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de Vasconcelos GS, Cini A, Sbruzzi G, Lima CS. Effects of proprioceptive training on the incidence of ankle sprain in athletes: systematic review and meta-analysis. Clin Rehabil 2018; 32:1581-1590. [PMID: 29996668 DOI: 10.1177/0269215518788683] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE: To investigate how dynamic neuromuscular control, postural sway, joint position sense, and incidence of ankle sprain are influenced by balance training in athletes compared with the control group in randomized clinical trials. DATA SOURCES: The search strategy included MEDLINE, Physical Therapy Evidence Database, Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Center on Health Sciences Information. Randomized controlled trials (RCTs) were published by June of 2018. METHODS: RCTs that evaluate the effectiveness of proprioception in these outcomes: dynamic neuromuscular control, postural sway, joint position, and the incidence of ankle sprains in athletes aged between 18 and 35 years. Two reviewers independently screened the searched records, extracted the data, and assessed risk of bias. The treatment effect sizes were pooled in a meta-analysis using the RevMan 5.2 software. Internal validity was assessed through topics suggested by Cochrane Collaborations. RESULTS: Of the 12 articles included ( n = 1817), eight were in the meta-analysis ( n = 1722). The balance training reduced the incidence of ankle sprains in 38% compared with the control group ( RR: 0.62; 95% CI: 0.43-0.90). In relation to the dynamic neuromuscular control, the training showed increase in the distance of reach in the anterior (0.62 cm, 95% CI: 0.13-1.11), posterolateral (4.22 cm, 95% CI: 1.76-6.68), and posteromedial (3.65 cm, 95% CI: 1.03-6.26) through the Star Excursion Balance test. Furthermore, training seems to improve postural sway and joint position sense. CONCLUSION: Balance training reduces the incidence of ankle sprains and increases dynamic neuromuscular control, postural sway, and the joint position sense in athletes.
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Affiliation(s)
- Gabriela Souza de Vasconcelos
- Laboratório de Pesquisa do Exercício (LAPEX), Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Anelize Cini
- Laboratório de Pesquisa do Exercício (LAPEX), Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Graciele Sbruzzi
- Laboratório de Pesquisa do Exercício (LAPEX), Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Cláudia Silveira Lima
- Laboratório de Pesquisa do Exercício (LAPEX), Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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van Reijen M, Asscheman M, Vriend I, van Mechelen W, Verhagen E. Users' Perspectives, Opportunities, and Barriers of the Strengthen Your Ankle App for Evidence-Based Ankle Sprain Prevention: Mixed-Methods Process Evaluation for a Randomized Controlled Trial. JMIR Rehabil Assist Technol 2018; 5:e13. [PMID: 29980497 PMCID: PMC6054707 DOI: 10.2196/rehab.8638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/11/2018] [Accepted: 05/09/2018] [Indexed: 12/26/2022] Open
Abstract
Background The “Strengthen Your Ankle” neuromuscular training program has been thoroughly studied over the past 8 years. This process evaluation is a part of a randomized controlled trial that examined both the short- and long-term effectiveness of this particular program. Although it was shown previously that the program, available both in a printed booklet and as a mobile app, is able to effectively reduce the number of recurrent ankle sprains, participants’ compliance with the program is an ongoing challenge. Objective This process evaluation explored participants’ opinions regarding both the methods of delivery, using RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) Framework to identify barriers and challenges to program compliance. Although Reach, Effectiveness, and Adaptation were the focus of a previous study, this paper focuses on the implementation and maintenance phases. Methods Semistructured interviews and online questionnaires were analyzed using qualitative content analysis. Fisher exact, chi-square, and t tests assessed between-group differences in quantitative survey responses. Interviews were assessed by thematic analysis to identify key themes. Results While there were no significant differences in the perceived simplicity, usefulness, and liking of the exercise during the 8 weeks of the neuromuscular training program, semistructured interviews showed that 14 of 16 participants agreed that an app would be of additional benefits over a booklet. After the 12-month follow-up, when asked how they evaluated the overall use of the app or the booklet, the users of the app gave a mean score of 7.7 (SD 0.99) versus a mean score 7.1 (SD 1.23) for the users of the booklet. This difference in mean score was significant (P=.006). Conclusions Although both the app and booklet showed a high user satisfaction, the users of the app were significantly more satisfied. Semistructured questionnaires allowed users to address issues they would like to improve in future updates. Including a possibility for feedback and postponement of exercises, an explanation of the use of specific exercises and possibly music were identified as features that might further improve the contentment of the program, probably leading to increased compliance. Trial Registration Netherlands Trial Register NTR4027; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4027 (Archived by Webcite at http://www.webcitation.org/70MTo9dMV)
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Affiliation(s)
- Miriam van Reijen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, Amsterdam, Netherlands
| | - Marianne Asscheman
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, Amsterdam, Netherlands
| | - Ingrid Vriend
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, Amsterdam, Netherlands.,Consumer Safety Institute VeiligheidNL, Amsterdam, Netherlands
| | - Willem van Mechelen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, Amsterdam, Netherlands.,School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland.,School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Brisbane, Australia.,Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, Amsterdam, Netherlands.,Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Prevention of Ankle Sprain Injuries in Youth Soccer and Basketball: Effectiveness of a Neuromuscular Training Program and Examining Risk Factors. Clin J Sport Med 2018; 28:325-331. [PMID: 29864071 DOI: 10.1097/jsm.0000000000000462] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The primary objective of this study was to examine the effectiveness of a neuromuscular training (NMT) warm-up program in reducing the risk of ankle sprain injury (ASI) in youth soccer and basketball. The secondary objective included the evaluation of risk factors for ASI. STUDY DESIGN Secondary analysis of pooled data from 5 studies. PARTICIPANTS Male and female youth (11-18 years) soccer and basketball players (n = 2265) in Alberta, Canada. OUTCOME MEASURES Ankle sprain injury was the primary outcome and was recorded using a validated prospective injury surveillance system consistent in all studies. The primary exposure of interest was NMT warm-up, which included aerobic, strength, agility, and balance components. Multivariable Poisson regression, controlling for clustering by team and offset for exposure hours, was used to estimate incidence rate ratios (IRRs) with 95% confidence intervals (CIs), with considerations for confounding and effect modification and evaluating all covariates as potential risk factors. RESULTS A total of 188 ASIs were reported in 171 players. Neuromuscular training significantly reduced the risk of ASI [IRR = 0.68 (95% CI; 0.46-0.99)]. Independent risk factors for ASI included previous ASI [IRR = 1.98 (95% CI; 1.38-2.81)] and participation in basketball versus soccer [IRR = 1.83 (95% CI; 1.18-2.85)]. Sex, age, body mass index, and previous lower extremity injury (without previous ASI) did not predict ASI (P > 0.05). CONCLUSIONS Exposure to an NMT program is significantly protective for ASI in youth soccer and basketball. Risk of ASI in youth basketball is greater than soccer, and players with a history of ASI are at greater risk.
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THE EFFECT OF BRACING AND BALANCE TRAINING ON ANKLE SPRAIN INCIDENCE AMONG ATHLETES: A SYSTEMATIC REVIEW WITH META-ANALYSIS. Int J Sports Phys Ther 2018. [PMID: 30038824 DOI: 10.26603/ijspt20180379] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background Ankle sprains are common musculoskeletal injuries in the athletic population that have been addressed with prevention strategies that include bracing and balance training. Many authors have examined ankle sprain incidence after bracing or balance training in athletes at different levels of competition and in various sports. No systematic review has analyzed the results of both interventions. Purpose The purpose of this review was to compare the effect of balance training and bracing in reducing the incidence and relative risk of ankle sprains in competitive athletes, with or without prior injury, across different sports. Design Systematic review, with meta-analysis. Methods A literature search of four databases was conducted for randomized control trials that reported ankle sprain incidence published from 2005 through 2016. Included articles studied high school, college, or professional level athletes with or without a history of a prior sprain, who received bracing or balance training as an intervention compared to a non-intervention control group. Methodological study quality was assessed by two reviewers using the PEDro scale, with scores ≥5 considered moderate quality. Group incidence and relative risk were determined to assess the preventative effect of bracing or balance training compared to control. Results From 1832 total citations, 71 full-text articles were reviewed, and eight articles were included in the study. Methodological quality of the available evidence contained in the systematic review was moderate. Five studied the effect of balance training, two studied the effect of bracing, and one studied the effect of bracing and balance training compared to the control condition. In all eight studies, athletes in the control condition did not receive any intervention. Athletes who wore braces had fewer ankle sprains (p=0.0037) and reduced their risk of sprains by 64% (RR=0.36) compared to controls, based on analysis of 3,581 subjects. Athletes performing balance training had fewer ankle sprains (p=0.0057) and reduced their risk by 46% (RR=0.54) compared to controls, based on analysis of 3,577 subjects. Conclusion The findings of the current systematic review and meta-analysis support the use of bracing and balance training to reduce the incidence and relative risk of ankle sprains in athletic populations. Clinicians can utilize this information to educate their patients on wearing a brace or performing balance training exercises to decrease the risk of an ankle sprain. Level of evidence Level 1a.
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Voizard P, Moore J, Leduc S, Nault ML. The heterogeneous management of pediatric ankle traumas: A retrospective descriptive study. Medicine (Baltimore) 2018; 97:e11020. [PMID: 29901592 PMCID: PMC6023842 DOI: 10.1097/md.0000000000011020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Frequent misdiagnosis of pediatric ankle traumas leads to inappropriate management, which may result in residual pain, instability, slower return to physical activity, and long-term degenerative changes. The purpose of this study was to evaluate the consistency of diagnosis, management, and the treatment of acute lateral pediatric ankle trauma in a tertiary care pediatric hospital. The hypothesis was that the initial diagnosis is often incorrect, and the treatment varies considerably amongst orthopedic surgeons.We conducted a retrospective study of all cases of ankle sprains and Salter-Harris one (SH1) fractures referred to our orthopedic surgery service between May and August 2014. Exclusion criteria included ankle fractures other than SH1 types, and cases where treatment was initially undertaken elsewhere before referral to our service. Primary outcome was the difference between initial and final diagnosis.Among 3047 cases reviewed, 31 matched our inclusion criteria. Initial diagnosis was 20 SH1 fractures, 8 acute ankle sprains, and 3 uncertain, with a change in diagnosis for 48.5% at follow-up.Accurate diagnosis can be difficult in pediatric ankle trauma, with case management and specific treatments varying considerably. This study reinforces the need to evaluate the safety of a general treatment algorithm for all lateral ankle trauma with normal radiographs.Level of evidence III.
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Affiliation(s)
| | - James Moore
- CHU Sainte-Justine, Chemin de la Côte Ste-Catherine
| | - Stéphane Leduc
- Université de Montréal, Department of Surgery, Boul. Edouard-Montpetit, Montreal, Quebec
- Hôpital du Sacré-Cœur de Montréal, Boul. Gouin oust, Montreal, QC, Canada
| | - Marie-Lyne Nault
- CHU Sainte-Justine, Chemin de la Côte Ste-Catherine
- Université de Montréal, Department of Surgery, Boul. Edouard-Montpetit, Montreal, Quebec
- Hôpital du Sacré-Cœur de Montréal, Boul. Gouin oust, Montreal, QC, Canada
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Pas HIMFL, Bodde S, Kerkhoffs GMMJ, Pluim B, Tiemessen IJH, Tol JL, Verhagen E, Gouttebarge V. Systematic development of a tennis injury prevention programme. BMJ Open Sport Exerc Med 2018; 4:e000350. [PMID: 29719728 PMCID: PMC5926669 DOI: 10.1136/bmjsem-2018-000350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2018] [Indexed: 12/26/2022] Open
Abstract
Introduction Despite an injury incidence of up to 3.0/1000 hours of play, there are no published tennis injury prevention programmes. This article aims to describe the developmental process of TennisReady, an e-health tennis-specific injury programme for adult recreational tennis players. Five-step approach A bottom-up, five-step approach was used with the Knowledge Transfer Scheme as a guideline. During the first step, a problem statement among targeted users was carried out. 475 (partially) completed surveys and group interviews (n=8) revealed a preference for an app-based prevention intervention of 10–15 min. As a second step, a systematic review was performed to identify prevention strategies in tennis. None were found. In step 3, during two expert group meetings (n=18), the findings of the first two steps were discussed and goals were formulated. Relevant and potential exercises for the programme were discussed. A subgroup of a total of six physical therapists, physicians and trainers developed the content of the programme in step 4. Step 5 included an evaluation of the exercises in 33 recreational tennis players. Participants evaluated the exercises during training sessions with trainers involved in the programme’s development or their colleagues. Participants evaluated the programme through standardised surveys or group interviews. Based on this evaluation, the programme was adjusted by altering exercises and frequencies, and it was evaluated in a second target group (n=27). The second evaluation did not result in any major changes to the final prevention programme. Conclusion Through a five-step approach guided by the Knowledge Transfer Scheme, we developed an e-health tennis-specific prevention programme for adult tennis players. This 10 min intervention will require testing in a randomised controlled setting.
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Affiliation(s)
- Haiko I M F L Pas
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,AMC/VUmc IOC Research Center, Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Stefan Bodde
- Department of Sports Medicine, Royal Netherlands Lawn Tennis Association, Amersfoort, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,AMC/VUmc IOC Research Center, Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Babette Pluim
- Department of Sports Medicine, Royal Netherlands Lawn Tennis Association, Amersfoort, The Netherlands
| | | | - Johannes L Tol
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Evert Verhagen
- AMC/VUmc IOC Research Center, Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam, The Netherlands.,Department of Public and Occupational Health, Amsterdam Movement Sciences, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.,Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa.,Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
| | - Vincent Gouttebarge
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,AMC/VUmc IOC Research Center, Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam, The Netherlands.,Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa.,Dutch Consumer Safety Institute, Amsterdam, The Netherlands
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Vuurberg G, Hoorntje A, Wink LM, van der Doelen BFW, van den Bekerom MP, Dekker R, van Dijk CN, Krips R, Loogman MCM, Ridderikhof ML, Smithuis FF, Stufkens SAS, Verhagen EALM, de Bie RA, Kerkhoffs GMMJ. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med 2018. [PMID: 29514819 DOI: 10.1136/bjsports-2017-098106] [Citation(s) in RCA: 188] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This guideline aimed to advance current understandings regarding the diagnosis, prevention and therapeutic interventions for ankle sprains by updating the existing guideline and incorporate new research. A secondary objective was to provide an update related to the cost-effectiveness of diagnostic procedures, therapeutic interventions and prevention strategies. It was posited that subsequent interaction of clinicians with this guideline could help reduce health impairments and patient burden associated with this prevalent musculoskeletal injury. The previous guideline provided evidence that the severity of ligament damage can be assessed most reliably by delayed physical examination (4-5 days post trauma). After correct diagnosis, it can be stated that even though a short time of immobilisation may be helpful in relieving pain and swelling, the patient with an acute lateral ankle ligament rupture benefits most from use of tape or a brace in combination with an exercise programme.New in this update: Participation in certain sports is associated with a heightened risk of sustaining a lateral ankle sprain. Care should be taken with non-steroidal anti-inflammatory drugs (NSAIDs) usage after an ankle sprain. They may be used to reduce pain and swelling, but usage is not without complications and NSAIDs may suppress the natural healing process. Concerning treatment, supervised exercise-based programmes preferred over passive modalities as it stimulates the recovery of functional joint stability. Surgery should be reserved for cases that do not respond to thorough and comprehensive exercise-based treatment. For the prevention of recurrent lateral ankle sprains, ankle braces should be considered as an efficacious option.
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Affiliation(s)
- Gwendolyn Vuurberg
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands
| | - Alexander Hoorntje
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands
| | - Lauren M Wink
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,VU Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Brent F W van der Doelen
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands
| | | | - Rienk Dekker
- Dutch Society of Rehabilitation, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - C Niek van Dijk
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands
| | - Rover Krips
- Department of Orthopaedic Surgery, Flevoziekenhuis, Almere, The Netherlands
| | | | | | - Frank F Smithuis
- Department of Musculoskeletal Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Sjoerd A S Stufkens
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Evert A L M Verhagen
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands.,VU Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of of Public and Occupational Health VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Rob A de Bie
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands
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Lazarou L, Kofotolis N, Malliou P, Kellis E. Effects of two proprioceptive training programs on joint position sense, strength, activation and recurrent injuries after ankle sprains. ISOKINET EXERC SCI 2017. [DOI: 10.3233/ies-171146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Lazaros Lazarou
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Nikolaos Kofotolis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Paraskevi Malliou
- Laboratory of Therapeutic Exercise and Rehabilitation, Department of Physical Education and Sport Sciences, Democritus University of Thrace, Komotini, Greece
| | - Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
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Punt IM, Armand S, Ziltener JL, Allet L. Effect of Wii Fit™ exercise therapy on gait parameters in ankle sprain patients: A randomized controlled trial. Gait Posture 2017; 58:52-58. [PMID: 28735202 DOI: 10.1016/j.gaitpost.2017.06.284] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/23/2017] [Accepted: 06/28/2017] [Indexed: 02/02/2023]
Abstract
Ankle sprains are the most common sport related injuries. An alternative to physical therapy in the treatment of ankle sprains is home based exercise therapy. This study aims to compare the effectiveness of Wii Fit™ exercise therapy in ankle sprain patients on temporal-spatial and kinematic gait parameters with a) conventional therapy and b) a control group not receiving exercise therapy. Ninety patients were randomly assigned to a Wii Fit™, physical therapy or control group. Temporal-spatial and kinematic gait parameters were assessed at baseline, 6 weeks and 6 months follow-up. All groups improved gait speed, cadence and step length between baseline and 6-week follow-up (P<0.036). Single support time improved only in the Wii Fit™ group (P<0.001). Symmetry index of the single support time improved in the Wii Fit™ group and physical therapy group (P<0.048). No between-group differences were found for temporal-spatial gait parameters (P>0.050). Maximum plantar flexion improved in the physical therapy and control group between baseline and 6-week follow-up (P<0.035). However, none of the groups improved dorsiflexion (P>0.050). In conclusion, an unsupervised home-based 6-week Wii Fit™ exercise therapy can be applied in ankle sprain patients. However, it was not more effective compared to physical therapy or no exercise therapy at all.
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Affiliation(s)
- Ilona M Punt
- University of Applied Sciences of Western Switzerland, HES-SO, Department of Physical Therapy, Geneva, Switzerland
| | - Stéphane Armand
- Geneva University Hospital and University of Geneva, Willy Taillard Laboratory of Kinesiology, Geneva, Switzerland
| | - Jean-Luc Ziltener
- Geneva University Hospitals and University of Geneva, Physical Medicine and Orthopaedics Rehabilitation Unit, Department of Surgery, Geneva, Switzerland
| | - Lara Allet
- University of Applied Sciences of Western Switzerland, HES-SO, Department of Physical Therapy, Geneva, Switzerland; University of Geneva, Medical Faculty, Department of Community Medicine, Geneva, Switzerland.
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60
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Wardle SL, Greeves JP. Mitigating the risk of musculoskeletal injury: A systematic review of the most effective injury prevention strategies for military personnel. J Sci Med Sport 2017; 20 Suppl 4:S3-S10. [PMID: 29103913 DOI: 10.1016/j.jsams.2017.09.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/11/2017] [Accepted: 09/19/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To update the current injury prevention strategy evidence base for making recommendations to prevent physical training-related musculoskeletal injury. DESIGN We conducted a systematic review to update the evidence base on injury prevention strategies for military personnel. METHODS Literature was systematically searched and extracted from five databases, and reported according to PRISMA guidelines. Sixty one articles meeting the inclusion criteria and published during the period 2008-2015 were selected for systematic review. RESULTS The retrieved articles were broadly categorised into six injury prevention strategies; (1) conditioning, (2) footwear modifications, (3) bracing, (4) physical activity volume, (5) physical fitness, and (6) leadership/supervision/awareness. The majority of retrieved articles (n=37 (of 61) evaluated or systematically reviewed a conditioning intervention of some nature. However, the most well-supported strategies were related to reducing physical activity volume and improving leadership/supervision/awareness of injuries and injury prevention efforts. CONCLUSIONS Several injury prevention strategies effectively reduce musculoskeletal injury rates in both sexes, and many show promise for utility with military personnel. However, further evaluation, ideally with prospective randomised trials, is required to establish the most effective injury prevention strategies, and to understand any sex-specific differences in the response to these strategies.
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Affiliation(s)
- Sophie L Wardle
- Division of Applied Human Physiology, Army Personnel Research Capability, Army Headquarters, Andover, UK.
| | - Julie P Greeves
- Division of Applied Human Physiology, Army Personnel Research Capability, Army Headquarters, Andover, UK
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61
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Shapes of distal tibiofibular syndesmosis are associated with risk of recurrent lateral ankle sprains. Sci Rep 2017; 7:6244. [PMID: 28740251 PMCID: PMC5524756 DOI: 10.1038/s41598-017-06602-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 06/14/2017] [Indexed: 12/26/2022] Open
Abstract
Distal tibiofibular syndesmosis (DTS) has wide anatomic variability in depth of incisura fibularis and shape of tibial tubercles. We designed a 3-year prospective cohort study of 300 young physical training soldiers in an Army Physical Fitness School. Ankle computed tomography (CT) scans showed that 56% of the incisura fibularis were a "C" shape, 25% were a "1" shape, and 19% were a "Г" shape. Furthermore, we invited a randomly selected subcohort of 6 participants in each shape of DTS to undergo a three-dimensional (3D) laser scanning. The "1" shape group showed widest displacement range of the DTS in the y-axis, along with the range of motion (ROM) on the position more than 20° of the ankle dorsiflexion, inversion and eversion. During the 3-year study period, 23 participants experienced recurrent lateral ankle sprains. 7 cases of the incisura fibularis were "C" shape, 13 cases were "1" shape, and 3 cases were "Г" shape. The "1" shape showed highest risk among the three shapes in incident recurrent lateral ankle sprains. We propose that it is possible to classify shapes of DTS according to the shapes of incisura fibularis, and people with "1" shape may have more risk of recurrent lateral ankle sprains.
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Janssen K, Van Den Berg A, Van Mechelen W, Verhagen E. User Survey of 3 Ankle Braces in Soccer, Volleyball, and Running: Which Brace Fits Best? J Athl Train 2017; 52:730-737. [PMID: 28661204 DOI: 10.4085/1062-2050-52.4.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Recurrence rates for ankle sprains are high. Therefore, preventive measures such as ankle bracing during sports are recommended. OBJECTIVE To systematically evaluate the perceived ease of use, quality, comfort, stability, and hindrance of and the overall satisfaction with 3 contemporary brace types in 3 types of sports. DESIGN Randomized comparative user survey. SETTING Recreational sports: soccer, volleyball, and running. PATIENTS OR OTHER PARTICIPANTS Young adult recreational athletes (29 soccer players, 26 volleyball players, and 31 runners). INTERVENTION(S) Compression brace (CB), lace-up brace (LB), and semirigid brace (SB). MAIN OUTCOME MEASURE(S) Rating of perceived ease of use, quality, comfort, stability, and hindrance of and overall satisfaction with the brace types during sports on a 5-point Likert scale. The secondary outcome measure was participants' willingness to buy the tested brace. RESULTS Overall, the 3 brace types received high mean scores for ease of use and quality. Soccer players preferred the CB over both alternatives, considering the higher scores for comfort (CB = 4.0, LB = 3.5, SB = 2.8), hindrance (CB = 3.7, LB = 2.9, SB = 2.8), overall satisfaction (CB = 3.6, LB = 3.0, SB = 2.5), and greatest willingness to buy this brace. Volleyball players preferred the LB over both alternatives, considering the higher scores for stability (LB = 4.2, CB = 3.2, SB = 3.3), overall satisfaction (LB = 3.8, CB = 3.0, SB = 3.0), and greatest willingness to buy this brace. Runners preferred the CB over both alternatives considering the better score for hindrance (CB = 3.6, LB = 2.8, SB = 2.9) and greatest willingness to buy this brace. CONCLUSIONS All 3 ankle-brace types scored high on perceived ease of use and quality. Regarding the brace types, soccer players, volleyball players, and runners differed in their assessments of subjective evaluation of comfort, stability, hindrance, overall satisfaction, and willingness to buy the brace. Soccer players and runners preferred the CB, whereas volleyball players preferred the LB.
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Affiliation(s)
- Kasper Janssen
- Elite Sports Medicine, Gelderse Vallei Hospital, Ede, Netherlands
| | | | - Willem Van Mechelen
- Department of Occupational Health and Sports Medicine, EMGO+ Institute for Health and Care Research, Vrije Universiteit Medical Centre, Amsterdam, Netherlands
| | - Evert Verhagen
- Department of Occupational Health and Sports Medicine, EMGO+ Institute for Health and Care Research, Vrije Universiteit Medical Centre, Amsterdam, Netherlands
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63
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van Reijen M, Vriend I, van Mechelen W, Finch CF, Verhagen EA. Compliance with Sport Injury Prevention Interventions in Randomised Controlled Trials: A Systematic Review. Sports Med 2017; 46:1125-39. [PMID: 26869058 PMCID: PMC4963451 DOI: 10.1007/s40279-016-0470-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Sport injury prevention studies vary in the way compliance with an intervention is defined, measured and adjusted for. OBJECTIVE The objective of this systematic review was to assess the extent to which sport injury prevention randomised controlled trials (RCTs) have defined, measured and adjusted results for compliance with an injury prevention intervention. METHODS An electronic search was performed in MEDLINE, PubMed, the Cochrane Center of Controlled Trials, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database) and SPORTDiscus. English RCTs, quasi-RCTs and cluster-RCTs were considered eligible. Trials that involved physically active individuals or examined the effects of an intervention aimed at the prevention of sport- or physical activity-related injuries were included. RESULTS Of the total of 100 studies included, 71.6 % mentioned compliance or a related term, 68.8 % provided details on compliance measurement and 51.4 % provided compliance data. Only 19.3 % analysed the effect of compliance rates on study outcomes. While studies used heterogeneous methods, pooled effects could not be presented. CONCLUSIONS Studies that account for compliance demonstrated that compliance significant affects study outcomes. The way compliance is dealt with in preventions studies is subject to a large degree of heterogeneity. Valid and reliable tools to measure and report compliance are needed and should be matched to a uniform definition of compliance.
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Affiliation(s)
- Miriam van Reijen
- Department of Public & Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands
| | - Ingrid Vriend
- Department of Public & Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands.,Consumer Safety Institute VeiligheidNL, Amsterdam, The Netherlands
| | - Willem van Mechelen
- Department of Public & Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands.,School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia.,UCT/MRC Research Unit for Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia
| | - Evert A Verhagen
- Department of Public & Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands. .,Amsterdam Collaboration on Health & Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands. .,School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia. .,UCT/MRC Research Unit for Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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64
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The “Strengthen your ankle” program to prevent recurrent injuries: A randomized controlled trial aimed at long-term effectiveness. J Sci Med Sport 2017; 20:549-554. [DOI: 10.1016/j.jsams.2016.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 11/19/2016] [Accepted: 12/03/2016] [Indexed: 12/26/2022]
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65
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Zech A, Wellmann K. Perceptions of football players regarding injury risk factors and prevention strategies. PLoS One 2017; 12:e0176829. [PMID: 28459845 PMCID: PMC5411057 DOI: 10.1371/journal.pone.0176829] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/18/2017] [Indexed: 12/26/2022] Open
Abstract
Current approaches regarding injury prevention focus on the transfer of evidence into daily practice. One promising approach is to influence attitudes and beliefs of players. The objective of this study was to record player’s perceptions on injury prevention. A survey was performed among players of one German high-level football (soccer) club. 139 professional and youth players between age 13 and 35 years completed a standardized questionnaire (response rate = 98%). It included categories with (1) history of lower extremity injuries, (2) perceptions regarding risk factors and (3) regularly used prevention strategies. The majority of players (84.2%) had a previous injury. 47.5% of respondents believe that contact with other players is a risk factor, followed by fatigue (38.1%) and environmental factors (25.9%). The relevance of previous injuries as a risk factor is differently perceived between injured (25%) and uninjured players (0.0%). Nearly all players (91.5%) perform stretching to prevent injuries, followed by neuromuscular warm up exercises (54.0%). Taping is used by 40.2% of previously injured players and 13.6% of players without a history of injuries. In conclusion, the perception of risk factors and performed preventive strategies are inconsistent with scientific evidence. Future transfer strategies should incorporate the players beliefs and attitudes.
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Affiliation(s)
- Astrid Zech
- Institute of Sports Science, University of Jena, Jena, Germany
| | - Kai Wellmann
- Institute of Sports Science, University of Jena, Jena, Germany.,Institute of Human Movement Science, University of Hamburg, Hamburg, Germany
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66
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Yong MS, Lee YS. Effect of ankle proprioceptive exercise on static and dynamic balance in normal adults. J Phys Ther Sci 2017; 29:242-244. [PMID: 28265149 PMCID: PMC5332980 DOI: 10.1589/jpts.29.242] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/04/2016] [Indexed: 12/26/2022] Open
Abstract
[Purpose] The present study was conducted to investigate whether ankle proprioceptive
exercise affects static and dynamic balance in normal adults. [Subjects and Methods]
Twenty-eight normal adults were recruited to measure their static and dynamic balancing
before and after the proprioceptive exercise. A subject stood with bare feet on the round
supporting platform of the device for measuring balance, and the investigator entered the
age and the height of the subjects and set his/her feet on the central point of the
monitor screen. Training of ankle proprioceptive sense for the movements of
plantar-flexion and dorsiflexion was performed. In the training of joint position sense in
plantar-flexion and dorsiflexion, the plantar-flexion and the dorsiflexion were set as
15°, respectively. [Results] The static balancing did not show significant differences in
average, while the dynamic balancing showed significant differences. [Conclusion] Ankle
proprioceptive exercise can affect dynamic balance.
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Affiliation(s)
- Min-Sik Yong
- Department of Physical Therapy, Youngsan University, Republic of Korea
| | - Yun-Seob Lee
- Department of Physical Therapy, Youngsan University, Republic of Korea
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67
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Cristofoli EL, Peres MM, Cecchini L, Pacheco I, Pacheco AM. COMPARAÇÃO DO EFEITO DO TREINAMENTO PROPRIOCEPTIVO NO TORNOZELO DE NÃO ATLETAS E JOGADORES DE VOLEIBOL. REV BRAS MED ESPORTE 2016. [DOI: 10.1590/1517-869220162206148309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
RESUMO Introdução: O tornozelo é a articulação que sofre mais lesões tanto na vida diária quanto na prática de esportes, especialmente em praticantes de voleibol, que exige movimentos bruscos. Um menor risco de lesão está ligado à estabilidade articular do tornozelo, que pode ser adquirida através de treinamentos proprioceptivos, utilizados para reabilitação e para prevenção de lesões. Objetivo: Avaliar o efeito de um treinamento proprioceptivo para tornozelo por meio do Star Excursion Balance Test (SEBT) em estudantes sedentárias e comparar com resultados obtidos com o mesmo treinamento em atletas do voleibol. Métodos: Onze estudantes sedentárias sem histórico de lesões nos membros inferiores participaram de um treinamento proprioceptivo para os tornozelos, durante quatro semanas. As estudantes foram avaliadas por meio do SEBT antes e após o protocolo de treinamento de propriocepção. Após obtenção das médias pré e pós-teste, foram analisadas intragrupo e comparadas com um banco de dados de estudo que utilizou metodologia idêntica, porém com atletas de voleibol. Resultados: Para a comparação de médias de ambos os tornozelos pré e pós-intervenção das estudantes foi utilizado o teste t pareado. Para comparar os resultados das estudantes com os das atletas foi utilizado o teste t independente. Adotou-se 5% (p ≤ 0,05) como nível de significância e as análises foram realizadas no programa SPSS (Statistical Package for the Social Sciences) versão 18. Os resultados no teste SEBT das estudantes pré e pós-intervenção mostraram diferença significativa em três direções para o tornozelo direito e em quatro direções para o esquerdo. As diferenças entre as estudantes e as atletas foram significativas para duas direções no tornozelo direito e para três no esquerdo. Conclusão: Treinar a propriocepção é eficaz para aumentar a estabilidade tanto de sedentários quanto de atletas, indicando ser um importante meio de prevenção a futuras lesões.
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Affiliation(s)
| | | | | | - Ivan Pacheco
- Grêmio Náutico União, Brasil; Federação Gaúcha de Futebol, Brasil
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68
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Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med 2016; 51:113-125. [PMID: 28053200 DOI: 10.1136/bjsports-2016-096178] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ankle sprains are highly prevalent with high risk of recurrence. Consequently, there are a significant number of research reports examining strategies for treating and preventing acute and recurrent sprains (otherwise known as chronic ankle instability (CAI)), with a coinciding proliferation of review articles summarising these reports. OBJECTIVE To provide a systematic overview of the systematic reviews evaluating treatment strategies for acute ankle sprain and CAI. DESIGN Overview of intervention systematic reviews. PARTICIPANTS Individuals with acute ankle sprain/CAI. MAIN OUTCOME MEASUREMENTS The primary outcomes were injury/reinjury incidence and function. RESULTS 46 papers were included in this systematic review. The reviews had a mean score of 6.5/11 on the AMSTAR quality assessment tool. There was strong evidence for bracing and moderate evidence for neuromuscular training in preventing recurrence of an ankle sprain. For the combined outcomes of pain, swelling and function after an acute sprain, there was strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques. There was conflicting evidence regarding the efficacy of surgery and acupuncture for the treatment of acute ankle sprains. There was insufficient evidence to support the use of ultrasound in the treatment of acute ankle sprains. CONCLUSIONS For the treatment of acute ankle sprain, there is strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques, for pain, swelling and function. Exercise therapy and bracing are supported in the prevention of CAI.
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Affiliation(s)
- Cailbhe Doherty
- Insight Centre for Data Analytics, O'Brien Centre for Science, University College Dublin, Dublin, Ireland
| | - Chris Bleakley
- Sport and Exercise Sciences Research Institute, Ulster Sports Academy, University of Ulster, Newtownabbey, UK
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Institute for Sport and Health, University College Dublin, Dublin, Ireland
| | - Sinead Holden
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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69
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Vriend I, Gouttebarge V, van Mechelen W, Verhagen EALM. Neuromuscular training is effective to prevent ankle sprains in a sporting population: a meta-analysis translating evidence into optimal prevention strategies. J ISAKOS 2016. [DOI: 10.1136/jisakos-2016-000062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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70
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Fatoye F, Haigh C. The cost-effectiveness of semi-rigid ankle brace to facilitate return to work following first-time acute ankle sprains. J Clin Nurs 2016; 25:1435-43. [DOI: 10.1111/jocn.13255] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Francis Fatoye
- Department of Health Professions; Manchester Metropolitan University; Manchester UK
| | - Carol Haigh
- Department of Nursing; Manchester Metropolitan University; Manchester UK
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71
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Van Reijen M, Vriend I, Zuidema V, van Mechelen W, Verhagen EA. Increasing compliance with neuromuscular training to prevent ankle sprain in sport: does the ‘Strengthen your ankle’ mobile App make a difference? A randomised controlled trial. Br J Sports Med 2016; 50:1200-5. [DOI: 10.1136/bjsports-2015-095290] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2015] [Indexed: 12/26/2022]
Abstract
BackgroundE-health has the potential to facilitate implementation of effective measures to prevent sports injuries.AimWe evaluated whether an interactive mobile application containing a proven effective exercise programme to prevent recurrent ankle sprains resulted in higher compliance as compared with regular written exercise materials.Methods220 athletes participated in this randomised controlled trial with a follow-up of 8 weeks; 110 athletes received a booklet explaining an 8-week neuromuscular training programme; 110 athletes participated in the same programme in an interactive mobile App (Strengthen your ankle). The primary outcome was compliance with the exercise programme. Secondary outcome measure was the incidence density of self-reported recurrent ankle sprains.ResultsThe mean compliance to the exercise scheme was 73.3% (95% CI 67.7% to 78.1%) in the App group, compared with 76.7% (95% CI 71.9% to 82.3%) in the Booklet group. No significant difference in compliance was found between groups. The incidence densities of self-reported time-loss recurrences were not significantly different between both groups (HR 3.07; 95% CI 0.62 to 15.20).SummaryThis study shows that the method of implementing the exercises by using an App or a Booklet does not lead to different compliance rates.New findingsThe use of a mobile App or a Booklet lead to similar compliance and injury rates in the short term.Trial registration numberThe Netherlands National Trial Register NTR 4027. The NTR is part of the WHO Primary Registries.
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72
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Correia C, Lopes S, Gonçalves R, Torres R, Pinho F, Gonçalves P, Rodrigues M, Costa R, Lopes M, Ribeiro F. Kinesiology taping does not change fibularis longus latency time and postural sway. J Bodyw Mov Ther 2016; 20:132-138. [DOI: 10.1016/j.jbmt.2015.07.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 07/09/2015] [Accepted: 07/20/2015] [Indexed: 12/26/2022]
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73
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Wolburg T, Rapp W, Rieger J, Horstmann T. Muscle activity of leg muscles during unipedal stance on therapy devices with different stability properties. Phys Ther Sport 2015; 17:58-62. [PMID: 26521158 DOI: 10.1016/j.ptsp.2015.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 04/15/2015] [Accepted: 05/06/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To test the hypotheses that less stable therapy devices require greater muscle activity and that lower leg muscles will have greater increases in muscle activity with less stable therapy devices than upper leg muscles. DESIGN Cross-sectional laboratory study. SETTING Laboratory setting. PARTICIPANTS Twenty-five healthy subjects. MAIN OUTCOME MEASURES Electromyographic activity of four lower (gastrocnemius medialis, soleus, tibialis anterior, peroneus longus) and four upper leg muscles (vastus medialis and lateralis, biceps femoris, semitendinosus) during unipedal quiet barefoot stance on the dominant leg on a flat rigid surface and on five therapy devices with varying stability properties. RESULTS Muscle activity during unipedal stance differed significantly between therapy devices (P < 0.001). The order from lowest to highest relative muscle activity matched the order from most to least stable therapy device. There was no significant interaction between muscle location (lower versus upper leg) and therapy device (P = 0.985). Magnitudes of additional relative muscle activity for the respective therapy devices differed substantially among lower extremity muscles. CONCLUSIONS The therapy devices offer a progressive increase in training intensity, and thus may be useful for incremental training programs in physiotherapeutic practice and sports training programs.
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Affiliation(s)
| | - Walter Rapp
- Institute for Sport and Sport Sciences, Albert-Ludwigs University Freiburg, Germany; Department of Sports Medicine, University Hospital Tübingen, Germany.
| | - Jochen Rieger
- Department of Sports Medicine, University Hospital Tübingen, Germany
| | - Thomas Horstmann
- Medical Park Bad Wiessee St. Hubertus, Bad Wiessee, Germany; Faculty for Sport and Health Sciences, Technische Universität München, Munich, Germany
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74
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Woitzik E, Jacobs C, Wong JJ, Côté P, Shearer HM, Randhawa K, Sutton D, Southerst D, Varatharajan S, Brison RJ, Yu H, van der Velde G, Stern PJ, Taylor-Vaisey A, Stupar M, Mior S, Carroll LJ. The effectiveness of exercise on recovery and clinical outcomes of soft tissue injuries of the leg, ankle, and foot: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. ACTA ACUST UNITED AC 2015; 20:633-45. [DOI: 10.1016/j.math.2015.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 03/09/2015] [Accepted: 03/18/2015] [Indexed: 12/26/2022]
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75
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van Dieën JH, van Leeuwen M, Faber GS. Learning to balance on one leg: motor strategy and sensory weighting. J Neurophysiol 2015; 114:2967-82. [PMID: 26400255 DOI: 10.1152/jn.00434.2015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/17/2015] [Indexed: 12/20/2022] Open
Abstract
We investigated motor and sensory changes underlying learning of a balance task. Fourteen participants practiced balancing on one leg on a board that could freely rotate in the frontal plane. They performed six, 16-s trials standing on one leg on a stable surface (2 trials without manipulation, 2 with vestibular, and 2 with visual stimulation) and six trials on the balance board before and after a 30-min training. Center of mass (COM) movement, segment, and total angular momenta and board angles were determined. Trials on stable surface were compared with trials after training to assess effects of surface conditions. Trials pretraining and posttraining were compared to assess rapid (between trials pretraining) and slower (before and after training) learning, and sensory manipulation trials were compared with unperturbed trials to assess sensory weighting. COM excursions were larger on the unstable surface but decreased with practice, with the largest improvement over the pretraining trials. Changes in angular momentum contributed more to COM acceleration on the balance board, but with practice this decreased. Visual stimulation increased sway similarly in both surface conditions, while vestibular stimulation increased sway less on the balance board. With practice, the effects of visual and vestibular stimulation increased rapidly. Initially, oscillations of the balance board occurred at 3.5 Hz, which decreased with practice. The initial decrease in sway with practice was associated with upweighting of visual information, while later changes were associated with suppression of oscillations that we suggest are due to too high proprioceptive feedback gains.
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Affiliation(s)
- Jaap H van Dieën
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marloes van Leeuwen
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Gert S Faber
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
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76
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Keene DJ, Willett K, Lamb SE. The effects of ankle supports on gait in adults: A randomized cross-over study. J Electromyogr Kinesiol 2015; 25:973-81. [PMID: 26337720 DOI: 10.1016/j.jelekin.2015.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 08/08/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022] Open
Abstract
We aimed to compare the effects of different ankle supports used after ankle injury/surgery on temporo-spatial gait characteristics. We conducted a randomized cross-over study including adult participants with no previous lower limb or neurological pathology, who underwent gait analysis on an electronic walkway in three different ankle supports, Tubigrip(®), a stirrup brace and a walker boot. The 18 participants were an average age of 42 (SD 13, range 24-62) years and 14 (88%) were female. Compared to Tubigrip(®), gait in the walker boot was slower (-0.19 m/s, 95%CI -0.23 to -0.16, P < 0.001), step length asymmetry was 10% (95%CI 9-12, P < 0.001) worse, single support time asymmetry was 5% (95%CI 3-7, P < 0.001) worse and participants also adopted a wider step width (4.1 cm, 95%CI 3.7-4.5, P < 0.001). There were no important differences in gait between the Tubigrip(®) and stirrup brace. The findings of this study suggest that there is a limit to the degree of normal walking characteristics in a walker boot in the absence of lower limb impairment. Further research is required to directly compare the effects of these ankle supports in clinical populations.
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Affiliation(s)
- David J Keene
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
| | - Keith Willett
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
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77
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Janssen KW, van der Zwaard BC, Finch CF, van Mechelen W, Verhagen EALM. Interventions preventing ankle sprains; previous injury and high-risk sport participation as predictors of compliance. J Sci Med Sport 2015; 19:465-9. [PMID: 26118849 DOI: 10.1016/j.jsams.2015.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/27/2015] [Accepted: 06/08/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To describe the association between participants' person-related potential predictor variables and cumulative compliance with interventions for preventing ankle sprains: neuromuscular training, wearing an ankle brace, and a combined training and bracing. DESIGN Secondary analysis of compliance data from a randomized controlled trial (RCT) comparing measures preventing ankle ligament injuries. METHODS Ordinal regression with a backward selection method was used to obtain a descriptive statistical model linking participants' person-related potential predictor variables with the monthly cumulative compliance measurements for three interventions preventing ankle ligament injuries. RESULTS Having had a previous ankle injury was significantly associated with a higher compliance with all of the preventive measures trialed. Overall compliance with bracing and the combined intervention was significantly lower than the compliance with NM training. Per group analysis found that participating in a high-risk sport, like soccer, basketball, and volleyball, was significantly associated with a higher compliance with bracing, or a combined bracing and NM training. In contrast, participating in a high-risk sport was significantly associated with a lower per group compliance with NM training. CONCLUSIONS Future studies should include at least registration of previous ankle sprains, sport participation (high- or low-risk), experience in NM training, and hours of sport exposure as possible predictors of compliance with interventions preventing ankle sprains. Practitioners should take into account these variables when prescribing preventive neuromuscular training or bracing.
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Affiliation(s)
- Kasper W Janssen
- Department of Public & Occupational Health and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081, Amsterdam BT, The Netherlands; Department of Sport and Exercise Medicine, De Sportartsengroep, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061, Amsterdam, AE, The Netherlands.
| | - Babette C van der Zwaard
- Department of General practice and Elderly care medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081, Amsterdam, BT, The Netherlands
| | - Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, PO Box 668, Ballarat, VIC, 3353, Australia
| | - Willem van Mechelen
- Department of Public & Occupational Health and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081, Amsterdam BT, The Netherlands
| | - Evert A L M Verhagen
- Department of Public & Occupational Health and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081, Amsterdam BT, The Netherlands
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78
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Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: A systematic review and meta-analysis. J Sci Med Sport 2015; 18:238-44. [DOI: 10.1016/j.jsams.2014.04.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/08/2014] [Accepted: 04/18/2014] [Indexed: 12/26/2022]
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Mailuhu AKE, Verhagen EALM, van Ochten JM, Bindels PJE, Bierma-Zeinstra SMA, van Middelkoop M. The trAPP-study: cost-effectiveness of an unsupervised e-health supported neuromuscular training program for the treatment of acute ankle sprains in general practice: design of a randomized controlled trial. BMC Musculoskelet Disord 2015; 16:78. [PMID: 25887998 PMCID: PMC4397707 DOI: 10.1186/s12891-015-0539-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/23/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Ankle sprains are one of the most frequent injuries of the musculoskeletal system, with yearly around 680.000 new sprains in The Netherlands. Of these, about 130.000 people will visit the general practitioner (GP) each year. In addition, patients have an increased risk of a recurrent ankle sprain and about a third report at least one re-sprain. No optimal treatment strategy has proven to be effective in general practice, however promising results were achieved in a preventive trial among athletes. Therefore, the objective is to examine the (cost)-effectiveness of an unsupervised e-health supported neuromuscular training program in combination with usual care in general practice compared to usual care alone in patients with acute ankle sprains in general practice. METHOD/DESIGN This study is a multi-center, open-label randomized controlled trial, with a one-year follow-up. Patients with an acute lateral ankle sprain, aged between 14 and 65 years and visiting the GP within three weeks of injury are eligible for inclusion. Patients will be randomized in two study groups. The intervention group will receive, in addition to usual care, a standardized eight-week neuromuscular training program guided by an App. The control group will receive usual care in general practice alone. The primary outcome of this study is the total number of ankle sprain recurrences reported during one year follow-up. Secondary outcomes are subjective recovery after one year follow-up, pain at rest and during activity, function, return to sport, cost-effectiveness and compliance of the intervention. Measurements will take place monthly for the study period of 12 months after baseline measurement. DISCUSSION For general practitioners the treatment of acute ankle sprains is a challenge. A neuromuscular training program that has proven to be effective for athletes might be a direct treatment tool for acute ankle sprains in general practice. Positive results of this randomized controlled trial can lead to changes in practice guidelines for general practitioners. In addition, since this training program is e-health supported, positive results can also lead to a novel way of injury prevention. TRIAL REGISTRATION Dutch Trial Registration: NTR4765.
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Affiliation(s)
- Adinda K E Mailuhu
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Evert A L M Verhagen
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.
| | - John M van Ochten
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
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80
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Supervised rehabilitation versus home exercise in the treatment of acute ankle sprains: a systematic review. Clin Sports Med 2015; 34:329-46. [PMID: 25818717 DOI: 10.1016/j.csm.2014.12.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In competitive sports medicine, supervised rehabilitation is the standard of care; in the general population, unsupervised home exercise is more common. We systematically reviewed randomized, controlled trials comparing outcomes for supervised rehabilitation versus home exercise programs. Supervised rehabilitation programs resulted in (1) less pain and subjective instability, (2) greater gains in ankle strength and joint position sense, and (3) inconclusive results regarding prevention of recurrent ankle sprains. We recommend supervised rehabilitation over home exercise programs owing to the improved short-term patient-recorded evidence with a strength-of-recommendation taxonomy level of evidence of 2B.
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81
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Lee H, Kim H, Ahn M, You Y. Effects of proprioception training with exercise imagery on balance ability of stroke patients. J Phys Ther Sci 2015; 27:1-4. [PMID: 25642023 PMCID: PMC4305533 DOI: 10.1589/jpts.27.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 06/27/2014] [Indexed: 12/26/2022] Open
Abstract
[Purpose] The purpose of the present study was to examine and compare the effects of
proprioceptive training accompanied by motor imagery training and general proprioceptive
training on the balance of stroke patients. [Subjects and Methods] Thirty-six stroke
patients were randomly assigned to either an experimental group of 18 patients or a
control group of 18 patients. The experimental group was given motor imagery training for
5 minutes and proprioceptive training for 25 minutes, while the control group was given
proprioceptive training for 30 minutes. Each session and training program was implemented
5 times a week for 8 weeks. The Korean version of the Berg Balance Scale (K-BBS), Timed Up
and Go test (TUG), weight bearing ratio (AFA-50, Alfoots, Republic of Korea), and joint
position sense error (Dualer IQ Inclinometer, JTECH Medical, USA) were measured. [Results]
Both groups showed improvements in K-BBS, TUG, weight bearing ratio, and joint position
sense error. The measures of the experimental group showed greater improvement than the
control group. [Conclusion] Motor imagery training, which is not subject to time
restrictions, is not very risky and can be used as an effective treatment method for
improving the balance ability of stroke patients.
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Affiliation(s)
- Hyungjin Lee
- Department of Rehabilitation Therapy, Graduate School of Hallym University, Republic of Korea
| | - Heesoo Kim
- Department of Rehabilitation Therapy, Graduate School of Hallym University, Republic of Korea
| | - Myunghwan Ahn
- Department of Rehabilitation Therapy, Rusk Rehabilitation Hospital, Republic of Korea
| | - Youngyoul You
- Department of Rehabilitation Medicine, Bronco Memorial Hospital, Republic of Korea
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Baltich J, Emery CA, Stefanyshyn D, Nigg BM. The effects of isolated ankle strengthening and functional balance training on strength, running mechanics, postural control and injury prevention in novice runners: design of a randomized controlled trial. BMC Musculoskelet Disord 2014; 15:407. [PMID: 25471989 PMCID: PMC4295291 DOI: 10.1186/1471-2474-15-407] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 11/24/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Risk factors have been proposed for running injuries including (a) reduced muscular strength, (b) excessive joint movements and (c) excessive joint moments in the frontal and transverse planes. To date, many running injury prevention programs have focused on a "top down" approach to strengthen the hip musculature in the attempt to reduce movements and moments at the hip, knee, and/or ankle joints. However, running mechanics did not change when hip muscle strength increased. It could be speculated that emphasis should be placed on increasing the strength of the ankle joint for a "ground up" approach. Strengthening of the large and small muscles crossing the ankle joint is assumed to change the force distribution for these muscles and to increase the use of smaller muscles. This would be associated with a reduction of joint and insertion forces, which could have a beneficial effect on injury prevention. However, training of the ankle joint as an injury prevention strategy has not been studied. Ankle strengthening techniques include isolated strengthening or movement-related strengthening such as functional balance training. There is little knowledge about the efficacy of such training programs on strength alteration, gait or injury reduction. METHODS/DESIGN Novice runners will be randomly assigned to one of three groups: an isolated ankle strengthening group (strength, n = 40), a functional balance training group (balance, n = 40) or an activity-matched control group (control, n = 40). Isokinetic strength will be measured using a Biodex System 3 dynamometer. Running kinematics and kinetics will be assessed using 3D motion analysis and a force platform. Postural control will be assessed by quantifying the magnitude and temporal structure of the center of pressure trace during single leg stance on a force platform. The change pre- and post-training in isokinetic strength, running mechanics, and postural control variables will be compared following the interventions. Injuries rates will be compared between groups over 6 months. DISCUSSION Avoiding injury will allow individuals to enjoy the benefits of participating in aerobic activities and reduce the healthcare costs associated with running injuries. TRIAL REGISTRATION Current Controlled Trial NCT01900262.
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Affiliation(s)
- Jennifer Baltich
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
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83
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Abstract
Ankle injuries are common in sports, and the ankle sprain is the most common of ankle injuries, but there are many injuries that can mimic a sprain. In the skeletally immature athlete, bone injuries, particularly those that affect the physis, are more likely to occur than a ligamentous injury. Knowledge of relevant anatomy, physical exam, and appropriate imaging can assist the primary care provider in accurately diagnosing the majority of ankle injuries in the young athlete.
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84
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Interventions to prevent sports related injuries: a systematic review and meta-analysis of randomised controlled trials. Sports Med 2014; 44:473-86. [PMID: 24370993 DOI: 10.1007/s40279-013-0136-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The effects of methods to prevent injuries have been studied in several systematic reviews. However, no meta-analysis taking into account all randomised controlled intervention trials aiming at the prevention of sports injuries has been published. OBJECTIVE To summarise the effects of sports injury prevention interventions. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES PubMed, MEDLINE, SPORTDiscus, the Cochrane Central Register of Controlled Trials, CINAHL, PEDro, and Web of Science, searched in September 2013. The reference lists of retrieved articles and reviews were hand searched. ELIGIBILITY CRITERIA FOR SELECTING STUDIES To be selected articles had to examine the effects of any preventive intervention on sports injuries, be randomised/quasi-randomised and controlled trials, published in a peer-reviewed journal. The outcome of the trial had to be injury rate or the number of injured individuals. RESULTS Of the 5580 articles retrieved after a search of databases and the relevant bibliography, 68 randomised controlled trials were included in the systematic review and 60 trials were included in the meta-analysis. Insoles (OR 0.51, 95% CI 0.32-0.81), external joint supports (OR 0.40, 95% CI 0.30-0.53), and specific training programmes (OR 0.55, 95% CI 0.46-0.66) appeared to be effective in reducing the risk of sports injuries. Stretching (OR 0.92, 95% CI 0.80-1.06), modified shoes (OR 1.23, 95% CI 0.81-1.87), and preventive videos (OR 0.86, 95% CI 0.44-1.68) seemed not to be effective. CONCLUSIONS This meta-analysis showed that certain interventions can reduce the risk of sports injuries. There were limitations regarding the quality of the trials, generalisability of the results, and heterogeneity of the study designs. In future, the mechanisms behind effective methods and the most beneficial elements of preventive training programmes need to be clarified.
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85
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Chronic complaints after ankle sprains: a systematic review on effectiveness of treatments. J Orthop Sports Phys Ther 2014; 44:862-71, C1-23. [PMID: 25299494 DOI: 10.2519/jospt.2014.5221] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Systematic review. Objective To determine the effectiveness of treatments for patients with chronic complaints after ankle sprain. BACKGROUND Though most people recover completely after a lateral inversion ankle injury, a considerable percentage have persistent complaints. Currently, it is still unclear which treatment options are best for these patients. METHODS Major databases, including PubMed, Embase, CINAHL, and PEDro, were searched for randomized controlled trials and controlled clinical trials conducted from 1966 to October 2012. Due to clinical heterogeneity, the data were analyzed using a best-evidence synthesis. RESULTS A total of 20 randomized controlled trials and 1 controlled clinical trial were included in the analysis. The included studies compared different treatments (training programs, physiotherapy, chiropractic/manual therapy, surgery, postoperative training, and functional treatment). For pain and function outcomes, limited to moderate evidence was found for effectiveness of a training program compared to conservative treatment. Two studies found a decrease of recurrences after a proprioceptive training program. Four studies showed good results for different surgical methods but did not include a nonsurgical control group for comparison. Limited evidence was found for the effectiveness of an early mobilization program after surgery. CONCLUSION In chronic ankle complaints after an ankle sprain, a training program gives better results for pain and function, and a decrease of recurrent ankle sprains, than a wait-and-see policy. There was insufficient evidence to determine the most effective surgical treatment, but limited evidence suggests that postoperative, early mobilization was more effective than a plaster cast. LEVEL OF EVIDENCE Therapy, level 1a-.
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86
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Abstract
UNLABELLED Many studies investigated the contributing factors of chronic ankle instability, but a consensus has not yet been obtained. The objective of this critical review is to provide recent scientific evidence on chronic ankle instability, including the epidemiology and pathology of lateral ankle sprain as well as the causative factors of chronic ankle instability. We searched MEDLINE from 1964 to December 2013 using the terms ankle, sprain, ligament, injury, chronic, functional, mechanical, and instability. Lateral ankle sprain shows a very high recurrence rate and causes considerable economic loss due to medical care, prevention, and secondary disability. During the acute phase, patients with ankle sprain demonstrate symptoms such as pain, range of motion deficit, postural control deficit, and muscle weakness, and these symptoms may persist, leading to chronic ankle instability. Although some agreement regarding the effects of chronic ankle instability with deficits in postural control and/or concentric eversion strength exists, the cause of chronic ankle instability remains controversial. LEVELS OF EVIDENCE Therapeutic Level IV: Review of Level IV studies.
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Affiliation(s)
- Takumi Kobayashi
- Department of Physical Therapy, Hokkaido Chitose Institute of Rehabilitation Technology, Hokkaido, Japan (TK)Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan (KG)
| | - Kazuyoshi Gamada
- Department of Physical Therapy, Hokkaido Chitose Institute of Rehabilitation Technology, Hokkaido, Japan (TK)Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan (KG)
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87
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Martins CN, Tarouco CP, Martin DG, Signori LU. Eletromiográfia do reto femoral em diferentes equipamentos proprioceptivos no meio aquático. REV BRAS MED ESPORTE 2014. [DOI: 10.1590/1517-86922014200401985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUÇÃO: A propriocepção é uma variável imprescindível para prevenção e reabilitação das lesões do joelho, podendo ser estimulada por diferentes equipamentos, os quais ainda não foram testados em meio aquático.OBJETIVO: Avaliar a atividade eletromiográfica (EMG) do músculo reto femoral de atletas no meio aquático frente a três diferentes equipamentos proprioceptivos (cama elástica, disco proprioceptivo e balancim).MÉTODOS: A amostra foi composta por dez jogadores de futsal profissional, sem histórico de lesões musculoesqueléticas (últimos três meses), com 23,1 (±1,5) anos e índice de massa corporal 25,2 (±0,5) kg/m². A aquisição do sinal EMG do reto femoral do membro dominante foi adquirido por eletrodos de superfície, aproximadamente 2,5 cm da posição distal do ponto motor. O nível da água foi ajustado individualmente (entre a região umbilical e o processo xifoide) e a temperatura mantida a 32 °C. As avaliações compreenderam o repouso, a contração voluntária máxima (CVM) antes e depois dos experimentos e os estímulos proprioceptivos (cama elástica, disco proprioceptivo e balancim) em apoio unipodal. Os dados (média ± erro padrão) foram comparados pelo teste-tpareado e pela ANOVA para medidas repetidas seguida de testeBonferrroni (post hoc).RESULTADOS: A EMG da CVM antes (221,0 ± 134 RMS/µVolts) e depois (243,0 ± 154,0 RMS/µVolts) foi semelhante (p = 0,129). No meio aquático, a cama elástica, o balancim e o disco apresentaram respectivamente 24,5 (±4,3), 33,9 (±4,3) e 32,5 (±6,7) %CVM. A atividade EMG do reto femoral na cama elástica foi 8% menor que o balancim e 9,5% que o disco proprioceptivo (p < 0,001).CONCLUSÃO: No meio aquático os equipamentos proprioceptivos promovem a ativação do reto femoral. Entretanto, a cama elástica apresenta menor atividade que o disco e o balancim, sugerindo-se que este equipamento deva ser utilizado no início da estimulação proprioceptiva.
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88
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Chan C, Ackermann B. Evidence-informed physical therapy management of performance-related musculoskeletal disorders in musicians. Front Psychol 2014; 5:706. [PMID: 25071671 PMCID: PMC4086404 DOI: 10.3389/fpsyg.2014.00706] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/19/2014] [Indexed: 12/26/2022] Open
Abstract
Playing a musical instrument at an elite level is a highly complex motor skill. The regular daily training loads resulting from practice, rehearsals and performances place great demands on the neuromusculoskeletal systems of the body. As a consequence, performance-related musculoskeletal disorders (PRMDs) are globally recognized as common phenomena amongst professional orchestral musicians. These disorders create a significant financial burden to individuals and orchestras as well as lead to serious consequences to the musicians’ performance and ultimately their career. Physical therapists are experts in treating musculoskeletal injuries and are ideally placed to apply their skills to manage PRMDs in this hyper-functioning population, but there is little available evidence to guide specific injury management approaches. An Australia-wide survey of professional orchestral musicians revealed that the musicians attributed excessively high or sudden increase in playing-load as major contributors to their PRMDs. Therefore, facilitating musicians to better manage these loads should be a cornerstone of physical therapy management. The Sound Practice orchestral musicians work health and safety project used formative and process evaluation approaches to develop evidence-informed and clinically applicable physical therapy interventions, ultimately resulting in favorable outcomes. After these methodologies were employed, the intervention studies were conducted with a national cohort of professional musicians including: health education, onsite injury management, cross-training exercise regimes, performance postural analysis, and music performance biomechanics feedback. The outcomes of all these interventions will be discussed alongside a focussed review on the existing literature of these management strategies. Finally, a framework for best-practice physical therapy management of PRMDs in musicians will be provided.
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Affiliation(s)
- Cliffton Chan
- Discipline of Biomedical Science, Sydney Medical School, The University of Sydney Sydney, NSW, Australia
| | - Bronwen Ackermann
- Discipline of Biomedical Science, Sydney Medical School, The University of Sydney Sydney, NSW, Australia
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89
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Janssen KW, Hendriks MRC, van Mechelen W, Verhagen E. The Cost-Effectiveness of Measures to Prevent Recurrent Ankle Sprains: Results of a 3-Arm Randomized Controlled Trial. Am J Sports Med 2014; 42:1534-41. [PMID: 24753237 DOI: 10.1177/0363546514529642] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ankle sprains are the most common sports-related injury, associated with a high rate of recurrence and societal costs. Recent studies have emphasized the effectiveness of both neuromuscular training and bracing for the secondary prevention of ankle sprains. PURPOSE To evaluate the cost-effectiveness of the separate and combined use of bracing and neuromuscular training for the prevention of the recurrence of ankle sprains. STUDY DESIGN Economic and decision analysis; Level of evidence, 2. METHODS A total of 340 athletes (157 male and 183 female; aged 12-70 years) who had sustained a lateral ankle sprain up to 2 months before inclusion were randomized to a neuromuscular training group (n = 107), brace group (n = 113), and combined intervention group (n = 120). Randomization was stratified by medical treatment of the inclusion sprain. Participants in the neuromuscular training group underwent an 8-week home-based exercise program. Participants in the brace group received a semirigid ankle brace to be worn during all sports activities for a period of 12 months. Participants allocated to the combined group underwent both interventions, with the ankle brace to be worn during all sports activities for a period of 8 weeks. The recurrence of ankle sprains and associated costs were registered during the 1-year follow-up. RESULTS There were no differences between groups at baseline with regard to age, sex, sports participation, previous injury, or knowledge of preventive measures. The incremental cost-effectiveness ratio (ICER) of the brace group in comparison with the combined group was -€2828.30 (approximately--US$3865.00), based on a difference in the mean cost of -€76.16 (approximately--US$104.00) and a difference in the mean effects of 2.68%. The ICER of the neuromuscular training group in comparison with the combined group was €310.08 (approximately US$424.00), based on a difference in the mean cost of -€28.37 (approximately--US$39.00) and a difference in the mean effects of 9.15%. CONCLUSION Bracing was found to be the dominant secondary preventive intervention over both neuromuscular training and the combination of both measures.
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Affiliation(s)
- Kasper W Janssen
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Marike R C Hendriks
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands Department of Human Movement Sciences, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Willem van Mechelen
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Evert Verhagen
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
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90
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Kemler E, van de Port I, Valkenberg H, Hoes AW, Backx FJG. Ankle injuries in the Netherlands: Trends over 10-25 years. Scand J Med Sci Sports 2014; 25:331-7. [PMID: 24840653 DOI: 10.1111/sms.12248] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2014] [Indexed: 12/11/2022]
Abstract
Ankle injuries are a common health problem; data on ankle injury rates and time trends in the population at large are scarce. Our aim was to investigate the incidence of and time trends in population-based and emergency department-treated ankle injuries related to sports activities and other activities related to daily living. Data were obtained from one national survey on accidents and injuries (2000-2010) and one based on emergency department data (1986-2010). Linear regression was used to determine linear trends in ankle injuries per 1000 person-years. The number of ankle injuries related to sports activities and other activities of daily living increased from 19.0 to 26.6 per 1000 person-years (P = 0.002). The number of sports-related ankle injuries treated in emergency departments decreased from 4.2 to 1.5 per 1000 person-years (P < 0.001), and from 3.2 to 2.1 per 1000 person-years (P < 0.001) for other activities of daily living. According to our data, the incidence rates of all ankle injuries are around 5.5 times higher than those registered at emergency departments. The high incidence rates of ankle injuries highlight the need for proper ankle injury treatment and prevention.
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Affiliation(s)
- E Kemler
- Department of Rehabilitation, Nursing Science and Sport, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands.,Consumer Safety Institute, Amsterdam, The Netherlands
| | - I van de Port
- Department of Rehabilitation, Nursing Science and Sport, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands.,Revant Rehabilitation Centre Breda, Breda, The Netherlands
| | - H Valkenberg
- Consumer Safety Institute, Amsterdam, The Netherlands
| | - A W Hoes
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - F J G Backx
- Department of Rehabilitation, Nursing Science and Sport, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands
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91
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Peres MM, Cecchini L, Pacheco I, Pacheco AM. Efeitos do treinamento proprioceptivo na estabilidade do tornozelo em atletas de voleibol. REV BRAS MED ESPORTE 2014. [DOI: 10.1590/1517-86922014200202046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUÇÃO: Nos esportes onde há contato entre os atletas, como no voleibol, a entorse por mecanismo de inversão é a lesão mais frequente e o tornozelo é a articulação mais acometida quando comparada com as outras, acarretando déficits importantes como a instabilidade articular. Programas de treinamento proprioceptivo têm sido amplamente utilizados para minimizar essas questões.OBJETIVO: Avaliar o efeito de um treinamento proprioceptivo na estabilidade articular do tornozelo por meio do teste Star Excusion Balance Test (SEBT) em atletas de voleibol.MÉTODOS: Foram avaliadas 11 atletas de voleibol de um clube poliesportivo da cidade de Porto Alegre, RS, Brasil, por meio de um teste de avaliação para estabilidade articular do tornozelo, SEBT. As atletas passaram por um programa de treinamento proprioceptivo composto por seis exercícios que trabalharam propriocepção em diferentes graus de exigência durante quatro semanas e este teste foi aplicado no pré e pós-intervenção pelo programa de treinamento proprioceptivo das atletas.RESULTADOS: As variáveis quantitativas foram descritas por média e desvio padrão, e o estudo da normalidade das variáveis foi descrito pelo teste de Shapiro-Wilk. As variáveis categóricas foram descritas por frequências absolutas e relativas. Para a comparação de médias de ambos os tornozelos pré e pós-intervenção foi utilizado o teste T pareado. O nível de significância adotado foi de 5% (p≤0,05) e as análises foram realizadas no programa SPSS (Statistical Package for the Social Sciences) versão 18. Os resultados no teste SEBT das atletas pré e pós-intervenção proprioceptivo mostrou diferença significativa em seis direções para o tornozelo direito e cinco para o tornozelo esquerdo.CONCLUSÃO: Um programa de treinamento proprioceptivo parece ser eficaz para o incremento da estabilidade articular que é fundamental para atletas de voleibol expostas ao risco de entorses de tornozelo que geram instabilidades crônicas.
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Affiliation(s)
| | | | - Ivan Pacheco
- Grêmio Náutico União, Brasil; Federação Gaúcha de Futebol, Brasil
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92
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Huurnink A, Fransz DP, Kingma I, Verhagen EALM, van Dieën JH. Postural stability and ankle sprain history in athletes compared to uninjured controls. Clin Biomech (Bristol, Avon) 2014; 29:183-8. [PMID: 24332381 DOI: 10.1016/j.clinbiomech.2013.11.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 11/17/2013] [Accepted: 11/18/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diminished postural stability is a risk factor for ankle sprain occurrence and ankle sprains result in impaired postural stability. To date, ankle sprain history has not been taken into account as a determinant of postural stability, while it could possibly specify subgroups of interest. METHODS Postural stability was compared between 18 field hockey athletes who had recovered from an ankle sprain (mean (SD); 3.6 (1.5) months post-injury), and 16 uninjured controls. Force plate and kinematics parameters were calculated during single-leg standing: mean center of pressure speed, mean absolute horizontal ground reaction force, mean absolute ankle angular velocity, and mean absolute hip angular velocity. Additionally, cluster analysis was applied to the 'injured' participants, and the cluster with diminished postural stability was compared to the other participants with respect to ankle sprain history. FINDINGS MANCOVA showed no significant difference between groups in postural stability (P = 0.68). A self-reported history of an (partial) ankle ligament rupture was typically present in the cluster with diminished postural stability. Subsequently, a 'preceding rupture' was added as a factor in the MANCOVA, which showed a significant association between diminished postural stability and a 'preceding rupture' (P = 0.01), for all four individual parameters (P: 0.001-0.029; Cohen's d: 0.96-2.23). INTERPRETATION Diminished postural stability is not apparent in all previously injured athletes. However, our analysis suggests that an (mild) ankle sprain with a preceding severe ankle sprain is associated with impaired balance ability. Therefore, sensorimotor training may be emphasized in this particular group and caution is warranted in return to play decisions.
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Affiliation(s)
- Arnold Huurnink
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands.
| | - Duncan P Fransz
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
| | - Idsart Kingma
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
| | | | - Jaap H van Dieën
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
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93
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Calatayud J, Borreani S, Colado JC, Flandez J, Page P, Andersen LL. Exercise and ankle sprain injuries: a comprehensive review. PHYSICIAN SPORTSMED 2014; 42:88-93. [PMID: 24565825 DOI: 10.3810/psm.2014.02.2051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ankle sprains are common in team sports and sports played on courts, and often result in structural and functional alterations that lead to a greater reinjury risk. Specific exercises are often used to promote neuromuscular improvements in the prevention and rehabilitation of ankle injuries. This literature review summarizes the neuromuscular characteristics of common ankle sprains and the effectiveness of exercise as an intervention for improving neuromuscular function and preventing reinjury. Our review found that appropriate exercise prescription can increase static and dynamic balance and decrease injury recurrence. In particular, the addition of dynamic activities in the exercise program can be beneficial because of the anticipatory postural adjustments identified as a key factor in the injury mechanism.
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94
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Vriend I, Coehoorn I, Verhagen E. Implementation of an app-based neuromuscular training programme to prevent ankle sprains: a process evaluation using the RE-AIM Framework. Br J Sports Med 2014; 49:484-8. [PMID: 24470587 DOI: 10.1136/bjsports-2013-092896] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIM The contemporary electronic media is regarded as a practical tool in the dissemination of preventive measures and interventions. For this purpose an App (free of charge) was developed including an efficacious programme for the prevention of ankle sprain recurrences. This study evaluated the implementation effectiveness of this 'Versterk je Enkel' App. METHODS The App was evaluated within its practical context using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) Framework. The launch of the App was accompanied by a press release, website banners, as well as online and offline advertisements. Data for the evaluation of the App were objectively registered through Google analytics. Data were obtained in February 2013 based on 25,781 users resulting in follow-ups of 18 months (iOS version) and 15 months (Android version), respectively. Users questionnaires provided a qualitative view of the objectively assessed measures (n=82) to gain insight into the demographics of users, reasons to download, user experience and how the information was used. RESULTS The App reached only 2.6% of the projected target population. User ratings for the App's relevancy, clarity, usefulness, appeal, information and reliability were high. App usage indicates that compliance with the embedded programme was low. CONCLUSIONS Although the App was well received by the users, targeted efforts are required to ensure proper uptake and usage of the App by the target population. This also holds true for eHealth and mHealth efforts aimed at athlete care and injury prevention in general.
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Affiliation(s)
| | | | - Evert Verhagen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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95
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Janssen KW, van Mechelen W, Verhagen EALM. Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial. Br J Sports Med 2014; 48:1235-9. [PMID: 24398222 PMCID: PMC4145426 DOI: 10.1136/bjsports-2013-092947] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Ankle sprain is the most common sports-related injury with a high rate of recurrence and associated costs. Recent studies have emphasised the effectiveness of both neuromuscular training and bracing for the secondary prevention of ankle sprains. Aim To evaluate the effectiveness of combined bracing and neuromuscular training, or bracing alone, against the use of neuromuscular training on recurrences of ankle sprain after usual care. Methods 384 athletes, aged 18–70, who had sustained a lateral ankle sprain, were included (training group n=120; brace group n=126; combi group n=138). The training group received an 8-week home-based neuromuscular training programme, the brace group received a semirigid ankle brace to be worn during all sports activities for 12 months, and the combi group received both the training programme, as well as the ankle brace, to be worn during all sports activities for 8 weeks. The main outcome measure was self-reported recurrence of the ankle sprain. Results During the 1-year follow-up, 69 participants (20%) reported a recurrent ankle sprain: 29 (27%) in the training group, 17 (15%) in the brace group and 23 (19%) in the combi group. The relative risk for a recurrent ankle sprain in the brace group versus the training group was 0.53 (95% CI 0.29 to 0.97). No significant differences were found for time losses or costs due to ankle sprains between the intervention groups. Conclusions Bracing was superior to neuromuscular training in reducing the incidence but not the severity of self-reported recurrent ankle sprains after usual care.
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Affiliation(s)
- Kasper W Janssen
- Department of Public and Occupational Health EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Department of Sports and Exercise Medicine, Sports Medical Centre JBZ, 's-Hertogenbosch, The Netherlands
| | - Willem van Mechelen
- Department of Public and Occupational Health EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Evert A L M Verhagen
- Department of Public and Occupational Health EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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96
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Van Reijen M, Vriend II, Zuidema V, van Mechelen W, Verhagen EA. The implementation effectiveness of the 'Strengthen your ankle' smartphone application for the prevention of ankle sprains: design of a randomized controlled trial. BMC Musculoskelet Disord 2014; 15:2. [PMID: 24393146 PMCID: PMC3923004 DOI: 10.1186/1471-2474-15-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/31/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Ankle sprains continue to pose a significant burden to the individual athlete, as well as to society as a whole. However, despite ankle sprains being the single most common sports injury and despite an active approach by various Dutch organisations in implementing preventive measures, large-scale community uptake of these preventive measures, and thus actual prevention of ankle sprains, is lagging well behind. In an attempt to bridge this implementation gap, the Dutch Consumer Safety Institute VeiligheidNL developed a freely available interactive App ('Strenghten your ankle' translated in Dutch as: 'Versterk je enkel; available for iOS and Android) that contains - next to general advice on bracing and taping - a proven cost-effective neuromuscular program. The 'Strengthen your ankle' App has not been evaluated against the 'regular' prevention approach in which the neuromuscular program is advocated through written material. The aim of the current project is to evaluate the implementation value of the 'Strengthen your ankle' App as compared to the usual practice of providing injured athletes with written materials. In addition, as a secondary outcome measure, the cost-effectiveness will be assessed against usual practice. METHODS/DESIGN The proposed study will be a randomised controlled trial. After stratification for medical caregiver, athletes will be randomised to two study groups. One group will receive a standardized eight-week proprioceptive training program that has proven to be cost-effective to prevent recurrent ankle injuries, consisting of a balance board (machU/ MSG Europe BVBA), and a traditional instructional booklet. The other group will receive the same exercise program and balance board. However, for this group the instructional booklet is exchanged by the interactive 'Strengthen your ankle' App. DISCUSSION This trial is the first randomized controlled trial to study the implementation effectiveness of an App for proprioceptive balance board training program in comparison to a traditional printed instruction booklet, with the recurrence of ankle sprains among athletes as study outcome. Results of this study could possibly lead to changes in practical guidelines on the treatment of ankle sprains and in the use of mobile applications for injury prevention. Results will become available in 2014. TRIAL REGISTRATION The Netherlands National Trial Register NTR4027. The NTR is part of the WHO Primary Registries.
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Affiliation(s)
| | | | | | | | - Evert A Verhagen
- Department of Public & Occupational Health, EMGO + Institute for Health and Care Research and VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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97
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Chan C, Driscoll T, Ackermann B. Exercise DVD effect on musculoskeletal disorders in professional orchestral musicians. Occup Med (Lond) 2013; 64:23-30. [DOI: 10.1093/occmed/kqt117] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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98
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Shrier I, Steele RJ, Verhagen E, Herbert R, Riddell CA, Kaufman JS. Beyond intention to treat: what is the right question? Clin Trials 2013; 11:28-37. [PMID: 24096636 DOI: 10.1177/1740774513504151] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Most methodologists recommend intention-to-treat (ITT) analysis in order to minimize bias. Although ITT analysis provides an unbiased estimate for the effect of treatment assignment on the outcome, the estimate is biased for the actual effect of receiving treatment (active treatment) compared to some comparison group (control). Other common analyses include measuring effects in (1) participants who follow their assigned treatment (Per Protocol), (2) participants according to treatment received (As Treated), and (3) those who would comply with recommended treatment (Complier Average Causal Effect (CACE) as estimated by Principal Stratification or Instrumental Variable Analyses). As each of these analyses compares different study subpopulations, they address different research questions. PURPOSE For each type of analysis, we review and explain (1) the terminology being used, (2) the main underlying concepts, (3) the questions that are answered and whether the method provides valid causal estimates, and (4) the situations when the analysis should be conducted. METHODS We first review the major concepts in relation to four nuances of the clinical question, 'Does treatment improve health?' After reviewing these concepts, we compare the results of the different analyses using data from two published randomized controlled trials (RCTs). Each analysis has particular underlying assumptions and all require dichotomizing adherence into Yes or No. We apply sensitivity analyses so that intermediate adherence is considered (1) as adherence and (2) as non-adherence. RESULTS The ITT approach provides an unbiased estimate for how active treatment will improve (1) health in the population if a policy or program is enacted or (2) health of patients if a clinician changes treatment practice. The CACE approach generally provides an unbiased estimate of the effect of active treatment on health of patients who would follow the clinician's advice to take active treatment. Unfortunately, there is no current analysis for clinicians and patients who want to know whether active treatment will improve the patient's health if taken, which is different from the effect in patients who would follow the clinician's advice to take active treatment. Sensitivity analysis for the CACE using two published data sets suggests that the underlying assumptions appeared to be violated. LIMITATIONS There are several methods within each analytical approach we describe. Our analyses are based on a subset of these approaches. CONCLUSIONS Although adherence-based analyses may provide meaningful information, the analytical method should match the clinical question, and investigators should clearly outline why they believe assumptions hold and should provide empirical tests of the assumptions where possible.
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Affiliation(s)
- Ian Shrier
- aCentre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
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99
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Guillodo Y, Simon T, Le Goff A, Saraux A. Interest of rehabilitation in healing and preventing recurrence of ankle sprains. Ann Phys Rehabil Med 2013; 56:503-14. [DOI: 10.1016/j.rehab.2013.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/26/2013] [Accepted: 06/29/2013] [Indexed: 12/15/2022]
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100
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Hoffmann TC, Erueti C, Glasziou PP. Poor description of non-pharmacological interventions: analysis of consecutive sample of randomised trials. BMJ 2013; 347:f3755. [PMID: 24021722 PMCID: PMC3768250 DOI: 10.1136/bmj.f3755] [Citation(s) in RCA: 252] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the completeness of descriptions of non-pharmacological interventions in randomised trials, identify which elements are most frequently missing, and assess whether authors can provide missing details. DESIGN Analysis of consecutive sample of randomised trials of non-pharmacological interventions. DATA SOURCES AND STUDY SELECTION All reports of randomised trials of non-pharmacological interventions published in 2009 in six leading general medical journals; 133 trial reports, with 137 interventions, met the inclusion criteria. DATA COLLECTION Using an eight item checklist, two raters assessed the primary full trial report, plus any reference materials, appendices, or websites. Questions about missing details were emailed to corresponding authors, and relevant items were then reassessed. RESULTS Of 137 interventions, only 53 (39%) were adequately described; this was increased to 81 (59%) by using 63 responses from 88 contacted authors. The most frequently missing item was the "intervention materials" (47% complete), but it also improved the most after author response (92% complete). Whereas some authors (27/70) provided materials or further information, other authors (21/70) could not; their reasons included copyright or intellectual property concerns, not having the materials or intervention details, or being unaware of their importance. Although 46 (34%) trial interventions had further information or materials readily available on a website, many were not mentioned in the report, were not freely accessible, or the URL was no longer functioning. CONCLUSIONS Missing essential information about interventions is a frequent, yet remediable, contributor to the worldwide waste in research funding. If trial reports do not have a sufficient description of interventions, other researchers cannot build on the findings, and clinicians and patients cannot reliably implement useful interventions. Improvement will require action by funders, researchers, and publishers, aided by long term repositories of materials linked to publications.
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Affiliation(s)
- Tammy C Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Qld, Australia, 4229
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