| Summary: | <p>For as long as orthopaedic surgeons have treated patients with ankle fractures, surgical dogma has enforced weight bearing restrictions on patients postoperatively.</p>
<p>These restrictions have perpetuated patients’ fear of pain, falls and re-injury, with subsequent muscle wasting, stiffness and delayed return to work and hobbies. This thesis explored the behavioural influences which underpin this delayed return to weight-bearing and established the components of ankle fracture rehabilitation requiring advancement.</p>
<p>Firstly, a systematic review found that existing rehabilitation interventions to improve ankle fracture recovery lack a theoretical grounding. Some interventions employed “Education” and “Training” techniques, but few attempted to modify underlying beliefs and behaviour to improve adherence and engagement with recovery.</p>
<p>An exploratory analysis built on previous research in the upper limb, finding association between unhelpful pain beliefs and worse medium-term patient-reported outcomes after ankle fracture surgery.</p>
<p>The gaps, inconsistencies and needs in rehabilitation were explored through interviews with patients recovering from ankle fracture surgery and healthcare professionals who treat them. Patient anxieties, uncertainties, and variable quality interactions with healthcare professionals were among many deficiencies identified and targeted during subsequent intervention design.</p>
<p>The components of a novel rehabilitation package were developed and prioritised through a series of online workshops and surveys. The findings were triangulated to establish theoretically congruent behaviour-change interventions. Surprisingly, the uncertainties and desires of patients were relatively simple. A small amount of information around swelling, weight-bearing and managing pain could be delivered with minimal additional healthcare professional resource.</p>
<p>Overall, this thesis challenges the dogma of weight-bearing restrictions and rehabilitation methods after ankle fracture surgery. It proposes methods for patients to self-manage their recovery, while highlighting some remaining barriers to implementation.</p>
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