Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial

Abstract

Objective To compare an accelerated intervention incorporating early therapeutic exercise after acute ankle sprains with a standard protection, rest, ice, compression, and elevation intervention. Design Randomised controlled trial with blinded outcome assessor. Setting Accident and emergency department and university based sports injury clinic. Participants 101 patients with an acute grade 1 or 2 ankle sprain. Interventions Participants were randomised to an accelerated intervention with early therapeutic exercise (exercise group) or a standard protection, rest, ice, compression, and elevation intervention (standard group). Main outcome measures The primary outcome was subjective ankle function (lower extremity functional scale). Secondary outcomes were pain at rest and on activity, swelling, and physical activity at baseline and at one, two, three, and four weeks after injury. Ankle function and rate of reinjury were assessed at 16 weeks. Results An overall treatment effect was in favour of the exercise group (P=0.0077); this was significant at both week 1 (baseline adjusted difference in treatment 5.28, 98.75% confidence interval 0.31 to 10.26; P=0.008) and week 2 (4.92, 0.27 to 9.57; P=0.0083). Activity level was significantly higher in the exercise group as measured by time spent walking (1.2 hours, 95% confidence interval 0.9 to 1.4 v 1.6, 1.3 to 1.9), step count (5621 steps, 95% confidence interval 4399 to 6843 v 7886, 6357 to 9416), and time spent in light intensity activity (53 minutes, 95% confidence interval 44 to 60 v 76, 58 to 95). The groups did not differ at any other time point for pain at rest, pain on activity, or swelling. The reinjury rate was 4% (two in each group). Conclusion An accelerated exercise protocol during the first week after ankle sprain improved ankle function; the group receiving this intervention was more active during that week than the group receiving standard care. Trial registration Current Controlled Trials ISRCTN13903946.

The Incidence and Prevalence of Ankle Sprain Injury: A Systematic Review and Meta-Analysis of Prospective Epidemiological Studies

“…There is also an abundance of literature investigating injury epidemiology in field based sports (98 of the studies included in our analysis were field-based focused). The high risk of ankle sprain has promoted an appropriate research response, as a large number of methodologically rigorous randomised control trials now exist investigating the effect of different interventions in injury rehabilitation (54,(228)(229)(230)(231) and prevention (232)(233)(234).…”

National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

“…This functional treatment has been shown to speed recovery when compared with immobilization. Bleakley et al 38 …”

Aquatic Physical Therapy in the Rehabilitation of Athletic Injuries: A Systematic Review of the Literatures

“…Because of these reasons, rehabilitation of athletes is initiated as quickly as possible, while respecting the constraints of healing [9]. In their study, Bleakley et al showed that exercise during the first week after sustaining an ankle sprain improved ankle function, which supports early rehabilitation [10].…”