Formal Physical Therapy Improves Patient-Reported Outcome Measurement Information System Physical Function for High Anxiety Patients After Ankle ORIF.

Abstract

To compare outcomes after ankle fracture fixation between those receiving formal physical therapy (PT) versus no formal PT and those with high versus low patient-reported outcome measurement information system (PROMIS) anxiety score (AS), and to evaluate the effect of PT in the setting of PROMIS ASs. Retrospective cohort study. Level 1 trauma center. Patients aged >18 years undergoing isolated ankle fracture (OTA/AO 44A, 44B, 44C) fixation with documented PROMIS scores postoperatively. The postoperative PROMIS physical function (PF) and pain interference (PI) were compared between patients receiving formal PT versus those receiving no PT and those with baseline high versus low PROMIS ASs. A subanalysis was performed between patients with low anxiety and no PT (LANP) versus low anxiety with PT (LAP) versus high anxiety and no PT (HANP), and high anxiety with PT (HAP). A total of 161 patients, 111 women (68.9%), with an average age of 46 years (range: 18-72 years), 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, patients with high anxiety had similar PROMIS PF (43.0) versus patients with low anxiety (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 patients with high and low anxiety 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 for 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 with 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. 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. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.