Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2012

Open Access 01-12-2012 | Research article

Life impact of ankle fractures: Qualitative analysis of patient and clinician experiences

Authors: Steven M McPhail, Joel Dunstan, Julie Canning, Terry P Haines

Published in: BMC Musculoskeletal Disorders | Issue 1/2012

Login to get access

Abstract

Background

Ankle fractures are one of the more commonly occurring forms of trauma managed by orthopaedic teams worldwide. The impacts of these injuries are not restricted to pain and disability caused at the time of the incident, but may also result in long term physical, psychological, and social consequences. There are currently no ankle fracture specific patient-reported outcome measures with a robust content foundation. This investigation aimed to develop a thematic conceptual framework of life impacts following ankle fracture from the experiences of people who have suffered ankle fractures as well as the health professionals who treat them.

Methods

A qualitative investigation was undertaken using in-depth semi-structured interviews with people (n=12) who had previously sustained an ankle fracture (patients) and health professionals (n=6) that treat people with ankle fractures. Interviews were audio-recorded and transcribed. Each phrase was individually coded and grouped in categories and aligned under emerging themes by two independent researchers.

Results

Saturation occurred after 10 in-depth patient interviews. Time since injury for patients ranged from 6 weeks to more than 2 years. Experience of health professionals ranged from 1 year to 16 years working with people with ankle fractures. Health professionals included an Orthopaedic surgeon (1), physiotherapists (3), a podiatrist (1) and an occupational therapist (1). The emerging framework derived from patient data included eight themes (Physical, Psychological, Daily Living, Social, Occupational and Domestic, Financial, Aesthetic and Medication Taking). Health professional responses did not reveal any additional themes, but tended to focus on physical and occupational themes.

Conclusions

The nature of life impact following ankle fractures can extend beyond short term pain and discomfort into many areas of life. The findings from this research have provided an empirically derived framework from which a condition-specific patient-reported outcome measure can be developed.
Literature
1.
Coyte PC, Asche CV, Croxford R, Chan B: The economic cost of musculoskeletal disorders in Canada. Arthritis Rheum. 1998, 11 (5): 315-325. 10.1002/art.1790110503.
2.
Praemer A, Furner S, Rice DP, Surgeons AA: Musculoskeletal conditions in the United States. 1992, American Academy of Orthopaedic Surgeons Park Ridge, IL
3.
Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R: Lost productive time and cost due to common pain conditions in the US workforce. JAMA. 2003, 290 (18): 2443-2454. 10.1001/jama.290.18.2443.PubMed
4.
5.
Yelin E: Cost of musculoskeletal diseases: impact of work disability and functional decline. J Rheumatol. 2003, 68: 8-11.
6.
Christey GR, Tomlinson M: Risk factors for ankle fracture requiring operative fixation. Aust N Z J Surg. 1999, 69 (3): 220-223. 10.1046/j.1440-1622.1999.01527.x.PubMed
7.
Lash N, Horne G, Fielden J, Devane P: Ankle fractures: functional and lifestyle outcomes at 2 years. Aust N Z J Surg. 2002, 72 (10): 724-730. 10.1046/j.1445-2197.2002.02530.x.
8.
Ponzer S, Nasell H, Bergman B, Tornkvist H: Functional outcome and quality of life in patients with Type B ankle fractures: a two-year follow-up study. J Orthop Traumatol. 1999, 13 (5): 363-368.
9.
van der Sluis CK, Eisma WH, Groothoff JW, ten Duis HJ: Long-term physical, psychological and social consequences of a fracture of the ankle. Injury. 1998, 29 (4): 277-280.PubMed
10.
Ahlborg HG, Rosengren BE, Jarvinen TL, Rogmark C, Nilsson JA, Sernbo I, Karlsson MK: Prevalence of osteoporosis and incidence of hip fracture in women–secular trends over 30 years. BMC Musculoskelet Disord. 2010, 11: 48-10.1186/1471-2474-11-48.PubMedPubMedCentral
11.
Den Hartog D, Van Lieshout EM, Tuinebreijer WE, Polinder S, Van Beeck EF, Breederveld RS, Bronkhorst MW, Eerenberg JP, Rhemrev S, Roerdink WH: Primary hemiarthroplasty versus conservative treatment for comminuted fractures of the proximal humerus in the elderly (ProCon): a multicenter randomized controlled trial. BMC Musculoskelet Disord. 2010, 11: 97-10.1186/1471-2474-11-97.PubMedPubMedCentral
12.
Goldhahn S, Kralinger F, Rikli D, Marent M, Goldhahn J: Does osteoporosis increase complication risk in surgical fracture treatment? A protocol combining new endpoints for two prospective multicentre open cohort studies. BMC Musculoskelet Disord. 2010, 11: 256-10.1186/1471-2474-11-256.PubMedPubMedCentral
13.
Hallberg I, Bachrach-Lindstrom M, Hammerby S, Toss G, Ek AC: Health-related quality of life after vertebral or hip fracture: a seven-year follow-up study. BMC Musculoskelet Disord. 2009, 10: 135-10.1186/1471-2474-10-135.PubMedPubMedCentral
14.
Wu MH, Huang TJ, Cheng CC, Li YY, Hsu RW: Role of the supine lateral radiograph of the spine in vertebroplasty for osteoporotic vertebral compression fracture: a prospective study. BMC Musculoskelet Disord. 2010, 11: 164-10.1186/1471-2474-11-164.PubMedPubMedCentral
15.
Stufkens SA, van den Bekerom MP, Kerkhoffs GM, Hintermann B, van Dijk CN: Long-term outcome after 1822 operatively treated ankle fractures: a systematic review of the literature. Injury. 2011, 42 (2): 119-127. 10.1016/j.injury.2010.04.006.PubMed
16.
Giannini S, Faldini C, Acri F, Leonetti D, Luciani D, Nanni M: Surgical treatment of post-traumatic malalignment of the ankle. Injury. 2010, 41 (11): 1208-1211. 10.1016/j.injury.2010.09.017.PubMed
17.
Proctor R, Wade R, Woodward Y, Pendleton N, Baldwin R, Tarrier N, Horan M, Burns A: The impact of psychological factors in recovery following surgery for hip fracture. Disabil Rehabil. 2008, 30 (9): 716-722. 10.1080/09638280701403536.PubMed
18.
Olsson LE, Nystrom AE, Karlsson J, Ekman I: Admitted with a hip fracture: patient perceptions of rehabilitation. J Clin Nurs. 2007, 16 (5): 853-859. 10.1111/j.1365-2702.2006.01635.x.PubMed
19.
Adachi JD, Adami S, Gehlbach S, Anderson FA, Boonen S, Chapurlat RD, Compston JE, Cooper C, Delmas P, Diez-Perez A: Impact of prevalent fractures on quality of life: baseline results from the global longitudinal study of osteoporosis in women. Mayo Clin Proc. 2010, 85 (9): 806-813. 10.4065/mcp.2010.0082.PubMedPubMedCentral
20.
Adachi JD, Ioannidis G, Olszynski WP, Brown JP, Hanley DA, Sebaldt RJ, Petrie A, Tenenhouse A, Stephenson GF, Papaioannou A: The impact of incident vertebral and non-vertebral fractures on health related quality of life in postmenopausal women. BMC Musculoskelet Disord. 2002, 3: 11-10.1186/1471-2474-3-11.PubMedPubMedCentral
21.
Hancock MJ, Herbert RD, Stewart M: Prediction of outcome after ankle fracture. J Orthop Sports Phys Ther. 2005, 35 (12): 786-792.PubMed
22.
Lindsjo U: Operative treatment of ankle fracture-dislocations. A follow-up study of 306/321 consecutive cases. Clin Orthop Relat Res. 1985, 199: 28-38.PubMed
23.
Day GA, Swanson CE, Hulcombe BG: Operative treatment of ankle fractures: a minimum ten-year follow-up. Foot Ankle Int. 2001, 22 (2): 102-106.PubMed
24.
Johnson EE, Davlin LB: Open ankle fractures The indications for immediate open reduction and internal fixation. Clin Orthop Relat Res. 1993, 292: 118-127.PubMed
25.
Beris AE, Kabbani KT, Xenakis TA, Mitsionis G, Soucacos PK,   PN: Surgical treatment of malleolar fractures. A review of 144 patients. Clin Orthop Relat Res. 1997, 341: 90-98.PubMed
26.
Nilsson G, Nyberg P, Ekdahl C, Eneroth M: Performance after surgical treatment of patients with ankle fractures - 14-month follow-up. Physiother Res Int. 2003, 8 (2): 69-82. 10.1002/pri.274.PubMed
27.
Lin CW, Moseley AM, Refshauge KM: Rehabilitation for ankle fractures in adults. Cochrane Database Syst Rev. 2008, CD005595-3
28.
Bergland A, Thorsen H, Karesen R: Association between generic and disease-specific quality of life questionnaires and mobility and balance among women with osteoporosis and vertebral fractures. Aging Clin Exp Res. 2011, 23 (4): 296-303.PubMed
29.
Cook DJ, Guyatt GH, Juniper E, Griffith L, McIlroy W, Willan A, Jaeschke R, Epstein R: Interviewer versus self-administered questionnaires in developing a disease-specific, health-related quality of life instrument for asthma. J Clin Epidemiol. 1993, 46 (6): 529-534. 10.1016/0895-4356(93)90125-K.PubMed
30.
Guyatt GH, King DR, Feeny DH, Stubbing D, Goldstein RS: Generic and specific measurement of health-related quality of life in a clinical trial of respiratory rehabilitation. J Clin Epidemiol. 1999, 52 (3): 187-192. 10.1016/S0895-4356(98)00157-7.PubMed
31.
Irvine EJ: Quality of Life–rationale and methods for developing a disease-specific instrument for inflammatory bowel disease. Scand J Gastroenterol Suppl. 1993, 199: 22-27.PubMed
32.
McPhail S, Lane P, Russell T, Brauer SG, Urry S, Jasiewicz J, Condie P, Haines T: Telephone reliability of the Frenchay Activity Index and EQ-5D amongst older adults. Health Qual Life Outcomes. 2009, 7: 48-10.1186/1477-7525-7-48.PubMedPubMedCentral
33.
McPhail S, Bagraith K, Schippers M, Hatton A: Use of condition specific patient reported outcome measures in clinical trials among patients with wrist osteoarthritis: A systematic review. Adv Orthop. 2012, In Press
34.
Leung AS, Lam TH, Hedley AJ, Twomey LT: Use of a subjective health measure on Chinese low back pain patients in Hong Kong. Spine (Phila Pa 1976). 1999, 24 (10): 961-966. 10.1097/00007632-199905150-00006.
35.
Schoenfeld AJ, Bono CM: Measuring spine fracture outcomes: common scales and checklists. Injury. 2011, 42 (3): 265-270. 10.1016/j.injury.2010.11.040.PubMed
36.
Verra ML, Angst F, Staal JB, Brioschi R, Lehmann S, Aeschlimann A, de Bie RA: Differences in pain, function and coping in Multidimensional Pain Inventory subgroups of chronic back pain: a one-group pretest-posttest study. BMC Musculoskelet Disord. 2011, 12: 145-10.1186/1471-2474-12-145.PubMedPubMedCentral
37.
Ostelo RWJG, de Vet HCW, Knol DL, van den Brandt PA: 24-item Roland-Morris Disability Questionnaire was preferred out of six functional status questionnaires for post-lumbar disc surgery. J Clin Epidemiol. 2004, 57 (3): 268-276. 10.1016/j.jclinepi.2003.09.005.PubMed
38.
Engelberg R, Martin DP, Agel J, Obremsky W, Coronado G, Swiontkowski MF: Musculoskeletal function assessment instrument: Criterion and construct validity. J Orthop Res. 1996, 14 (2): 182-192. 10.1002/jor.1100140204.PubMed
39.
Alexanderson H, Lundberg IE, Stenstrom CH: Development of the myositis activities profile–validity and reliability of a self-administered questionnaire to assess activity limitations in patients with polymyositis/dermatomyositis. J Rheumatol. 2002, 29 (11): 2386-2392.PubMed
40.
McPhail S, Beller E, Haines T: Physical function and health-related quality of life of older adults undergoing hospital rehabilitation: how strong is the association?. J Am Geriatr Soc. 2010, 58 (12): 2435-2437. 10.1111/j.1532-5415.2010.03163.x.PubMed
41.
Ware J, Sherbourne C: The MOS 36-item short-form health survey (SF-36) I. Conceptual framework and item selection. Med Care. 1992, 30: 473-483. 10.1097/00005650-199206000-00002.PubMed
42.
Anderson RT, Aaronson NK, Wilkin D: Critical review of the international assessments of health-related quality of life. Qual Life Res. 1993, 2 (6): 369-395. 10.1007/BF00422215.PubMed
43.
Ghislandi S, Apolone G, Garattini L, Ghislandi I: Is EQ-5D a valid measure of HRQoL in patients with movement disorders? A comparison with SF-36 and FIM questionnaires. Eur J Health Econ. 2002, 3 (2): 125-130. 10.1007/s10198-002-0105-x.PubMed
44.
Calvisi V, De Vincentiis B, Palumbo P, Padua R, Lupparelli S: Health-related quality of life in patients with anterior cruciate ligament insufficiency undergoing arthroscopic reconstruction: a practice-based Italian normative group in comorbid-free patients. J Orthop Traumatol. 2008, 9 (4): 233-238. 10.1007/s10195-008-0034-2.PubMedPubMedCentral
45.
Linde L, Sorensen J, Ostergaard M, Horslev-Petersen K, Hetland ML: Health-related quality of life: validity, reliability, and responsiveness of SF-36, 15D, EQ-5D [corrected] RAQoL, and HAQ in patients with rheumatoid arthritis. J Rheumatol. 2008, 35 (8): 1528-1537.PubMed
46.
McPhail S, Comans T, Haines T: Evidence of disagreement between patient-perceived change and conventional longitudinal evaluation of change in health-related quality of life among older adults. Clin Rehabil. 2010, 24 (11): 1036-1044. 10.1177/0269215510371422.PubMed
47.
Kearney RS, Achten J, Lamb SE, Plant C, Costa ML: A systematic review of patient-reported outcome measures used to assess Achilles tendon rupture management: What's being used and should we be using it?. Br J Sports Med. 2011
48.
Mishoe SC, Maclean JR: Assessment of health-related quality of life. Respir Care. 2001, 46 (11): 1236-1257.PubMed
49.
Dawson J, Doll H, Fitzpatrick R, Jenkinson C, Carr AJ: The routine use of patient reported outcome measures in healthcare settings. BMJ. 2010, 340: c186-10.1136/bmj.c186.PubMed
50.
Clancy CM, Eisenberg JM: Outcomes research: measuring the end results of health care. Science. 1998, 282 (5387): 245-PubMed
51.
Anouchi YS, McShane M, Kelly F, Elting J, Stiehl J: Range of motion in total knee replacement. Clin Orthop Relat Res. 1996, 331: 87-PubMed
52.
Fife RS, Brandt KD, Braunstein EM, Katz BP, Shelbourne KD, Kalasinski LA, Ryan S: Relationship between arthroscopic evidence of cartilage damage and radiographic evidence of joint space narrowing in early osteoarthritis of the knee. Arthritis Rheum. 1991, 34 (4): 377-382. 10.1002/art.1780340402.PubMed
53.
Deyo RA, Battie M, Beurskens A, Bombardier C, Croft P, Koes B, Malmivaara A, Roland M, Von Korff M, Waddell G: Outcome measures for low back pain research: a proposal for standardized use. Spine. 1998, 23 (18): 2003-10.1097/00007632-199809150-00018.PubMed
54.
Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HC: The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010, 63 (7): 737-745. 10.1016/j.jclinepi.2010.02.006.PubMed
55.
Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HC: The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010, 19 (4): 539-549. 10.1007/s11136-010-9606-8.PubMedPubMedCentral
56.
Lin CW, Moseley AM, Refshauge KM: Effects of rehabilitation after ankle fracture: a Cochrane systematic review. Eur J Phys Rehabil Med. 2009, 45 (3): 431-441.PubMed
57.
Mazur JM, Schwartz E, Simon SR: Ankle arthrodesis Long-term follow-up with gait analysis. J Bone Joint Surg Am. 1979, 61 (7): 964-975.PubMed
58.
Wetzler M, Whitelaw G, Lee P: The post-operative management of ankle fractures with pneumatic braces versus short leg cast. Orthop Trans. 1991, 15: 719-
59.
DiStasio AJ, Jaggears FR, DePasquale LV, Frassica FJ, Turen CH: Protected early motion versus cast immobilization in postoperative management of ankle fractures. Contemp Orthop. 1994, 29 (4): 273-277.PubMed
60.
Moseley AM, Herbert RD, Nightingale EJ, Taylor DA, Evans TM, Robertson GJ, Gupta SK, Penn J: Passive stretching does not enhance outcomes in patients with plantarflexion contracture after cast immobilization for ankle fracture: a randomized controlled trial. Arch Phys Med Rehabil. 2005, 86 (6): 1118-1126. 10.1016/j.apmr.2004.11.017.PubMed
61.
Brink O, Staunstrup H, Sommer J: Stable lateral malleolar fractures treated with aircast ankle brace and DonJoy R.O.M.-Walker brace: a prospective randomized study. Foot Ankle Int. 1996, 17 (11): 679-684.PubMed
62.
Finsen V, Saetermo R, Kibsgaard L, Farran K, Engebretsen L, Bolz KD, Benum P: Early postoperative weight-bearing and muscle activity in patients who have a fracture of the ankle. J Bone Joint Surg Am. 1989, 71 (1): 23-27.PubMed
63.
Olerud C, Molander H: A scoring scale for symptom evaluation after ankle fracture. Arch Orthop Trauma Surg. 1984, 103 (3): 190-194. 10.1007/BF00435553.PubMed
64.
Eechaute C, Vaes P, Van Aerschot L, Asman S, Duquet W: The clinimetric qualities of patient-assessed instruments for measuring chronic ankle instability: a systematic review. BMC Musculoskelet Disord. 2007, 8: 6-10.1186/1471-2474-8-6.PubMedPubMedCentral
65.
Binkley JM, Stratford PW, Lott SA, Riddle DL: The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther. 1999, 79 (4): 371-383.PubMed
66.
Stratford PW, Kennedy DM, Hanna SE: Condition-specific Western Ontario McMaster Osteoarthritis Index was not superior to region-specific Lower Extremity Functional Scale at detecting change. J Clin Epidemiol. 2004, 57 (10): 1025-1032. 10.1016/j.jclinepi.2004.03.008.PubMed
67.
Watson CJ, Propps M, Ratner J, Zeigler DL, Horton P, Smith SS: Reliability and responsiveness of the lower extremity functional scale and the anterior knee pain scale in patients with anterior knee pain. J Orthop Sports Phys Ther. 2005, 35 (3): 136-146.PubMed
68.
Lin CW, Moseley AM, Refshauge KM, Bundy AC: The lower extremity functional scale has good clinimetric properties in people with ankle fracture. Phys Ther. 2009, 89 (6): 580-588. 10.2522/ptj.20080290.PubMed
69.
Yeung TS, Wessel J, Stratford P, Macdermid J: Reliability, validity, and responsiveness of the lower extremity functional scale for inpatients of an orthopaedic rehabilitation ward. J Orthop Sports Phys Ther. 2009, 39 (6): 468-477.PubMed
70.
Maykut P, Maykut PS, Morehouse RE, Morehouse R: Beginning qualitative research: A philosophic and practical guide, vol. 6. 1994, Routledge, London, UK
71.
Patton MQ: Qualitative research and evaluation methods. 2002, Sage Publications, Inc, London, UK
72.
Gunn J, Diggens J, Hegarty K, Blashki G: A systematic review of complex system interventions designed to increase recovery from depression in primary care. BMC Health Serv Res. 2006, 6: 88-10.1186/1472-6963-6-88.PubMedPubMedCentral
73.
McPhail S, Haines T: Response shift, recall bias and their effect on measuring change in health-related quality of life amongst older hospital patients. Health Qual Life Outcomes. 2010, 8 (1): 65-10.1186/1477-7525-8-65.PubMedPubMedCentral
Metadata
Title
Life impact of ankle fractures: Qualitative analysis of patient and clinician experiences
Authors
Steven M McPhail
Joel Dunstan
Julie Canning
Terry P Haines
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2012
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-13-224

Other articles of this Issue 1/2012

BMC Musculoskeletal Disorders 1/2012 Go to the issue

Research article

Prevalence of vertebral fractures in a disease activity steered cohort of patients with early active rheumatoid arthritis

Study protocol

Design of the muscles in motion study: a randomized controlled trial to evaluate the efficacy and feasibility of an individually tailored home-based exercise training program for children and adolescents with juvenile dermatomyositis

Research article

Perceived exertion, comfort and working technique in professional computer users and associations with the incidence of neck and upper extremity symptoms

Research article

Sagittal plane gait characteristics in hip osteoarthritis patients with mild to moderate symptoms compared to healthy controls: a cross-sectional study

Research article

Relationship between radiological grading and clinical status in knee osteoarthritis. a multicentric study

Research article

The age- and sex-specific occurrence of bothersome neck pain in the general population – results from the Stockholm public health cohort