Digital Rehabilitation for Acute Ankle Sprains: Prospective Longitudinal Cohort Study (Preprint)

Abstract

BACKGROUND Ankle sprains are one of the most prevalent soft-tissue injuries worldwide. Physical therapy, and especially progressive exercise, has proven effective in improving function, while preventing recurrence. OBJECTIVE We aimed to present the results of a fully remote and digitally guided rehabilitation program for acute ankle sprains. METHODS Prospective, longitudinal cohort study of individuals referred for digital rehabilitation therapy for ankle sprain, and eligible for workers’ compensation. Primary endpoints were the change in self-reported Numerical Pain Rating Scale (NPRS) and Foot and Ankle Ability Measure - activities of daily living (FAAM-ADL) and -sports (FAAM-Sports). Participants were assessed at baseline, end-of-program and 6-months after program completion. Secondary outcomes included digital therapy dosage, pain and fatigue during sessions, and satisfaction. RESULTS Ninety-three patients (89.4%) completed the program and seventy-nine were available for follow-up (76.0%). Changes in the primary outcomes between baseline and the 6-months follow-up were both statistically significant (P<.001) and clinically meaningful: mean difference of -2.72 points (95% CI -3-31 to -2.13) in NPRS (49.8% reduction), 21.7 points (95% CI 17.13 to 26.27) in FAAM-ADL (41.1% increase) and 37.8 points (95% CI 30.45 to 45.15) in FAAM-Sports (151.8% increase). Longer waiting periods between accident date and treatment initiation were found to negatively impact functional status at baseline and end-of-program, triggering extended program duration. Total training volume (12.5 h, sd=10.5) was similar to other interventions for ankle sprains, but dosage per week was much higher (2.4 h per week, sd=0.87). Mean patient satisfaction score was 8.8/10 (sd=1.57). Among program completers, 83.9% attained full recovery and were discharged with no residual disability. CONCLUSIONS Being far less demanding in terms of human resources, the digital program presented constitutes a viable, clinically effective and convenient solution for ankle sprains rehabilitation, particularly in pandemic times. This is the first study presenting a fully remote home-based rehabilitation program for acute ankle sprains, with patients achieving sustained long-term results, comparable to those published for face-to-face interventions. CLINICALTRIAL NCT04819022; https://clinicaltrials.gov/ct2/show/NCT04819022