{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T11:22:08Z","timestamp":1772364128292,"version":"3.50.1"},"reference-count":35,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T00:00:00Z","timestamp":1669161600000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000659","name":"Research\n                                    Trainees Coordinating Centre","doi-asserted-by":"publisher","award":["PDF-2016-09-056"],"award-info":[{"award-number":["PDF-2016-09-056"]}],"id":[{"id":"10.13039\/501100000659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:sec>\n                        <jats:title>Objective<\/jats:title>\n                        <jats:p>The aim of the Ankle Fracture Treatment: Enhancing Rehabilitation\n                            (AFTER) study, a multicentre external pilot parallel-group randomised\n                            controlled trial (RCT), was to assess feasibility of a definitive trial\n                            comparing rehabilitation approaches after ankle fracture.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                        <jats:title>Setting<\/jats:title>\n                        <jats:p>Five UK National Health Service hospitals.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                        <jats:title>Participants<\/jats:title>\n                        <jats:p>Participants were aged 50 years and over with an ankle fracture\n                            requiring immobilisation for at least 4 weeks.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                        <jats:title>Interventions<\/jats:title>\n                        <jats:p>Participants were allocated 1:1 via a central web-based\n                            randomisation system to: (1) best practice advice (one session of\n                            physiotherapy, up to two optional additional advice sessions) or (2)\n                            progressive exercise (up to six sessions of physiotherapy).<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                        <jats:title>Primary outcome measures<\/jats:title>\n                        <jats:p>Feasibility: (1) participation rate, (2) intervention adherence and\n                            (3) retention.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                        <jats:title>Results<\/jats:title>\n                        <jats:p>Sixty-one of 112 (54%) eligible participants participated, exceeding\n                            progression criteria for participation of 25%. Recruitment progression\n                            criteria was 1.5 participants per site per month and 1.4 was observed.\n                            At least one intervention session was delivered for 28\/30 (93%) of best\n                            practice advice and 28\/31 (90%) of progressive exercise participants,\n                            exceeding the 85% progression criteria. For those providing follow-up\n                            data, the proportion of participants reporting performance of home\n                            exercises in the best practice advice and the progressive exercise\n                            groups at 3\u2009months was 20\/23 (87%) and 21\/25 (84%), respectively. Mean\n                            time from injury to starting physiotherapy was 74.1\u2009days (95%\u2009CI 53.9 to\n                            94.1\u2009days) for the best practice advice and 72.7\u2009days (95%\u2009CI 54.7 to\n                            88.9) for the progressive exercise group. Follow-up rate (6-month Olerud\n                            and Molander Ankle Score) was 28\/30 (93%) for the best practice advice\n                            group and 26\/31 (84%) in the progressive exercise group with an overall\n                            follow-up rate of 89%.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                        <jats:title>Conclusions<\/jats:title>\n                        <jats:p>This pilot RCT demonstrated that a definitive trial would be\n                            feasible. The main issues to address for a definitive trial are\n                            intervention modifications to enable earlier provision of rehabilitation\n                            and ensuring similar rates of follow-up in each group.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                        <jats:title>Trial registration number<\/jats:title>\n                        <jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" specific-use=\"clinicaltrial\" xlink:href=\"ISRCTN16612336\">ISRCTN16612336<\/jats:ext-link>.<\/jats:p>\n                    <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-059235","type":"journal-article","created":{"date-parts":[[2023,2,26]],"date-time":"2023-02-26T05:38:57Z","timestamp":1677389937000},"page":"e059235","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Progressive exercise versus best practice advice for adults aged 50 years\n                        or over after ankle fracture: the AFTER pilot randomised controlled\n                        trial"],"prefix":"10.1136","volume":"12","clinical-trial-number":[{"clinical-trial-number":"nct16612336","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7249-6496","authenticated-orcid":false,"given":"David J","family":"Keene","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew 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