational rehabilitation of patients with near-ankle fractures and delayed recovery

Status:

completed 12/2009

Aims:

Fractures close to ankle joint are the most frequent occupational injuries at the workplace and often lead to high medical costs and longer inability to work. Up to now, only a few studies have examined therapy effects on patients insured through the German statutory accident insurance with the abovementioned traumata after an accident at the workplace.

Activities/Methods:

The present prospective randomized study evaluates the effects of in-patient rehabilitation treatment over a period of three until four weeks on 76 patients with fractures close to ankle joint and delayed healing process. In addition to a standardized treatment programme (standard group - SG, n = 25) one group of patients completed additional endurance training on a bicycle ergometer (endurance group - EG, n = 27) and another group completed whole body vibration training on a Galileo Fitness machine (vibration group - VG, n = 24). The functional parameters mobility, strength, endurance, balance and the OMA functional score according to Olerud/Molander (1984) were measured at the beginning and at the end of the in-patient rehabilitation treatment, as well as four weeks and six months thereafter. In addition, a patients were questioned about their discomfort (pain intensity NRS 0-10, PDI), health-related quality of life (SF-36) and different psychosocial variables (among other things job satisfaction and job load).

Results:

A significant improvement (p < 0.05) was found for the whole group in all functional and pain variables for the period of the in-patient rehabilitation treatment. When comparing the groups, clinically relevant improvements in ankle joint mobility were only found in both experimental groups (EG and VG) in relation to SG. EG had the greatest improvements in strength endurance (ankle dorsal extensors), basic endurance, as well as in most SF-36 scales. VG had clinically relevant improvements in balance, all pain variables and the OMA score. Strength qualities were the only area in which SG improved more than EG or VG. At the end of the investigation period, the patients still incapable of working showed a higher degree of discontent with the intended workplace. Moreover, this group had a clearly higher percentage of patients who still had outstanding financial demands (cost bearers, other party) than the group of participants who were fully able to go back to work.

From the measured functional and pain variables, we can conclude that the examined patient groups have a great need for rehabilitation. For the period of the stationary treatment, the deconditioning cycle due to patients sparing their injured limb could be broken and the functional restrictions were significantly improved by a predominantly activating therapy, though they could not be caught up completely. The individually designed endurance training, as well as the standardised Galileo vibration training were carried out easily without undesirable reactions by the test persons as an additional therapy form. The, in part, considerable improvements in both experimental groups compared to SG suggest that complementary endurance training or vibration training leads to greater therapy effects than a classical standard treatment programme. Endurance training on the bicycle ergometer led to a professional reintegration of patients in EG about 20 days earlier than for the comparative groups.

In addition to functional and pain variables, medical and occupational rehabilitation must also consider the psychosocial factors of the affected patients. The main goal of the medical treatment of these patients should be the avoidance of chronic pain. This requires a purposeful therapeutic consultation and fine-meshed medical monitoring of the patients, as well as clear agreements between all professional groups involved in the therapy. At the first signs of a delayed healing process, high consequential costs due to long periods of work disability can be avoided by beginning in-patient treatment (BGSW) in a timely manner.

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