Efficacy and Clinical Feasibility of the Ankle Muscle Power (AMP) Program for Return to Duty After an Ankle Fracture

Adherence refers to the commitment of a participant to participate in the rehab. Adherence will be measured by calculating the number of rehab sessions attended divided by the number of rehab sessions possible.

Fidelity refers to the ability to perform the protocol as intended and that the participants receive the intended treatment as designed. It will be calculated as the number of deviations from protocol divided by the number of treatment sessions.

This will be calculated as the number of participants completing each intervention divided by the number of participants who start each intervention.

A participant satisfaction survey will be utilized to evaluate each rehabilitation protocol, care given, and rehab facility procedures. Scores will range from 1 to 5 with 1 indicating poor performance of the facility and care received versus 5 indicating excellent performance of the facility and care received.

Will be assessed isotonically on a dynamometer as the change in peak power from baseline to post-intervention follow-up

Will be assessed isometrically on a dynamometer as the change between baseline and post-intervention follow-up. Ankle RTD is calculated as the initial slope of the generated force curve, measured in Newton meters per second.

Ankle joint power measured with 3D motion capture during walking

Ankle joint power measured with 3D motion capture while climbing stairs

Participants will walk at a pace that feels normal for the participant with the time to complete 5 meters recorded.

Participants will walk at their fastest comfortable speed with the time to complete 5 meters recored.

The stair test is a measurement of functional strength, balance, and agility achieved by ascending and descending a specific number of steps (11). Scoring involves recording the total time taken to ascend and descend the steps to the nearest 100th of a second. Lower values indicate better performance.

The Ankle Fracture Outcome of Rehabilitation Measure (A-FORM) is a patient-reported outcome measure designed to assess recovery after an ankle fracture. It focuses on physical, social, and psychological aspects of recovery. A summary score (ranging from 0 to 100) is calculated, with lower scores indicating better outcomes.

The PROMIS Physical Function computer adaptive test will be administered to each subject. Scale 0-100, where higher numbers indicate better physical functioning. A score of 50 is consistent with the mean score of the U.S. general population.

This patient reported outcome measures assesses pain severity and interference. Scores range from 0-10 for each subscale of pain/severity or interference/impact with higher scores indicating greater pain severity and impact of pain. Scores can be compared to norms to determine if pain is considered significant.

A patient reported outcome measures that assesses fear of movement due to pain. The full TSK (17-item) yields a total score between 17 and 68, where higher scores indicate greater kinesiophobia.

The cross sectional area of the gastrocnemius muscle will be evaluated using ultrasound imaging. The area of the muscle will be measured in cm squared.

A patient reported outcome measures that assesses impairments in work productivity following an injury. The WPAI questionnaire yields four scores; absenteeism, presenteeism, overall work impairment, and activity impairment which are expressed as percentages. Absenteeism is calculated as hours missed divided by total hours available for work. Presenteeism is derived from the 0-10 scale measuring health's impact on productivity while working. Overall work impairment combines both, and activity impairment measures health's effect on non-work tasks. Higher percentage scores indicate greater impairment and reduced productivity.

A summary score (ranging from 0 to 100) is calculated, with lower scores indicating better outcomes. The Ankle Fracture Outcome of Rehabilitation Measure (A-FORM) is a patient-reported outcome measure designed to assess recovery after an ankle fracture. It focuses on physical, social, and psychological aspects of recovery.

Participants will walk at their fastest comfortable speed with the time to complete 5 meters recorded.

Participants will walk at a pace that feels normal for the participant with the time to complete 5 meters recorded.

The stair test is a measurement of functional strength, balance, and agility achieved by ascending and descending a specific number of steps. Scoring involves recording the total time taken to ascend and descend the steps to the nearest 100th of a second. Lower values indicate better performance.

Will be assessed isotonically on a dynamometer as the peak power.

Will be assessed isometrically on a dynamometer as the slope of the generated force curve. It is the peak rate of force development measured in Newton meters per second.

The AOFAS Ankle-Hindfoot Scale is a short survey and exam that looks at ankle and foot problems. It measures three main things: pain, how well a person can move and do daily activities, and how well the ankle and foot are lined up. The score goes from 0 to 100, with higher scores meaning less pain and better function. It helps doctors and researchers track recovery and compare treatments.