Rehabilitation Strategies to Improve Outcomes For Patients With a Lower Extremity Fracture

Inclusion Criteria: * Ability to read and speak English * Acute orthopedic injury to the femoral or tibial shaft requiring surgical fixation with an intramedullary rod * Age 18-50 years of age Exclusion Criteria: * History of chronic pain defined as pain lasting more than 3 months and bothersome at least half the days over the past 6 months that started before the fracture * Moderate or severe traumatic brain injury * Initial treatment requiring amputation * Not employed at the time of the accident at least 20 hours per week. * Spinal cord injury * History of schizophrenia, dementia or neurologic disorder with peripheral dysfunction * Non ambulatory or limited ability to walk without an assistive device prior to the fracture * Multiple trauma that prevents early weight bearing * Current Pregnancy * Unable to participate in or complete in-person follow-up visits or therapy sessions * In outpatient Physical Therapy at the start of the intervention * Use of an assistive device to walk for community ambulation at the 10-12 weeks post hospital discharge time point