Telerehabilitation lowers costs without worse recovery
Home-based telerehabilitation after ankle fixation achieved similar functional recovery to in-person therapy while lowering short-term costs.
*Noninferiority randomized controlled trial; Level 1b (OCEBM).

Citation

Wu T, Wang R, Chen Y, et al. Telerehabilitation for Patients After Open Reduction and Internal Fixation for Ankle Fracture: A Noninferiority Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation. 2026;107:703–714. doi:10.1016/j.apmr.2025.10.024

Background

Rehabilitation after surgical fixation of an ankle fracture is important for regaining motion and function, but frequent clinic visits can be difficult. Remote, coached home programs may improve access and reduce costs.

Patients

468 adults (18–60 years) in China after surgery for an acute, isolated ankle fracture. Excluded: prior surgery on the injured ankle, severe muscle-and-bone disorders, or lower-limb malformations. Required regular access to a smart device.

Intervention

12-week home-based telerehabilitation with tablet video instruction and remote coaching.

Control

12-week standard face-to-face rehabilitation with a physical therapist.

Outcome

Ankle function, health-related quality of life, and 12-week costs per patient.

Follow-up Period

24 weeks after discharge (costs collected through 12 weeks).

Results

Finding Result
Total 12-week cost per patient Telerehabilitation lower by 10,679 Chinese Yuan (57,378 vs 68,057); ~15% reduction
Quality-of-life index at 24 weeks Higher with telerehabilitation: adjusted difference +0.016 (95% CI 0.005 to 0.026)
Self-rated health scale at 6 weeks Lower with telerehabilitation: adjusted difference −0.541 (95% CI −0.864 to −0.219)
Notes: “Quality-of-life index” was measured with the EuroQol 5-Dimension 5-Level tool. Main ankle function score showed no meaningful differences at 6, 12, or 24 weeks.
Analyses included intention-to-treat and per-protocol approaches; results were similar. This was a noninferiority trial.

Limitations

Single-center study in China and limited to patients comfortable with technology, which may reduce generalizability. Pre-injury health was recalled, risking bias. Costs were measured only to 12 weeks, so longer-term cost impact is uncertain.

Funding

Equipment support from a local clinic; no other funding reported.

Clinical Application

For eligible post-surgery ankle fracture patients, consider telerehabilitation to reduce costs without sacrificing recovery; monitor early perceived health and provide extra support as needed.