OBJECTIVE: To determine the efficacy and cost-effectiveness of telerehabilitation compared to face-to-face rehabilitation for patients after open reduction and internal fixation (ORIF) for ankle fractures. DESIGN: A randomized controlled trial was conducted. SETTING: The trial was conducted at the largest trauma center in Shanghai. PARTICIPANTS: A total of 468 patients who underwent ORIF for ankle fractures participated in the study. Participants were randomly assigned to either the telerehabilitation group (TELE group) or the face-to-face rehabilitation group (PT group), with 234 patients in each group. INTERVENTIONS: The TELE group received a 12-week home-based rehabilitation program, which included video instructions on a tablet and remote coaching. The PT group received standard face-to-face rehabilitation with the assistance of a physical therapist for 12 weeks. MAIN OUTCOME MEASURES: Effectiveness was measured using the Olerud and Molander Ankle Score (OMAS) and the EQ-5D-5L, with assessments at baseline, 12 weeks, and 24 weeks postoperatively. The incremental cost-effectiveness ratio (ICER) was calculated using bootstrapping methods. RESULTS: At the 12-week follow-up, the difference in OMAS scores between the TELE and PT groups was negligible, with a coefficient of -0.477 (p = 0.086). At 24 weeks post-surgery, the OMAS difference was -0.050 (p = 0.857). The EQ-5D-5L Utility score had a coefficient of -0.008 (p = 0.146), and the EQ-5D-5L VAS score showed a coefficient of 0.312 (p = 0.058) at 12 weeks, indicating no significant difference between the groups at 12 weeks. Total 12-week costs per patient were 15% lower in the TELE group compared to the PT group. CONCLUSION: Telerehabilitation for patients following ORIF for ankle fracture was found to be cost-effective, with no significant difference in clinical outcomes compared to face-to-face rehabilitation.

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