Original ReportsHow Knowledge Relates to Confidence in Orthopedics and Emergency Medicine Regarding Return to Sport and Rehabilitation in Foot and Ankle Trauma
Introduction
Patients who have sustained foot and ankle trauma are usually managed by consultants and trainees in emergency medicine and orthopedics, with their rehabilitation managed by physiotherapists. Many patients are involved in sports at a variety of levels and are often keen to be given guidance on the likely course and timescale of their rehabilitation back to their preinjury level of participation. Previous work on physician perceptions of sports injury and rehabilitation knowledge found, in a survey of emergency medicine consultants and specialty trainees, that 100% of them felt that they should know and understand the prognosis of common sporting injuries, and 95% agreed that they should understand the principles of rehabilitation after injury.1 A study by Murphy et al.2 found that emergency department staff would benefit from increased training in sports injury management. Despite this, there is very little time afforded to sports injury or rehabilitation in either the emergency medicine or orthopedic curricula.
The aim of this study was to survey knowledge of rehabilitation in several groups of health care professionals and compare this to self-reported confidence. We reviewed the current state of knowledge regarding rehabilitation following lateral ankle ligament injury, bimalleolar ankle fracture, fifth metatarsal fracture, navicular stress fracture, and tendoachilles rupture, and created 5 clinical scenarios covering these common conditions and used an online survey to gather information on health care professionalsʼ knowledge and confidence in providing guidance on these areas.
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Questionnaire Design
The questionnaire was created in conjunction with a consultant foot and ankle surgeon with input from extended scope practitioners (ESPs) in foot and ankle, using the current orthopedic and sports medicine literature, to produce a combination of open and closed questions based on clinical scenarios, on return to sport, and rehabilitation principles. The 5 scenarios used were related to (1) bimalleolar ankle fracture, (2) fifth metatarsal fracture, (3) lateral ankle ligament injury, (4)
Results
There were 102 survey participants including 11 emergency medicine registrars (two year-1, four year-2, two year-3, one year-4, and two year-6), 11 trauma and orthopedics registrars (three year-1, two year-2, three year-3, two year-4, and one year-6), 13 senior physiotherapists, 9 junior physiotherapists, 10 emergency medicine consultants, 16 orthopedics consultants (from specialties other than foot and ankle), 13 consultant foot and ankle surgeons, 9 ESPs in foot and ankle, and 10 ESPs in
Discussion
There is very little information currently available in the literature regarding patient expectations following foot and ankle trauma. A Canadian study demonstrated good overall patient satisfaction with physician discharge information but does not address how physician knowledge influences this and does not specifically address advice on rehabilitation.6 There are several validated patient expectation scales currently in use in orthopedics; however, these were designed and validated for use in
Conclusions
A trend for greater knowledge of rehabilitation from sports injuries to the foot and ankle was found among consultants in orthopedics and extended scope physiotherapy practitioners in comparison to orthopedic and emergency medicine registrars as well as more junior physiotherapists. The most significant area of gaps in knowledge among the 2 groups of registrars was in the specifics of rehabilitation programs. There was a markedly higher confidence with greater seniority that correlated poorly
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