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J Rehabil Med. 2008 Jun;40(6):433-9. doi: 10.2340/16501977-0187.

Manual therapy in addition to physiotherapy does not improve clinical or economic outcomes after ankle fracture.

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Centre for Evidence-Based Physiotherapy, The University of Sydney, Lidcombe, NSW 1825, Australia.



The primary aim of this study was to determine the effectiveness and cost-effectiveness of adding manual therapy to a physiotherapy programme for ankle fracture.


Assessor-blinded randomized controlled trial.


Ninety-four adults were recruited within one week of cast removal for isolated ankle fracture. Inclusion criteria were: they were able to weight-bear as tolerated or partial weight-bear, were referred for physiotherapy, and experienced pain. Ninety-one participants completed the study.


Participants were randomly allocated to receive manual therapy (anterior-posterior joint mobilization over the talus) plus a standard physiotherapy programme (experimental), or the standard physiotherapy programme only (control). They were assessed by a blinded assessor at baseline, and at 4, 12 and 24 weeks. The main outcomes were activity limitation and quality of life. Information on costs and healthcare utilization was collected every 4 weeks up to 24 weeks.


There were no clinically worthwhile differences in activity limitation or quality of life between groups at any time-point. There was also no between-group difference in quality-adjusted life-years, but the experimental group incurred higher out-of-pocket costs (mean between-group difference = AU$200, 95% confidence interval 26-432).


When provided in addition to a physiotherapy programme, manual therapy did not enhance outcome in adults after ankle fracture.

[Indexed for MEDLINE]
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