Telerehabilitation in Patients With Ankle Fracture

Patients will be selected from the pelvic limb consultation, they will be invited to go to the tele-rehabilitation module where they will be taught the rehabilitation program that they must carry out, as well as written information about the program. Once the teaching is finished, they will be asked if they have any questions to clarify them. Once the teaching is finished, they will be followed up through the Moodle platform to see their clinical evolution and identify the date of their discharge from work. Later, this group will be compared with the patients who carried out their rehabilitation treatment in the usual way.

Randomization Randomization will be carried out through a software-based randomization program. The assignment will be done by balanced random blocks, block size 8, with an assignment ratio of 1:1. The recruitment of participants, the assignment of participants to the interventions and the evaluations will be carried out by medical evaluators.

Blinding of subjects, therapists and evaluators: Due to the nature of the intervention, it is not possible to blind participants and therapists. The statistical analysis will be performed in a blinded manner, only the treatment will be mentioned as Group A or Group B.

Data quality: Several strategies will be implemented to ensure data quality. All procedures will be adjusted with the standard operating procedures of the North Physical Medicine and Rehabilitation Unit. Evaluators and treating physiotherapists will receive appropriate training before working. Compliance with the intervention follow-up will be closely monitored by a research associate in the Physical Medicine and Rehabilitation Unit and on the platform. Forms and data processing will be periodically reviewed for accuracy. All data entry will be double-checked for accuracy.

Intervention Experimental group: Tele-Rehabilitation Group (Online Exercise and Counseling) Conceptual definition: Rehabilitation service that is provided remotely through information and communication technologies. In this case it will be carried out online through the Moodle platform.

Operational definition: The Moodle application will be installed on their mobile phone to access the online content that will be integrated into three modules: 1) Information module on the disease and self-care, 2) Exercise module (stretching, strengthening and proprioception), 3) Phased walking module. These will be integrated with video and text. The exercise program is based on the recommendations of national and international clinical practice guidelines, which lasts 4 weeks.

Participants will also be provided with written exercise material and a physical activity diary to assess adherence to treatment.

Control Group: Exercise supervised by the physiotherapist and advice Conceptual definition: Rehabilitation program that is carried out in person. Operational Definition: The rehabilitation program will be conducted in person at the relevant Department of Physical Medicine and Rehabilitation. The program will be carried out by a physiotherapist and the patient will be taught: Information about the disease and self-care, Exercise module (stretching, strengthening and proprioception), gait re-education in phases. During the rehabilitation program, the physiotherapist can use physical means such as ultrasound, laser or interferential currents. The rehabilitation program is similar to the telerehabilitation program with a duration of 4 weeks.

Likewise, written exercise material will be provided to participants and a physical activity diary to evaluate adherence to treatment.

Statistical analysis

Descriptive statistics: qualitative variables will be summarized in absolute and relative frequencies, quantitative variables will be summarized in measures of central tendency and dispersion, if they meet the normality criterion, mean and standard deviation will be used. If they do not meet the assumption, median and interquartile ranges will be used.

Inferential statistics: For the comparison of the dependent variables between the telerehabilitation group and the traditional rehabilitation group, at the end of the study, the Student t test will be used for independent samples.

Likewise, to assess the evolution of the dependent variables in the same group, the Kruskal Wallis test will be used.

In order to identify possible confounding variables, the clinical and demographic characteristics of both groups will be compared. The Student t test will be used to compare quantitative variables and the CHi2 test will be used to compare qualitative variables. If there is a difference in any of the variables, a multivariate model will be entered to adjust the effectiveness of the intervention. A value of p< 0.05 will be considered statistically significant. All analyses will be performed on an intention-to-treat basis using the SPSS statistical program version 20.

Blind analysis Statistical analysis will be performed by a statistician who will be blinded to group assignment by dummy coding the group names. The remaining project staff and the patient will not be blinded.

Dealing with missing data It is anticipated that missing data will be 'random'. After considering the amount and distribution of data, the likely approach will be to use multiple imputation to impute missing data for the primary outcomes. The data will be used for imputation. The researchers did not plan to impute missing data for any of the secondary outcomes or endpoints

Sample size calculation

The researchers determined the sample size based on the design of a two-group randomized trial to evaluate independent means (two-sided comparison). With an alpha level of 0.05, 80% power, an expected difference of 7 points on the FFI between the groups, and a standard deviation of 16 points, the initial requirement was 97 participants per group. After adjusting for an anticipated dropout rate of 15%, the final recruitment target was set at 100 participants per group, for a total of 200 subjects.