Co-design of a novel rehabilitation intervention for patients after ankle fracture surgery: establishing healthcare professional consensus.

Abstract

Post-surgical rehabilitation advice after ankle fracture surgery, particularly regarding weight-bearing, varies significantly, leading to patient frustration and inconsistent recovery outcomes. This study aimed to establish a consensus for ankle fracture rehabilitation advice and identify content and implementation options for future interventions through consultation with healthcare professionals (HCPs). This study was part of the weight-bearing in ankle fractures (WAX) trial, a multicentre, randomised controlled trial. Using the behaviour change wheel (BCW) framework, three online workshops with HCPs were conducted between April 25, 2022, to May 4, 2022, to generate consensus on rehabilitation interventions. Participants completed pre-workshop tasks, and data were collected using an adapted nominal group technique (NGT). Workshop data were collated to create a survey with indicative statements about rehabilitation preferences. An online survey was subsequently disseminated to surgeons and physiotherapists between May 5, 2022, and July 13, 2022. Respondents were asked to indicate how strongly they agreed with various statements by ranking statements on a 5-point Likert scale from "strongly disagree" to "strongly agree"; 75% was used as a threshold for consensus agreement. Eight HCPs participated in the workshops, and 79 HCPs responded to the survey, representing 38 different NHS hospital trusts. Consensus was achieved on several key aspects: Patients could rest their foot on the floor while seated during non-weight-bearing periods and gradually increase weight-bearing based on comfort. It was agreed that orthotic boots are for comfort, and patients can discontinue use as early as two weeks post-operatively if weight-bearing is permitted. Guidelines for wound management, including when to get wounds wet and how to handle numbness, were also established. This study established a consensus for ankle fracture rehabilitation, emphasising patient autonomy and clear, standardised advice. The findings support the development of a tailored, patient-centred rehabilitation interventions, potentially delivered through digital platforms, to enhance recovery outcomes.