Short Attention Span Summary
Myth – Ankle PT works.
I have always told patients that they need to do exercises after ankle sprain to avoid repeat injury. Turns out, it didn’t help recovery, according to this RCT. They found that the group that got usual care instructions, namely “protection, rest, cryotherapy, compression, elevation, and graduated weight bearing activities,” vs. usual care plus a supervised program of physical therapy were no different at 3 months (the primary outcome) or at any other time measured in the study. All enrolled were minor grade 1 or 2 sprains. So this may not apply to more severe injuries. Take this single study with a grain of salt. A recent meta-analysis concluded ankle PT may help.
Ankle PT after a mild sprain may not be helpful in making an excellent recovery. Journal Watch covered this article.
BMJ. 2016 Nov 16;355:i5650. doi: 10.1136/bmj.i5650.
1Queen’s University Department of Emergency Medicine, Kingston, ON, Canada.
2Kingston General Hospital Research Institute, Kingston, ON, Canada.
3Queen’s University Department of Public Health Sciences, Kingston, ON, Canada.
4Queen’s University School of Rehabilitation Therapy, Kingston, ON, Canada.
5The Human Mobility Research Centre, Kingston General Hospital and Queen’s University, Kingston, ON, Canada.
6Queen’s University Division of Orthopaedics, Kingston, ON, Canada.
To assess the efficacy of a programme of supervised physiotherapy on the recovery of simple grade 1 and 2 ankle sprains.
A randomised controlled trial of 503 participants followed for six months.
Participants were recruited from two tertiary acute care settings in Kingston, ON, Canada.
The broad inclusion criteria were patients aged ≥16 presenting for acute medical assessment and treatment of a simple grade 1 or 2 ankle sprain. Exclusions were patients with multiple injuries, other conditions limiting mobility, and ankle injuries that required immobilisation and those unable to accommodate the time intensive study protocol.
Participants received either usual care, consisting of written instructions regarding protection, rest, cryotherapy, compression, elevation, and graduated weight bearing activities, or usual care enhanced with a supervised programme of physiotherapy.
MAIN OUTCOME MEASURES:
The primary outcome of efficacy was the proportion of participants reporting excellent recovery assessed with the foot and ankle outcome score (FAOS). Excellent recovery was defined as a score ≥450/500 at three months. A difference of at least 15% increase in the absolute proportion of participants with excellent recovery was deemed clinically important. Secondary analyses included the assessment of excellent recovery at one and six months; change from baseline using continuous scores at one, three, and six months; and clinical and biomechanical measures of ankle function, assessed at one, three, and six months.
The absolute proportion of patients achieving excellent recovery at three months was not significantly different between the physiotherapy (98/229, 43%) and usual care (79/214, 37%) arms (absolute difference 6%, 95% confidence interval -3% to 15%). The observed trend towards benefit with physiotherapy did not increase in the per protocol analysis and was in the opposite direction by six months. These trends remained similar and were never statistically or clinically important when the FAOS was analysed as a continuous change score.
In a general population of patients seeking hospital based acute care for simple ankle sprains, there is no evidence to support a clinically important improvement in outcome with the addition of supervised physiotherapy to usual care, as provided in this protocol.Trial registration ISRCTN 74033088 (www.isrctn.com/ISRCTN74033088).
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
PMID: 27852621 [PubMed – in process]