Co-design of a novel rehabilitation intervention for patients after ankle fracture surgery: the patient perspective.

Purpose: Effective rehabilitation following ankle fracture surgery is essential for optimal recovery and patient satisfaction. However, traditional rehabilitation strategies often lack personalisation, leading to suboptimal outcomes. This study aimed to co-design a rehabilitation package, collaborating directly with patients, to understand their individual needs, using the Behaviour Change Wheel (BCW) framework.

Methods: Integrated within the larger weight-bearing in ankle fractures (WAX) trial, this study employed the BCW to understand behaviour, intervention options and content implementation. Nominal Group Technique was used to facilitate a workshop with 10 ankle fracture patients, and subsequent surveys were used to gather and prioritise rehabilitation needs and strategies. Participants were aged between 28 and 69, and nine (90%) were female, with representation from seven different NHS hospital trusts. Two experienced patient representatives facilitated the workshop.

Results: Rehabilitation strategies were developed focussing on interventions that included education, training, environmental restructuring, persuasion and enablement, delivered through an app or website. Survey results indicated high patient enthusiasm for structured, accessible rehabilitation support, including instructional videos, live chats with physiotherapists and peer support forums. Patients desired advice on returning to hobbies and life roles, and particularly returning to driving, bathing and work.

Conclusion: The BCW framework facilitated the development of a patient-centred rehabilitation package, highlighting the importance of tailored, accessible interventions. Patients expressed strong support for the proposed strategies, suggesting potential for improved rehabilitation outcomes through personalised, digitally delivered support. These components will be used to co-design future rehabilitation interventions.