Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial.
Abstract: Bleakley CM, O'Connor SR, Tully MA, Rocke LG, MacAuley D, Bradbury I, Keegan S and McDonough SM (2010): Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial BMJ May 10; 340:c1964. doi: 10.1136/bmj.c1964. (Abstract prepared by Stafford Thompson)

Aim: To compare (i) an accelerated rehabilitation protocol with (ii) protection, rest, ice, compression and elevation (PRICE), following a mild to moderate ankle sprain.

Methods: Randomised controlled trial with a blinded assessor. Patients presenting to an accident and emergency and a sports injury clinic with a grade 1 or 2 ankle sprain were randomly assigned into an accelerated rehabilitation group or a PRICE group. The lower extremity functional scale, pain at rest, pain on activity, swelling and physical activity were used as outcome measures at weeks one, two, three and four. The lower extremity functional scale and rate of reinjury were evaluated at 16 weeks.

Results: The accelerated rehabilitation group demonstrated significant improvements in ankle function compared to the PRICE group, both at one and two weeks post-injury. Activity level was significantly higher in the accelerated rehabilitation group as measured by activities such as time spent walking and time spent undertaking light intensity activity. No difference was found between the two groups for pain at rest, pain on activity, or swelling. The re-injury rate was 4% in both groups.

Conclusion: An accelerated rehabilitation programme during the first week post-ankle injury improved ankle function without increasing pain or swelling.
Article Type: Report
Subject: Rehabilitation (Research)
Ankle (Injuries)
Ankle (Diagnosis)
Ankle (Care and treatment)
Ankle (Research)
Authors: Bleakley, C.M.
O'Connor, S.R.
Tully, M.A.
Rocke, L.G.
MacAuley, D.
Bradbury, I.
Keegan, S.
McDonough, S.M.
Pub Date: 11/01/2010
Publication: Name: New Zealand Journal of Physiotherapy Publisher: New Zealand Society of Physiotherapists Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 New Zealand Society of Physiotherapists ISSN: 0303-7193
Issue: Date: Nov, 2010 Source Volume: 38 Source Issue: 3
Topic: Event Code: 310 Science & research
Geographic: Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand
Accession Number: 263880357
Full Text: Commentary

This is a well-conducted study investigating the effect of accelerated rehabilitation on function after ankle sprain. Over a four week period, participants in the intervention group had significant improvements in function as measured by the lower extremity functional scale, without increased pain or swelling. The findings of this study are in line with previous randomised controlled trials that have investigated early functional rehabilitation and therapeutic exercise after lateral ankle sprain (Holme et al 1999; Wester et al 1996).

The clinical implications of this study are relatively straightforward. The importance of early mobilisation and functional rehabilitation following acute injury are concepts that physiotherapists have embraced as part of clinical practice in New Zealand. However, this information may seem counterintuitive to those patients who are experiencing pain and dysfunction following an ankle sprain. In New Zealand, physiotherapists are often the first contact practitioner and so are ideally positioned to assist a patient through this experience, and provide appropriate rehabilitation so that the patient can return to previous levels of activity in a timely fashion. Yet another large group of patients in this country access care following acute ankle injuries through emergency departments or similar medical facilities. In these situations patients present to facilities that are designed and staffed to manage serious injuries, and so potentially, opportunities for early mobilisation, weight bearing and rehabilitation are not identified. For physiotherapists to provide best practice care for these patients, a close working relationship with emergency departments needs to be fostered.

Stafford Thompson, BPhty

Unit Manager Physiotherapy, Occupational Therapy and Social Work

Allied Health Unit

Southern District Health Board

REFERENCES

Holme E, Magnusson SP, Becher K, Bieler K, Bieler T, Aagaard P and Kjaer M (1999): The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain. Scandinavian Journal of Medicine in Science and Sports 9: 104-109.

Wester JU, Jespersen SM, Nielsen KD and Neumann L (1996): Wobble board training after partial sprains of the lateral ligaments of the ankle: a prospective randomized study. Journal of Orthopaedic and Sports Physical Therapy 23: 332-336.
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