Differences in gait and trunk movement between patients after ankle fracture and healthy subjects

Abstract

Background: Studies have shown that gait asymmetry and activity limitation can persist several months or years after ankle fracture. However, evidence of gait and trunk movement patterns following ankle fracture during the early rehabilitation period is scarce. Thus, we compared gait patterns and trunk movement during the early phase of rehabilitation between patients with ankle fracture and matched controls. Methods: Ten patients with ankle fractures, and ten age-and sex-matched healthy controls were prospectively enrolled. An automated infrared-assisted, trunk accelerometer-based gait analysis system was used to measure walking speed, step length, and cadence. The median time of the evaluation following ankle fracture was 4.0 months. Trunk movement intensity was evaluated as acceleration root mean square. Trunk movement symmetry and regularity were analysed using the autocorrelation method. Differences in gait characteristics between the patient and control groups were analysed using the Mann-Whitney U test. Follow-up assessment of falls was performed 24 months after the fracture. The correlations between Lower Extremity Functional Scale (LEFS) scores/falls and gait parameters were evaluated using Spearman's rank correlation coefficient. Results: Walking speed (p = 0.019), step length (p = 0.023), cadence (p = 0.003), and trunk movement intensity in anterior-posterior and vertical axis (p = 0.001, p = 0.003, respectively) were all significantly lower in the ankle fracture group than in the control group. Trunk movement symmetry in vertical direction (p = 0.019) decreased significantly in patients with ankle fractures, whereas between-strides regularity did not differ between groups. LEFS scores were moderately correlated with walking speed (r = 0.60, p = 0.044) and step length (r = 0.68, p = 0.021). During the 24 months after the fracture, 3 falls were reported by 3 patients. Trunk acceleration root mean square ratio in mediolateral axis (r = 0.72, p = 0.018) was highly correlated with future falls. Conclusion: During early rehabilitation, patients with ankle fracture may develop trunk movement asymmetry in the vertical direction accompanied with slower walking speed and cadence, and smaller step lengths, which can contribute to muscular imbalances and potential injury. Thus, proper rehabilitation strategies should be employed for these patients.

Content validity and measurement properties of the Lower Extremity Functional Scale in patients with fractures of the lower extremities: a systematic review

“…Sample sizes of the included studies varied from 20 [ 31 ] to 567 patients [ 32 ]. The mean age of the patients ranged from 38.0 [ 31 ] to 57.5 years [ 32 ], and 50.3% [ 33 ] to 70.0% [ 31 ] of the patients were female.…”

“…Sample sizes of the included studies varied from 20 [ 31 ] to 567 patients [ 32 ]. The mean age of the patients ranged from 38.0 [ 31 ] to 57.5 years [ 32 ], and 50.3% [ 33 ] to 70.0% [ 31 ] of the patients were female. These figures are based on the descriptive statistics where we rely on the reported numbers as published in the included studies.…”

“…These figures are based on the descriptive statistics where we rely on the reported numbers as published in the included studies. The setting in which the measurement properties of the LEFS were assessed differed between studies and included a physical therapy clinic [ 23 ], a (teaching) hospital [ 32 , 34 , 35 ], a rehabilitation department [ 31 , 33 ], and records from a national electronic database on post-operative patients [ 36 ]. The LEFS was assessed in four languages, including English [ 23 , 33 ], Norwegian [ 32 ], Chinese [ 31 ], and Finnish [ 34 – 36 ].…”

“…The setting in which the measurement properties of the LEFS were assessed differed between studies and included a physical therapy clinic [ 23 ], a (teaching) hospital [ 32 , 34 , 35 ], a rehabilitation department [ 31 , 33 ], and records from a national electronic database on post-operative patients [ 36 ]. The LEFS was assessed in four languages, including English [ 23 , 33 ], Norwegian [ 32 ], Chinese [ 31 ], and Finnish [ 34 – 36 ]. All included studies met the criterion of having at least 75% subjects with a fracture of the lower extremity, except for Binkley et al's [ 23 ] development study, where only 10.2% had a lower extremity fracture.…”

The Need to Improve Patient-Centered Outcome Reporting Following Lower Extremity Flap Reconstruction: A Systematic Review and Meta-analysis

“…21,22 Validated scales and scoring systems, including the Lower Extremity Functional Scale (LEFS), are frequently incorporated into patient evaluations among orthopaedic and trauma surgery research. [23][24][25] In contrast, there has been infrequent and inconsistent reporting of PCO in the literature examining outcomes of chronic LE wound management in highly comorbid populations. A systemic review by Economides et al analyzed articles published between 1990 and 2012 on LE flap reconstruction among comorbid patients and described a notable discrepancy between disease-centered and PCO reporting.…”