CompletedInterventional

AFTER – Ankle fracture treatment: enhancing rehabilitation trial

After breaking an ankle, your leg is usually held still in a cast or support boot for several weeks. Once this comes off, the joint often feels stiff, weak, and sore. Doctors know that gentle movement helps recovery, but NHS hospitals currently offer different types of care. Some hospitals provide advice and home exercises, while others arrange regular physiotherapy appointments. At present, there is no clear evidence showing whether hands-on physiotherapy leads to a better recovery than guided home exercises. Regular hospital appointments can also be difficult to fit into daily life. The AFTER trial, led by the University of Oxford, aims to find out the best approach for adults aged 50 and older. Half of the participants follow a home exercise plan, while the other half also see a physiotherapist. The results will help improve NHS care for future patients.

At a glance

Status

Completed

Sponsor

University of Oxford

Enrolment target

344

Start

15 Sep 2022

Estimated completion

15 Nov 2023

Ankle fracture

What is this study about?

When you break an ankle, your leg is kept still in a plaster cast or removable boot for several weeks so the bone can heal safely. Once the cast or boot is removed, it is completely normal for your ankle to feel stiff, swollen, and tender. Getting your ankle moving again is an essential step on the path back to everyday activities like walking, climbing stairs, and shopping.

Across the UK, different NHS hospitals support people in different ways after an ankle fracture. Some hospitals provide an information booklet with home exercises, while others schedule several one-to-one sessions with a physiotherapist. Right now, doctors do not have enough scientific proof to know whether attending physiotherapy sessions leads to better long-term healing than following a good home exercise plan.

Attending hospital appointments can take time, effort, and travel. It is also important for the NHS to use its staff and resources in the most effective way. The AFTER study is designed to compare these two standard approaches directly to see which helps people aged 50 and over recover their mobility, strength, and confidence best.

By taking part, you can help researchers answer this important question. The findings will provide clear evidence so that NHS hospitals across the country can offer the most supportive and effective care for anyone recovering from a broken ankle.

Key takeaways

The AFTER study looks at the best way to rebuild ankle strength and movement after a break.
Open to people aged 50 and over whose cast or boot came off within the last 14 days.
Compares guided home exercises against home exercises plus 4 to 6 NHS physiotherapy sessions.
Involves filling in four short questionnaires over a total period of six months.
Both treatments are widely used across the NHS and run by qualified healthcare staff.

Who may be eligible?

This study is open to men and women aged 50 and over who have broken an ankle. It does not matter whether your break was treated with an operation or allowed to heal naturally, as long as your ankle was kept in a cast or support boot for between 4 and 10 weeks.

To take part, you must be able to join within two weeks (14 days) of your cast or boot being removed. You also need to have been able to walk on your own before your injury occurred, and be comfortable completing simple health questionnaires.

You will not be able to join if your doctor advises that you have a medical condition that makes standard gentle exercise unsafe, or if you are unable to follow the study steps and fill in the check-in forms.

Could this study suit you?

Answer these quick questions to see if you may be eligible. This is a guide only — the research team makes the final call.

I am aged 50 or over.
I recently broke my ankle and had it in a cast or support boot for 4 to 10 weeks.
My cast or boot came off within the last 14 days (or is about to come off).
I was able to walk before I broke my ankle.
I am happy to do gentle leg exercises and fill in short questionnaires about my recovery.

Answer every question to see your result.

What does participation involve?

If you agree to take part, you will first fill in a short 10-minute questionnaire about your general health, your normal activity levels, and how your ankle feels. A computer program will then place you by chance (like flipping a coin) into one of two treatment groups.

In the first group (self-directed recovery), hospital staff will give you clear advice and an exercise guide, along with access to a helpful website. You will practice these exercises at home in your own time, gradually building up your movement over a few months.

In the second group (supervised recovery), you will receive the exact same exercise guide and website access, but you will also have 4 to 6 sessions with an NHS physiotherapist over a three-month period. These sessions can take place in person at the clinic or remotely by phone or video call.

Whichever group you are in, you will be asked to fill in three more short questionnaires at two, four, and six months after joining. These forms track your progress and can be done at home. Your total time in the study is six months.

Potential risks and benefits

Both treatments use standard, well-established NHS care delivered by qualified healthcare professionals. While joining may not directly change your personal recovery, the information you provide will help doctors understand how to give future patients the best care. You are very unlikely to come to any harm from taking part. It is common to feel some mild muscle stiffness or soreness when starting new exercises, but your team will explain how to manage this safely. Your participation is entirely voluntary, and you can change your mind and leave the study at any time without your usual NHS care being affected.

Locations (28)

Some site locations are approximate. We're improving this — please verify with the trial team before travelling.

Royal United Hospitals Bath NHS Foundation Trust
City only
Bath, England
Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
City only
Doncaster, England
Oxford University Hospitals NHS Foundation Trust
City only
Oxford, England
Pinderfields Hospitals NHS Trust
City only
Wakefield, England
Nottingham University Hospitals NHS Trust - City Campus
City only
Nottingham, England
Somerset NHS Foundation Trust
Unverified
Taunton, England
North Bristol NHS Trust
Unverified
Bristol, England
Royal Devon University Healthcare NHS Foundation Trust
Unverified
Exeter, England
The Princess Alexandra Hospital
Unverified
Harlow, England
King’s College Hospital NHS Foundation Trust
Unverified
London, England
Airedale General Hospital
Unverified
Keighley, England
Betsi Cadwaladr University Lhb Anglesey Office
Unverified
Llangefni, Wales

Common questions

Can I choose whether I see a physiotherapist or exercise at home?

No. A computer system puts people into groups by chance. This makes the comparison fair and ensures the results are reliable.

Are travel costs covered if I have to go to physiotherapy?

No. Travel costs are not paid because physiotherapy appointments are treated as part of normal NHS care.

Do physiotherapy sessions have to be in person?

Not always. Sessions can be held face-to-face at the hospital clinic, or remotely over the phone or via video call, depending on what works best.

What happens if my ankle hurts while doing the exercises?

Some mild aching or tiredness in the muscles is normal when moving a stiff joint again. Your care team will give you clear guidance on how to pace yourself and manage discomfort.

Will taking part affect my regular medical care?

No. Your safety and wellbeing always come first, and you will continue to receive all the standard NHS medical attention you need.

How to find out more

David Keene

after@ndorms.ox.ac.uk +44 1865223126 Official trial record

Always speak to your GP or specialist before deciding to take part in a study.