What question did this study set out to answer?

The study aims to determine how the timing of physical therapy affects fear of falling and functional recovery in elderly patients with ankle fractures.

February 12, 2026Open Access

Impact of physical therapy timing on fear of falling and outcomes in elderly patients with ankle fractures

Key Points

The study aims to determine how the timing of physical therapy affects fear of falling and functional recovery in elderly patients with ankle fractures.
Retrospective cohort study design involving 2,816 elderly patients (≥ 65 years) with ankle fractures.
Patients were divided into early PT (≤ 2 weeks post-operation) and conventional PT (>2 weeks) groups.
Primary outcomes included changes in FES-I and AOFAS scores.
Propensity score matching was utilized to control for confounding variables.
Interaction analysis examined the impact of fracture type (Weber classification).
Early PT group had significantly lower FES-I scores at 12 months compared to conventional PT (P < 0.001).
Higher AOFAS scores were observed in the early PT group (P < 0.001).
Weber type B fractures showed the greatest improvement with early PT (FES-I improvement of 2.8 points and AOFAS gain of 10.0 points; P < 0.001).
Complication rates were similar between early and conventional PT, with lower deep vein thrombosis incidence in the early PT group (P = 0.035).

Abstract

Objective Fear of falling (FOF) after ankle fracture surgery significantly hinders rehabilitation in elderly patients, yet the optimal timing for physical therapy (PT) remains debated. This study examines how PT initiation time affects FOF and functional recovery. Methods In this single-center retrospective cohort study, we analyzed 2,816 patients (aged ≥ 65) with ankle fractures (2014–2023), stratified into early (≤ 2 weeks post-operation) and conventional PT (>2 weeks) groups. Primary outcomes were changes in FES-I and AOFAS scores; secondary outcomes included complication rates and time to resuming daily activities. Propensity score matching controlled for confounders, and interaction analysis assessed the moderating effect of fracture type (Weber classification). Results At 12 months, the early PT group showed significantly lower FES-I scores (median 19 IQR 17–23 vs. 17 IQR 22–27, P < 0.001), and higher AOFAS scores (85.5 78–92 vs. 77 70–86, P < 0.001). Weber type B fractures benefited most, with early PT yielding greater FES-I improvements (2.8-point difference; 95% CI 1.8–3.8, P < 0.001) and AOFAS gains (10.0 points; 95% CI 8.4–11.6, P < 0.001). Complication rates were similar (9.2% early vs. 11.8% conventional, P = 0.078), but early PT had lower deep vein thrombosis incidence (3.5% vs. 5.7%, P = 0.035). Conclusion Early PT significantly reduces FOF and enhances functional recovery, particularly in Weber type B fractures. We recommend individualized PT protocols based on fracture type and bone density. Trial registration Retrospectively registered.

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