The adjunctive role of imagery on the functional rehabilitation of a grade II ankle sprain

The Effects of Motor Imagery on Static and Dynamic Balance and on the Fear of Re-Injury in Professional Football Players with Grade II Ankle Sprains

Lateral ankle sprains are one of the most frequent athletic injuries in football, causing deficits in balance. Motor Imagery (MI) has been successively included in sports rehabilitation as a complementary therapeutic intervention. The aim of the present study was to explore the effects of MI on static and dynamic balance and on the fear of re-injury in professional football players with Grade II ankle sprains. Fifty-eight participants were randomly allocated into two groups: First-MI group (n = 29) and second-Placebo group (n = 29), and they each received six intervention sessions. The first MI group received MI guidance in addition to the balance training program, while the second Placebo group received only relaxation guidance. One-way ANOVA showed statistically significant results for all variables, both before and 4 weeks after the interventions for both groups. The t-test showed statistically significant differences between the two groups for static balance for the right lower extremity (t = 3.25, S (two-tailed) = 0.002, p < 0.05) and also for heart rate (final value) in all time phases. Further research is needed in order to establish MI interventions in sports trauma recovery using stronger MI treatments in combination with psychophysiological factors associated with sports rehabilitation.

The effect of movement representation techniques on ankle function and performance in persons with or without a lateral ankle sprain: a systematic review and meta-analysis

BACKGROUND

Lateral ankle sprains are highly prevalent and result in tissue damage, impairments of muscle strength, instability, and muscle activation. Up to 74% will experience ongoing symptoms after a lateral ankle sprain. In healthy subjects, motor imagery might induce neural changes in the somatosensory and motor areas of the brain, yielding favourable enhancements in muscular force. However, during motor imagery, difficulties in building a motor image, no somatosensory feedback, and the absence of structural changes at the level of the muscle might explain the differences found between motor imagery and physical practice. In rehabilitation, motor imagery might be supportive in rebuilding motor networks or creating new networks to restore impairments in muscle activation and movement patterns. This systematic review was undertaken to summarize the current body of evidence about the effect on motor imagery, or action observation, on lower leg strength, muscle performance, ankle range of motion, balance, and edema in persons with, and without, a lateral ankle sprain compared to usual care, a placebo intervention, or no intervention.

METHODS

A systematic review with meta-analysis of randomized controlled trials was conducted in healthy participants and participants with a lateral ankle sprain. Motor imagery or action observation in isolation, or in combination with usual care were compared to a placebo intervention, or no intervention. An electronic search of MEDLINE, EMBASE, Cinahl, Psychinfo, Sportdiscus, Web of Science, Cochrane and Google Scholar was conducted, and articles published up to 7th June 2023 were included. Two reviewers individually screened titles and abstracts for relevancy using the inclusion criteria. Variables related to muscle strength, muscle function, range of motion, balance, return to sports tests, or questionnaires on self-reported function or activities were extracted. A risk of bias assessment was done using the Cochrane Risk-of-Bias tool II by two reviewers. Meta-analysis using a random effects model was performed when two or more studies reported the same outcome measures. The Standardized Mean Difference (SMD) was calculated over the change from baseline scores. Review manager 5.4 was used to perform analysis of subgroup differences and test for statistically significant differences. Confidence intervals were visually checked for overlap between subgroups.

RESULTS

Nine studies, six examining healthy participants and three examining participants with an acute lateral ankle sprain, were included. All studies were rated with moderate to high risk of bias overall. Quality of the motor imagery interventions differed largely between studies. Meta-analysis showed a large and significant effect of motor imagery on lower leg strength (SMD 1.47, 95% CI 0.44 to 2.50); however, the evidence was downgraded to very low certainty due to substantial heterogeneity (I2 = 73%), limitations in the studies (some concerns in risk of bias in all studies), and imprecision (n =  < 300). Evidence showed no association with ankle range of motion (SMD 0.25, 95% CI -0.43 to 0.93), edema (SMD -1.11, 95% CI -1.60 to 3.81), the anterior reach direction of the Star Excursion Balance Test (SEBT) (SMD 0.73, 95% CI -0.62 to 2.08), the posterolateral direction (SMD 0.32, 95% CI -0.94 to 1.57), and the posteromedial direction (SMD 0.52, 95% CI -0.07 to 1.10). The certainty of evidence for the different comparisons was very low.

CONCLUSIONS

There is a low certainty, significant, positive effect for motor imagery being able to improve lower leg muscle strength in healthy participants. The effect on balance, range of motion and edema was uncertain and of very low certainty.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021243258.

Current Clinical Concepts: Integration of Psychologically Informed Practice for Management of Patients With Sport-Related Injuries

Psychologically informed practice is an approach to patient management that encourages clinicians to treat patients from a biopsychosocial perspective and can be adopted by athletic trainers to manage sport-related injuries. As described in the domains of athletic training clinical practice, athletic trainers are expected to identify, address, and make appropriate referrals regarding psychosocial responses to injuries and mental health symptoms. Psychologically informed practice suggests addressing physical impairments in addition to screening and intervening for psychosocial responses with patients. In this Current Clinical Concepts paper, we discuss appropriate patient-reported outcome measures used to screen for mental health symptoms and psychosocial responses, provide recommendations on psychological interventions that can be integrated to enhance patient outcomes, and describe how to effectively refer a patient to an appropriate mental health professional.

The Effects of Motor Imagery on Pain in Lower Limb Sports Injuries: A Systematic Review and Meta-Analysis

This review evaluated the efficacy of Motor Imagery intervention in athletes with lower limb sports injuries that could affect their pain levels during rehabilitation. We carried out a thorough research of the scientific literature for RCT studies in athletes with lower limb musculoskeletal sports injuries including search terms Motor Imagery AND pain, Motor Imagery AND sport injuries, Motor Imagery AND lower limb. We searched 3 major databases, PubMed, Scopus, and ScienceDirect, with the search period ranging from their inception until May 2022. We assessed the quality of the studies using the PEDro Scale and the data was recorded and extracted with the use of Mendeley software. The search criteria resulted in a pool of 10.107 possible articles. Upon completion of the selection procedure, only 3 RCT studies met the inclusion criteria with a total of 60 injured athletes (n = 18 with ankle sprain and n = 42 with ACL injuries). The meta-analysis showed no statistically significant positive effects of MI intervention on pain intensity after lower limb sports injuries (n = 60; MD = -1.57; 95% CI: -3.60 to 0.46; I² = 50%; p = 0.13). The limited number of studies could justify the statistically insignificant effect of MI, but although the methodological quality of the studies was moderate to high, the heterogeneity of them was also relatively high. More RCT's are required to explore the effect of MI on pain in athletes with lower limb injuries in order to address psychophysiological processes during rehabilitation.

Imagery ability assessments: a cross-disciplinary systematic review and quality evaluation of psychometric properties

BACKGROUND

Over the last two centuries, researchers developed several assessments to evaluate the multidimensional construct of imagery. However, no comprehensive systematic review (SR) exists for imagery ability evaluation methods and an in-depth quality evaluation of their psychometric properties.

METHODS

We performed a comprehensive systematic search in six databases in the disciplines of sport, psychology, medicine, education: SPORTDiscus, PsycINFO, Cochrane Library, Scopus, Web of Science, and ERIC. Two reviewers independently identified and screened articles for selection. COSMIN checklist was used to evaluate the methodological quality of the studies. All included assessments were evaluated for quality using criteria for good measurement properties. The evidence synthesis was summarised by using the GRADE approach.

RESULTS

In total, 121 articles reporting 155 studies and describing 65 assessments were included. We categorised assessments based on their construct on: (1) motor imagery (n = 15), (2) mental imagery (n = 48) and (3) mental chronometry (n = 2). Methodological quality of studies was mainly doubtful or inadequate. The psychometric properties of most assessments were insufficient or indeterminate. The best rated assessments with sufficient psychometric properties were MIQ, MIQ-R, MIQ-3, and VMIQ-2 for evaluation of motor imagery ability. Regarding mental imagery evaluation, only SIAQ and VVIQ showed sufficient psychometric properties.

CONCLUSION

Various assessments exist to evaluate an individual's imagery ability within different dimensions or modalities of imagery in different disciplines. However, the psychometric properties of most assessments are insufficient or indeterminate. Several assessments should be revised and further validated. Moreover, most studies were only evaluated with students. Further cross-disciplinary validation studies are needed including older populations with a larger age range. Our findings allow clinicians, coaches, teachers, and researchers to select a suitable imagery ability assessment for their setting and goals based on information about the focus and quality of the assessments.

SYSTEMATIC REVIEWS REGISTER

PROSPERO CRD42017077004 .

Motor effects of movement representation techniques and cross-education: a systematic review and meta-analysis

INTRODUCTION

The objective was to assess the impact of movement representation techniques (MRT) through motor imagery (MI), action observation (AO) and visual mirror feedback (VMF) and cross-education training (CE) on strength, range of motion (ROM), speed, functional state and balance during experimental immobilization processes in healthy individuals, in patients with injuries that did not require surgery and in those with surgical processes that did or did not require immobilization.

EVIDENCE ACQUISITION

MEDLINE, EMBASE, CINAHL and Google Scholar were searched. Thirteen meta-analyses were conducted.

EVIDENCE SYNTHESIS

Regarding the immobilized participants, in the healthy individuals, MI showed significant results regarding maintenance of strength and ROM, with low-quality evidence. Regarding the process with no immobilization, VMF and MI techniques showed significant changes in maintaining ROM in patients with injury without surgery, with very low-quality evidence. Results had shown that MI demonstrated significantly higher maintenance of strength and speed in patients undergoing surgery, with low-quality evidence. No significant results were found in ROM. Low-quality evidence showed better results in AO plus usual care compared with usual treatment in isolation with respect to maintenance of functional state and balance. CE training demonstrated maintenance of strength in patients undergoing surgery, with moderate evidence; however, not in healthy experimentally immobilized individuals. VMF did not show significant results in maintaining ROM after surgery without immobilization, nor did MI in maintaining strength after surgery and immobilization.

CONCLUSIONS

MRT and CE training have been shown to have a significant impact on the improvement of various motor variables and on physical maintenance in general.

Effect of Motor Imagery Training on Motor Learning in Children and Adolescents: A Systematic Review and Meta-Analysis

Background: There is an urgent need to systematically analyze the growing body of literature on the effect of motor imagery (MI) training in children and adolescents. Methods: Seven databases and clinicaltrials.gov were searched. Two reviewers independently screened references and full texts, and extracted data (studies’ methodology, MI elements, temporal parameters). Two studies were meta-analyzed providing the standard mean difference (SDM). Selected studies were evaluated with the risk of bias (RoB) and GRADE tools. Results: A total of 7238 references were retrieved. The sample size of the 22 included studies, published between 1995 and 2021, ranged from 18 to 136 participants, totaling 934 (nine to 18 years). Studies included healthy pupils, mentally retarded adolescents, children with motor coordination difficulties or with mild mental disabilities. The motor learning tasks focused on upper, lower and whole body movements. SMDs for the primary outcome of pooled studies varied between 0.83 to 1.87 (95% CI, I², T² varied 0.33–3.10; p = 0.001; 0–74%; 0–0.59). RoB varied between some concerns and high risk. GRADE rating was low. Conclusions: MI combined with physical practice (PP) might have a high potential for healthy and impaired children and adolescents. However, important reporting recommendations (PETTLEP, TIDieR, CONSORT) should be followed. The systematic review was registered with PROSPERO: CRD42021237361.

Thumbs up: Imagined hand movements counteract the adverse effects of post-surgical hand immobilization. Clinical, behavioral, and fMRI longitudinal observations

Motor imagery (M.I.) training has been widely used to enhance motor behavior. To characterize the neural foundations of its rehabilitative effects in a pathological population we studied twenty-two patients with rhizarthrosis, a chronic degenerative articular disease in which thumb-to-fingers opposition becomes difficult due to increasing pain while the brain is typically intact. Before and after surgery, patients underwent behavioral tests to measure pain and motor performance and fMRI measurements of brain motor activity.

After surgery, the affected hand was immobilized, and patients were enrolled in a M.I. training. The sample was split in those who had a high compliance with the program of scheduled exercises (T+, average compliance: 84%) and those with low compliance (T−, average compliance: 20%; cut-off point: 55%). We found that more intense M.I. training counteracts the adverse effects of immobilization reducing pain and expediting motor recovery. fMRI data from the post-surgery session showed that T+ patients had decreased brain activation in the premotor cortex and the supplementary motor area (SMA); meanwhile, for the same movements, the T− patients exhibited a reversed pattern. Furthermore, in the post-surgery fMRI session, pain intensity was correlated with activity in the ipsilateral precentral gyrus and, notably, in the insular cortex, a node of the pain matrix.

These findings indicate that the motor simulations of M.I. have a facilitative effect on recovery by cortical plasticity mechanisms and optimization of motor control, thereby establishing the rationale for incorporating the systematic use of M.I. into standard rehabilitation for the management of post-immobilization syndromes characteristic of hand surgery.

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Motor imagery training counteracts the effects of post-surgical hand immobilization.

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It also reduces pain and expedites motor recovery after immobilization.

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These effects were accompanied by significant fMRI signs of brain plasticity.

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The clinical-fMRI evidence advocates for the use of motor imagery in rehabilitation.

Motor imagery ability assessments in four disciplines: protocol for a systematic review

INTRODUCTION

Motor imagery (MI) is a very popular and well-accepted technique in different disciplines. Originating from sport and psychology, MI is now also used in the field of medicine and education. Several studies confirmed the benefits of MI to facilitate motor learning and skill acquisition. The findings indicated that individual's MI ability might influence the effectiveness of MI interventions. Over the last two centuries, researchers have developed several assessments to evaluate MI's abstract construct. However, no systematic reviews (SR) exist for MI ability evaluation methods and their measurement properties.

METHODS AND ANALYSIS

The SR will evaluate available MI ability assessments and their psychometric properties in four relevant disciplines: sports, psychology, medicine and education. This involves performing searches in SPORTDiscus, PsycINFO, Cochrane Library, Scopus, Web of Science and ERIC. Working independently, two reviewers will screen articles for selection. Then all raw information will be compiled in an overview table-including the articles' characteristics (eg, a study's setting or the population demographics) and the MI ability assessment (psychometric properties). To evaluate the articles' methodological quality, we will use the COSMIN checklist. Then we will evaluate all the included assessments' quality and perform a best-evidence synthesis. Results of this review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

ETHICS AND DISSEMINATION

The SR is based on published data, and ethical approval is not required. This review will provide information on assessment performance and equipment, as well as its main focus and usefulness. Furthermore, we will present the methodological quality of all the included articles and assess the included instruments' quality. Ultimately, this will act as a valuable resource, providing an overview of MI ability assessments for individual clinical settings, treatment aims, and various populations. The SR's final report will be published in a peer-reviewed journal and presented at relevant conferences.

PROSPERO REGISTRATION NUMBER

CRD42017077004.

Effects of two proprioceptive training programs on ankle range of motion, pain, functional and balance performance in individuals with ankle sprain

BACKGROUND

Following ankle sprain, residual symptoms are often apparent, and proprioceptive training is a treatment approach. Evidence, however, is limited and the optimal program has to be identified.

OBJECTIVE

To investigate the effects of two post-acute supervised proprioceptive training programs in individuals with ankle sprain.

METHODS

Participants were recruited from a physiotherapy center for ankle sprain rehabilitation. In a pre-post treatment, blinded-assessor design, 22 individuals were randomly allocated to a balance or a proprioceptive neuromuscular facilitation (PNF) group. Both groups received 10 rehabilitation sessions, within a six-week period. Dorsiflexion range of motion (ROM), pain, functional and balance performance were assessed at baseline, at the end of training and eight weeks after training.

RESULTS

Follow-up data were provided for 20 individuals. Eight weeks after training, statistically significant (p< 0.017) improvements were found in dorsiflexion ROM and most functional performance measures for both balance and PNF groups. Eight weeks after training, significant (p< 0.017) improvements in the frontal plane balance test and pain were observed for the balance group.

CONCLUSIONS

Balance and PNF programs are recommended in clinical practice for improving ankle ROM and functional performance in individuals with sprain. Balance programs are also recommended for pain relief.

Surgical management of chronic lateral ankle instability: a meta-analysis

Background

A key point to surgical treatment of chronic lateral ankle instability is choosing a suitable surgical procedure. The purpose of this meta-analysis was to compare different surgical techniques for management of chronic lateral ankle instability.

Methods

We searched the Cochrane Library, MEDLINE, and EMBASE. All identified randomized and quasi-randomized controlled trials of operative treatment for chronic lateral ankle instability were included. Two review authors independently extracted data from each study and assessed risk of bias. Where appropriate, results of comparable studies were pooled.

Results

Seven randomized controlled trials were included for analysis. They fell in five clearly distinct groups.

One study comparing two different kinds of non-anatomic reconstruction procedures (dynamic and static tenodesis) found two clinical outcomes favoring static tenodesis: better clinical satisfaction and fewer subsequent sprains.

Two studies compared non-anatomic reconstruction versus anatomic repairment. In one study, nerve damage was more frequent in non-anatomic reconstruction group; the other one reported that radiological measurement of ankle laxity showed that non-anatomic reconstruction provided higher reduction of talar tilt angle.

Two studies comparing two anatomic repairment surgical techniques (transosseous suture versus imbrication) showed no significant difference in any clinical outcome at the follow-up except operation time.

One study compared two different anatomic repairment techniques. They found that the double anchor technique was superior with respect to the reduction of talar tilt than single anchor technique.

One study compared an anatomic reconstruction procedure with a modified Brostrom technique. Primary reconstruction combined with ligament advanced reinforcement system results in better patient-scored clinical outcome, at 2 years post-surgery, than the modified Brostrom procedure.

Conclusions

There is limited evidence to support any one surgical technique over another surgical technique for chronic lateral ankle instability, but based on the evidence, we could still get some conclusions: (1) There are limitations to the use of dynamic tenodesis, which obtained poor clinical satisfaction and more subsequent sprains. (2) Non-anatomic reconstruction abnormally increased inversion stiffness at the subtalar level as compare with anatomic repairment. (3) Multiple types of modified Brostrom procedures could acquire good clinical results. (4) Anatomic reconstruction is a better procedure for some specific patients.

Electronic supplementary material

The online version of this article (10.1186/s13018-018-0870-6) contains supplementary material, which is available to authorized users.

The therapeutic role of motor imagery during the acute phase after total knee arthroplasty: a pilot study

PURPOSE

The aim of this study was to measure physical and functional outcomes during the acute postoperative recovery in patients who underwent total knee arthroplasty. Motor imagery has been shown to decrease pain and promote functional recovery after both neurological and peripheral injuries. Yet, whether motor imagery can be included as an adjunct effective method into physical therapy programs following total knee arthroplasty remains a working hypothesis that we aim to test in a pilot study.

METHOD

Twenty volunteers were randomly assigned to either a motor imagery or a control group. Pain, range of motion, knee girth as well as quadriceps strength and Timed Up and Go Test time were the dependent variables during pre-test and post-test.

RESULTS

The motor imagery group exhibited larger decrease of ipsilateral pain and knee girth, a slightly different evolution of range of motion and an increase of ipsilateral quadriceps strength compared to the control group. No effects of motor imagery on Timed Up and Go Test scores were observed.

CONCLUSION

Implementing motor imagery practice into the course of physical therapy enhanced various physical outcomes during acute postoperative recovery after total knee arthroplasty. According to this pilot study, motor imagery might be relevant to promote motor relearning and recovery after total knee arthroplasty.Partial effect-sizes should be conducted in the future. Implications for rehabilitation    Adding motor imagery to physical therapy sessions during the acute period following total knee arthroplasty:    • Enhances quadriceps strength.    • Alleviates pain.    • Enhances range of motion.    • Does not have any effect on basic functional mobility.    • Does not have any effect on knee girth.

Mental steps: Differential activation of internal pacemakers in motor imagery and in mental imitation of gait

Gait imagery and gait observation can boost the recovery of locomotion dysfunctions; yet, a neurologically justified rationale for their clinical application is lacking as much as a direct comparison of their neural correlates. Using functional magnetic resonance imaging, we measured the neural correlates of explicit motor imagery of gait during observation of in-motion videos shot in a park with a steady cam (Virtual Walking task). In a 2 × 2 factorial design, we assessed the modulatory effect of gait observation and of foot movement execution on the neural correlates of the Virtual Walking task: in half of the trials, the participants were asked to mentally imitate a human model shown while walking along the same route (mental imitation condition); moreover, for half of all the trials, the participants also performed rhythmic ankle dorsiflexion as a proxy for stepping movements. We found that, beyond the areas associated with the execution of lower limb movements (the paracentral lobule, the supplementary motor area, and the cerebellum), gait imagery also recruited dorsal premotor and posterior parietal areas known to contribute to the adaptation of walking patterns to environmental cues. When compared with mental imitation, motor imagery recruited a more extensive network, including a brainstem area compatible with the human mesencephalic locomotor region (MLR). Reduced activation of the MLR in mental imitation indicates that this more visually guided task poses less demand on subcortical structures crucial for internally generated gait patterns. This finding may explain why patients with subcortical degeneration benefit from rehabilitation protocols based on gait observation. Hum Brain Mapp 38:5195-5216, 2017. © 2017 Wiley Periodicals, Inc.

Supervised rehabilitation versus home exercise in the treatment of acute ankle sprains: a systematic review

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.

Effects of mental practice in novice learners in a serial positioning skill acquisition

The effects of mental practice in novices were investigated. University students (N = 60) performed a serial aiming task, distributed in 5 groups of 12: mental practice, physical practice, mental-physical practice (first mental then physical practice), physical-mental practice (first physical then mental practice), and a control group that only performed the tests. Participants transported three tennis balls among six containers in a pre-established sequence in a target time. In the acquisition phase and retention test (24 hr. later), the task was the same; in the transfer test, 5 min. after the acquisition phase, sequence and time changed. Six trials were performed in the acquisition phase, and each test consisted of 9 trials. The performance measures were absolute error, constant error, and variable error; a t test and a two-way ANOVA were used to compare the acquisition phase and tests, respectively. Physical practice and both groups of combined conditions presented better performance in tests than the mental practice and control groups. Mental practice without motor experience in the task did not improve motor learning. Prior physical performance is desirable before conducting mental practice.

The therapeutic role of motor imagery on the functional rehabilitation of a stage II shoulder impingement syndrome

PURPOSE

Motor imagery (MI) has been used as a complementary therapeutic tool for motor recovery after central nervous system disease and peripheral injuries. However, it has never been used as a preventive tool. We investigated the use of MI in the rehabilitation of stage II shoulder impingement syndrome. For the first time, MI is used before surgery.

METHOD

Sixteen participants were randomly assigned to either a MI or control group. Shoulder functional assessment (Constant score), range of motion and pain were measured before and after intervention.

RESULTS

Higher Constant score was observed in the MI than in the control group (p=0.04). Participants in the MI group further displayed greater movement amplitude (extension (p<0.001); flexion (p=0.025); lateral rotation (p<0.001). Finally, the MI group showed greater pain decrease (p=0.01).

CONCLUSION

MI intervention seems to alleviate pain and enhance mobility, this is probably due to changes in muscle control and consequently in joint amplitude. MI might contribute to postpone or even protect from passing to stage III that may require surgery. Implications for Rehabilitation Adding motor imagery training to classical physical therapy in a stage II impingement syndrome: Helps in alleviating pain Enhances shoulder mobility Motor imagery is a valuable technique that can be used as a preventive tool before the stage III of the impingement syndrome.

Therapeutic interventions for increasing ankle dorsiflexion after ankle sprain: a systematic review

CONTEXT

Clinicians perform therapeutic interventions, such as stretching, manual therapy, electrotherapy, ultrasound, and exercises, to increase ankle dorsiflexion. However, authors of previous studies have not determined which intervention or combination of interventions is most effective.

OBJECTIVE

To determine the magnitude of therapeutic intervention effects on and the most effective therapeutic interventions for restoring normal ankle dorsiflexion after ankle sprain.

DATA SOURCES

We performed a comprehensive literature search in Web of Science and EBSCO HOST from 1965 to May 29, 2011, with 19 search terms related to ankle sprain, dorsiflexion, and intervention and by cross-referencing pertinent articles.

STUDY SELECTION

Eligible studies had to be written in English and include the means and standard deviations of both pretreatment and posttreatment in patients with acute, subacute, or chronic ankle sprains. Outcomes of interest included various joint mobilizations, stretching, local vibration, hyperbaric oxygen therapy, electrical stimulation, and mental-relaxation interventions.

DATA EXTRACTION

We extracted data on dorsiflexion improvements among various therapeutic applications by calculating Cohen d effect sizes with associated 95% confidence intervals (CIs) and evaluated the methodologic quality using the Physiotherapy Evidence Database (PEDro) scale.

DATA SYNTHESIS

In total, 9 studies (PEDro score = 5.22 ± 1.92) met the inclusion criteria. Static-stretching interventions with a home exercise program had the strongest effects on increasing dorsiflexion in patients 2 weeks after acute ankle sprains (Cohen d = 1.06; 95% CI = 0.12, 2.42). The range of effect sizes for movement with mobilization on ankle dorsiflexion among individuals with recurrent ankle sprains was small (Cohen d range = 0.14 to 0.39).

CONCLUSIONS

Static-stretching intervention as a part of standardized care yielded the strongest effects on dorsiflexion after acute ankle sprains. The existing evidence suggests that clinicians need to consider what may be the limiting factor of ankle dorsiflexion to select the most appropriate treatments and interventions. Investigators should examine the relationship between improvements in dorsiflexion and patient progress using measures of patient self-reported functional outcome after therapeutic interventions to determine the most appropriate forms of therapeutic interventions to address ankle-dorsiflexion limitation.

Psychosocial interventions for the prevention of disability following traumatic physical injury

BACKGROUND

Traumatic physical injury can result in many disabling sequelae including physical and mental health problems and impaired social functioning.

OBJECTIVES

To assess the effectiveness of psychosocial interventions in the prevention of physical, mental and social disability following traumatic physical injury.

SEARCH STRATEGY

The search was not restricted by date, language or publication status. We searched the following electronic databases; Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2009, Issue 1), MEDLINE (Ovid SP), EMBASE (Ovid SP), PsycINFO (Ovid SP), Controlled Trials metaRegister (www.controlled-trials.com), AMED (Allied & Complementary Medicine), ISI Web of Science: Social Sciences Citation Index (SSCI), PubMed. We also screened the reference lists of all selected papers and contacted authors of relevant studies. The latest search for trials was in February 2008.

SELECTION CRITERIA

Randomised controlled trials that consider one or more defined psychosocial interventions for the prevention of physical disability, mental health problems or reduced social functioning as a result of traumatic physical injury. We excluded studies that included patients with traumatic brain injury (TBI).

DATA COLLECTION AND ANALYSIS

Two authors independently screened the titles and abstracts of search results, reviewed the full text of potentially relevant studies, independently assessed the risk of bias and extracted data.

MAIN RESULTS

We included five studies, involving 756 participants. Three studies assessed the effect of brief psychological therapies, one assessed the impact of a self-help booklet, and one the effect of collaborative care. The disparate nature of the trials covering different patient populations, interventions and outcomes meant that it was not possible to pool data meaningfully across studies. There was no evidence of a protective effect of brief psychological therapy or educational booklets on preventing disability. There was evidence from one trial of a reduction in both post-traumatic stress disorder (PTSD) and depressive symptoms one month after injury in those who received a collaborative care intervention combined with a brief psycho-educational intervention, however this was not retained at follow up. Overall mental health status was the only disability outcome affected by any intervention. In three trials the psychosocial intervention had a detrimental effect on the mental health status of patients.

AUTHORS' CONCLUSIONS

This review provides no convincing evidence of the effectiveness of psychosocial interventions for the prevention of disability following traumatic physical injury. Taken together, our findings cannot be considered as supporting the provision of psychosocial interventions to prevent aspects of disability arising from physical injury. However, these conclusions are based on a small number of disparate trials with small to moderate sample sizes and are therefore necessarily cautious. More research, using larger sample sizes, and similar interventions and patient populations to enable pooling of results, is needed before these findings can be confirmed.

Understanding acute ankle ligamentous sprain injury in sports

This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL) which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing – a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms). Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60–90 ms). The failure supination or inversion torque is about 41–45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative. Immobilization should not be used as it results in joint stiffness, muscle atrophy and loss of proprioception. Traditional Chinese medicine such as herbs, massage and acupuncture were well applied in China in managing sports injuries, and was reported to be effective in relieving pain, reducing swelling and edema, and restoring normal ankle function. Finally, the best practice of sports medicine would be to prevent the injury. Different previous approaches, including designing prophylactice devices, introducing functional interventions, as well as change of games rules were highlighted. This paper allows the readers to catch up with the previous researches on ankle sprain injury, and facilitate the future research idea on sport-related ankle sprain injury.

Effects of Practice, Visual Loss, Limb Amputation, and Disuse on Motor Imagery Vividness

Background. The ability to generate vivid images of movements is variable across individuals and likely influenced by sensorimotor inputs. Objectives. The authors examined (1) the vividness of motor imagery in dancers and in persons with late blindness, with amputation or an immobilization of one lower limb; (2) the effects of prosthesis use on motor imagery; and (3) the temporal characteristics of motor imagery. Methods. Eleven dancers, 10 persons with late blindness, 14 with amputation, 6 with immobilization, and 2 groups of age-matched healthy individuals (27 in control group A; 35 in control group B) participated. The Kinesthetic and Visual Imagery Questionnaire served to assess motor imagery vividness. Temporal characteristics were assessed with mental chronometry. Results. The late blindness group and dance group displayed higher imagery scores than respective control groups. In the amputation and immobilization groups, imagery scores were lower on the affected side than the intact side and specifically for imagined foot movements. Imagery scores of the affected limb positively correlated with the time since walking with prosthesis. Movement times during imagination and execution (amputation and immobilization) were longer on the affected side than the intact side, but the temporal congruence between real and imagined movement times was similar to that in the control group. Conclusions. The mental representation of actions is highly modulated by imagery practice and motor activities. The ability to generate vivid images of movements can be specifically weakened by limb loss or disuse, but lack of movement does not affect the temporal characteristics of motor imagery.