Effectiveness of additional supervised exercises compared with conventional treatment alone in patients with acute lateral ankle sprains: systematic review

Abstract

Objective To summarise the effectiveness of adding supervised exercises to conventional treatment compared with conventional treatment alone in patients with acute lateral ankle sprains.Design Systematic review.Data sources Medline, Embase, Cochrane Central Register of Controlled Trials, Cinahl, and reference screening.Study selection Included studies were randomised controlled trials, quasi-randomised controlled trials, or clinical trials. Patients were adolescents or adults with an acute lateral ankle sprain. The treatment options were conventional treatment alone or conventional treatment combined with supervised exercises. Two reviewers independently assessed the risk of bias, and one reviewer extracted data. Because of clinical heterogeneity we analysed the data using a best evidence synthesis. Follow-up was classified as short term (up to two weeks), intermediate (two weeks to three months), and long term (more than three months). Results 11 studies were included. There was limited to moderate evidence to suggest that the addition of supervised exercises to conventional treatment leads to faster and better recovery and a faster return to sport at short term follow-up than conventional treatment alone. In specific populations (athletes, soldiers, and patients with severe injuries) this evidence was restricted to a faster return to work and sport only. There was no strong evidence of effectiveness for any of the outcome measures. Most of the included studies had a high risk of bias, with few having adequate statistical power to detect clinically relevant differences.Conclusion Additional supervised exercises compared with conventional treatment alone have some benefit for recovery and return to sport in patients with ankle sprain, though the evidence is limited or moderate and many studies are subject to bias.

Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline

“…Including supervised physiotherapy has shown to have some benefit in patients with a severe ankle sprain compared with a mild LAS as measured by PROMs,60 and whence compared with a home exercise programme137 138 (level 1). Additionally, supervised exercise therapy may lead to improvements in ankle strength138 and proprioception,138 faster return to work139 and sport,134 compared with performing the exercise programme without supervision or guidance (level 1). Many articles, however, contradict these findings, concluding that there is no effect from the addition of supervised exercise therapy to conventional treatment alone (two RCTs, n=130)140 141 (level 2) nor an improvement of postural balance after exercise therapy131 142 (level 1).…”

“…Recommendation (modified): Supervised exercises focusing on a variety of exercises such as proprioception, strength, coordination and function will lead to a faster return to sport in patients after a LAS134 and are therefore recommended (level 1).…”

Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis

“…There was a significant amount of overlap between the reviews regarding the injury type of interest, with 15 reviews being classified as investigating treatment strategies for both acute ankle sprain and CAI 14 17 19 24 28 32 34 37 41 43 45 50 52 53 60. Twenty reviews investigated treatment strategies for acute ankle sprain specifically 18 21–23 26 27 29–31 39 40 44 46–49 54 55 58 61.…”

“…Eighteen systematic reviews evaluated a physiotherapeutic intervention for the treatment of acute ankle sprain14 17 19 23 29 31 32 39 41 44 45 50 52 53 58 60 61 95 (quality range=2–10), which themselves included 118 individual reports were included on removal of papers duplicated between each review. The two main kinds of physiotherapeutic intervention evaluated were exercise therapy and manual therapy.…”

Structural abnormalities and persistent complaints after an ankle sprain are not associated: an observational case control study in primary care

“…3 Despite the many treatment options available, such as early mobilisation, cooling, instruction for weight bearing, taping, and exercises, many patients have persistent complaints after an acute ankle sprain. [4][5][6][7] Up to 33% still experience pain after 1 year and re-sprains occur in up to 34% of all patients. 8 When complaints last for at least 6 months, the terms chronic or functional ankle instability are used.…”