Evidence map›Paper›PMID 38216176›Full record

Trial reportBMJ open2024

Use of removable support boot versus cast for early mobilisation after ankle fracture surgery: cost-effectiveness analysis and qualitative findings of the Ankle Recovery Trial (ART).

Petra Baji, Estela C Barbosa, Vanessa Heaslip, Bob Sangar, Lee Tbaily, Rachel Martin, Sharon Docherty, Helen Allen, Christopher Hayward, Elsa M R Marques

Open access · goldAbstract readRandomized Controlled TrialMulticenter StudyPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 3 pooled it
1.9field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 3 syntheses or guidelines pooled it, 4 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Review
  5. Review
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 5 institutions in 2 countries.

Petra Baji *Musculoskeletal Research Unit, Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, UK petra.baji@bristol.ac.uk.ORCID 0000-0003-2899-8557
Estela C Barbosa *Musculoskeletal Research Unit, Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, UK.ORCID 0000-0001-8282-131X
Vanessa HeaslipSchool of Nursing and Society, University of Salford, Salford, UK.ORCID 0000-0003-2037-4002
Bob SangarUniversity Hospitals Dorset NHS Foundation Trust, Poole, UK.
Lee TbailyUniversity Hospitals Dorset NHS Foundation Trust, Poole, UK.ORCID 0000-0003-4203-480X
Rachel MartinUniversity Hospitals Dorset NHS Foundation Trust, Poole, UK.
Sharon DochertyDepartment of Medical Science and Public Health, Bournemouth University, Poole, UK.ORCID 0000-0003-3209-1560
Helen AllenBournemouth University Clinical Research Unit, Bournemouth University, Poole, UK.
Christopher HaywardPeninsula Clinical Trials Unit, Plymouth University, Plymouth, UK.ORCID 0000-0002-2666-5073
Elsa M R MarquesMusculoskeletal Research Unit, Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, UK.ORCID 0000-0003-1360-5677
Poole Hospital · GBUniversity of Bristol · GBBournemouth University · GBUniversity of Exeter · GBUniversity of Salford · GB

Funding

Wellcome Trust
6 · The paper itself

Abstract

objectivesTo estimate the cost-effectiveness of using a removable boot versus a cast following ankle fracture from the National Health Service and Personal Social Services (NHS+PSS) payer and societal perspectives and explore the impact of both treatments on participants' activities of daily living.

designCost-effectiveness analyses and qualitative interviews performed alongside a pragmatic multicentre randomised controlled trial.

settingEight UK NHS secondary care trusts.

participants243 participants (60.5% female, on average 48.2 years of age (SD 16.4)) with ankle fracture. Qualitative interviews with 16 participants. Interventions removable air boot versus plaster cast 2 weeks after surgery weight bearing as able with group-specific exercises. PRIMARY AND SECONDARY OUTCOME MEASURES: Quality-adjusted life years (QALYs) estimated from the EQ-5D-5L questionnaire, costs and incremental net monetary benefit statistics measured 12 weeks after surgery, for a society willing-to-pay £20 000 per QALY.

resultsCare in the boot group cost, on average, £88 (95% CI £22 to £155) per patient more than in the plaster group from the NHS+PSS perspective. When including all societal costs, the boot saved, on average, £676 per patient (95% CI -£337 to £1689). Although there was no evidence of a QALY difference between the groups (-0.0020 (95% CI -0.0067 to 0.0026)), the qualitative findings suggest participants felt the boot enhanced their quality of life. Patients in the boot felt more independent and empowered to take on family responsibilities and social activities.

conclusionsWhile the removable boot is slightly more expensive than plaster cast for the NHS+PSS payer at 12 weeks after surgery, it reduces productivity losses and the need for informal care while empowering patients. Given that differences in QALYs and costs to the NHS are small, the decision to use a boot or plaster following ankle surgery could be left to patients' and clinicians' preferences. TRIAL REGISTRATION NUMBER: ISRCTN15497399, South Central-Hampshire A Research Ethics Committee (reference 14/SC/1409).

Indexed as

AnkleAnkle FracturesActivities of Daily LivingCost-Benefit AnalysisCost-Effectiveness AnalysisEarly AmbulationFemaleHumansMaleQuality-Adjusted Life YearsQuality of LifeState Medicineclinical trialfoot & anklehealth economics

Identifiers

PMID38216176
PMCPMC10810042
OpenAlexW4390830313

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.