Hadaya Mosaad Eladl ^1,2 Dalia Mahmoud Abdelmonem Elsherbini ^3* Radwa T. Elshorbagy ^1,4 Ateya Megahed Ibrahim ^5,6 Mohamed El-Sherbiny ⁷ Sherief El-Sayed Abd El-Farrag Ibrahim ⁸ Ghada Ibrahim Fahmi Elfayoumi ⁸ Moutasem Salih Aboonq ⁹ Yasser M Elbastawisy ^10,11 Nesma M. Allam ^1,2

• ¹ Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
• ² Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Beni Suef, Egypt
• ³ Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
• ⁴ Department of Physical Therapy for Musculoskeletal Disorders and Their Surgeries, Faculty of Physical Therapy, Cairo University, Giza, Beni Suef, Egypt
• ⁵ College of Nursing, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
• ⁶ Department of Family and Community Health Nursing, Faculty of Nursing, Port Said University, Port Said, Port Said, Egypt
• ⁷ Department of Basic Medical Sciences, College of Medicine, AlMaarefa University, Diriyah, Saudi Arabia
• ⁸ Department of Rheumatology& Rehabilitation, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
• ⁹ Department of Basic Medical Sciences, College of Medicine, Taibah University, Madinah, Al Madinah, Saudi Arabia
• ¹⁰ Department of Basic Medical Sciences, College of Medicine, Al-Rayan Colleges, Al-Madinah, Saudi Arabia
• ¹¹ Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura, Egypt

Background: Incidence of fractures to the ankle joint accounts for 10.2% of all fractures. It has been hypothesized that mobilizing the ankle joint is a crucial intervention for improving balance and range of motion (ROM).Aim: The current study explores the impact of incorporating mobilization, balance, and physical therapy exercise programs into home-based exercises on pain, ROM, health-related quality of life (HRQoL), and peak muscle torque after road traffic accidents (RTAs) related to ankle disability. Methods: In this single-blinded, randomized controlled study, a total of 60 participants with post-RTA ankle disability were randomly allocated into either the experimental group or the control group. The experimental group received home-based exercise, mobilization, balance training, and a physical therapy program for two months, while the control group only received a home exercise program. The intervention was implemented three days/week. Pain was evaluated by visual analogue scale (VAS), ankle ROM by universal goniometer, HRQoL by the Short Form (SF 36) survey, and peak torque by the Biodex System isokinetic dynamometer. Results: There were significant differences in pain, ROM, HRQoL, and peak muscle strength in the experimental group (P < 0.001). After eight weeks of intervention, the outcomes for VAS, ROM of ankle DF/PF, peak torque of DF/PF, and HRQoL physical component summary (PCS) and mental component summary (MCS) were 2.55±0.22, 13.02±0.38, 25.06±0.40, 34.12±0.81, 47.46±0.90, 43.15±0.78, and 45.01±0.68 in the experimental group, and 5.98±0.31, 6.16±0.28, 14.97±0.35, 26.17±0.90, 41.38±0.94, 33.05±1.10, and 34.52±1.06 in the control group, respectively. Conclusion: Adding mobilization and balance exercise to the physical therapy program significantly improved pain, ankle ROM, HRQoL, and muscle torque DF/PF in patients with ankle disability after road traffic accidents.Clinical trial registration: Clinical Trials. gov, NCT06010706.