Effect of Severe Distal Tibia, Ankle, and Mid- to Hindfoot Trauma on Meeting Physical Activity Guidelines 18 Months After Injury.

This was an observational study, so it cannot show that depression, sex, race, or ethnicity caused lower activity. Physical activity was self-reported and may have recall bias or overestimate minutes. Some moderate activities were household work or employment, not the leisure activities the questionnaire was intended to capture. The analysis used only 328 of 478 limb reconstruction participants because of missing data. Those with missing data were younger, less educated, less likely to be readmitted, less likely to have depressive symptoms, and more likely to have PTSD, which may bias the estimates. Because missing-data patients had lower depression rates, the true proportion meeting guidelines after injury may be higher than reported. Early predictors were used, so time-varying relationships closer to 18 months were not identified. Other factors such as fear of movement, pain catastrophizing, and resilience were not measured. Results may not generalize to injuries proximal to the ankle, older patients, or patients treated with amputation. The study did not test whether treating depression or changing rehabilitation increases activity.

The supplied text does not include an author conflict-of-interest declaration. The publication types list research support from the U.S. government, NIH extramural, and non-PHS funding.

Do not read these associations as proof that treating depression, or changing rehabilitation, will increase activity. This was an observational study of self-reported activity after injury, and it did not test a treatment.