Adherence and effectiveness of rehabilitation in acute ankle sprain

Factors associated with return to play following conservative treatment for lumbar spondylolysis among young athletes: A retrospective case series using structural equation modeling

INTRODUCTION

Lumbar spondylolysis is the most common underlying cause of lower back pain (LBP) in young athletes. Conservative treatment methods are often used to reduce pain and promote healing. Several parameters may affect the duration of conservative treatment, such as the time to return to play (RTP), patient behavior, and physical parameters; however, no study has comprehensively assessed the factors that affect the time to RTP.

OBJECTIVES

This study aimed to determine the factors associated with the time required for RTP among young athletes with early-stage spondylolysis receiving conservative treatment using structural equation modeling (SEM).

METHODS

In this retrospective case series, 137 young athletes (128 males and 9 females, aged 9-18 years) with early-stage lumbar spondylolysis were enrolled. All patients were examined using plain radiography and magnetic resonance imaging and treated conservatively (sports cessation, wearing a corset, therapeutic exercises, and low-intensity pulsed ultrasound radiation). SEM was used to investigate the factors affecting the time to RTP in these patients.

RESULTS

The final model included the following factors: spondylolysis laterality, symptom duration, lower-extremity flexibility, treatment interval, patient adherence, and residual LBP. SEM revealed that patient adherence to physician orders (p < 0.01), treatment interval (p < 0.001), and spondylolysis laterality (p < 0.001) contributed directly to shortened RTP.

CONCLUSION

Patient adherence is essential for reducing the time to RTP among young athletes receiving conservative treatment for early-stage spondylolysis.

Patient Compliance With Physical Therapy Following Orthopedic Surgery and Its Outcomes

BACKGROUND AND OBJECTIVES

Patient compliance is a major concern for the efficacy of physiotherapy amongst those that undergo orthopedic surgery. The substantial number of people who are non-compliant makes this an imperative issue to address. Our objectives were to quantify the percentage of patient compliance for physiotherapy after their surgery, to measure the association between compliance and the status of health, mobility, and pain, and to identify the causes of non-compliance.

METHODS

A cross-sectional study was conducted on post-orthopedic surgery patients attending physical therapy sessions at King Khalid University Hospital in Riyadh, Kingdom of Saudi Arabia, over a one-year period. The sample size of 359 was calculated and selected using simple random sampling. Our questionnaire was developed by adopting questions from two previously validated studies.

RESULTS

The majority of the participants (n=194; 54%) were male. One hundred and ninety-three (53.8%) participants had a diploma or higher. The age group 18-35 was found to be significantly associated with skipping physiotherapy sessions when they started to feel well (P= 0.016) and skipping due to other responsibilities (P=0.002). Single people skip physiotherapy when they start to feel well (P=0.023), due to other responsibilities (P=0.028), and due to poor timing (P=0.049). Self-reported compliance to physical therapy after surgery was 231 (64.3%). Patient status showed overall improvement.

CONCLUSION

There is a significant percentage of non-compliance and the patient's age, gender, marital status, and level of education play a role in the causes of non-compliance. In addition, the patient's status (health, pain, and mobility) is better in those who are compliant than in those who are not.

Current Concept Review: State of Acute Lateral Ankle Injury Classification Systems

Acute lateral ankle sprain (ALAS) is one of the most frequent musculoskeletal injuries, with a great impact on health and socioeconomic factors. There are few consensuses on this subject and multiple therapeutic options that are difficult to compare due to the lack of a universally adopted classification system. The objective of this study is to is to report the actual knowledge on how ALAS are classified and reported and not to make any therapeutic recommendation. A comprehensive literature review of the literature was carried out through a search in the MEDLINE, Cochrane Library and Google Scholar databases, with identification of articles that describe ways to classify lateral ankle sprains or with relevant content for their classification. Twenty-five different classification systems were identified. The majority of articles referring to ALAS use an unspecific classification. Most classification systems divide sprains into 3 degrees. The most used parameters are the anatomy of the injury, clinical parameters, functional loss and the presence of instability. No articles were found to verify the validity of the systems used, namely regarding their association with therapeutic proposals or prognostic predictions. Based on the available evidence, recommendations cannot be made regarding the most appropriate classification system. The considerable heterogeneity of the existing literature makes it difficult to compare studies and to optimize the treatment and follow-up of these injuries. Future research in this area is necessary to define a practical and rigorous system that can be used universally.

A pilot randomised control trial of the efficacy of stability-based training with visualisation for people with chronic ankle instability

Chronic ankle instability (CAI) is associated with recurring symptoms that inhibit daily activity. Stability-based rehabilitative training is recommended for CAI. Visualisation (VIS) produces real-time feedback using motion capture and virtual reality. This pilot study aimed to determine the feasibility, adherence, safety, and efficacy of incorporating VIS into stability training for people with CAI. Efficacy was examined through effect of VIS training on dynamic stability, perception of stability, and rehabilitative experience. Individuals with CAI completed a 4-week stability-based training programme with VIS, or without visualisation (NO-VIS). Participants completed the Star Excursion Balance Test (SEBT) and Cumberland Ankle Instability Tool (CAIT) prior to, and after training. Enjoyment of training was recorded using the Physical Activity Enjoyment Scale (PACES-8). Of 17 participants (VIS = 10, NO-VIS = 7), there were 2 drop outs (VIS = 1, NO-VIS = 1). No adverse events were reported, and participant drop-out was due to injury unrelated to the study. The VIS group showed a significantly greater increase in average SEBT reach distance (d = 1.7, p = 0.02). No significant differences were reported for the CAIT or PACES-8. This study supports the feasibility and safety of stability-based training with VIS in those with CAI. The enhanced performance outcome on the SEBT suggests VIS may enhance stability-based training.

Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study

Background

Acute musculoskeletal (MSK) pain is very common and associated with impaired productivity and high economic burden. Access to timely and personalized, evidence-based care is key to improve outcomes while reducing healthcare expenditure. Digital interventions can facilitate access and ensure care scalability.

Objective

Present the feasibility and results of a fully remote digital care program (DCP) for acute MSK conditions affecting several body areas.

Methods

Interventional single-arm study of individuals applying for digital care programs for acute MSK pain. Primary outcome was the mean change between baseline and end-of-program in self-reported Numerical Pain Rating Scale (NPRS) score and secondary outcomes were change in analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI-GH) and engagement.

Results

Three hundred forty-three patients started the program, of which 300 (87.5%) completed the program. Latent growth curve analysis (LGCA) revealed that changes in NPRS between baseline and end-of-program were both statistically (p < 0.001) and clinically significant: 64.3% reduction (mean − 2.9 points). Marked improvements were also noted in all secondary outcomes: 82% reduction in medication intake, 63% reduction in surgery intent, 40% in fear-avoidance beliefs, 54% in anxiety, 58% in depression and 79% recovery in overall productivity. All outcomes had steeper improvements in the first 4 weeks, which paralleled higher engagement in this period (3.6 vs 3.2 overall weekly sessions, p < 0.001). Mean patient satisfaction score was 8.7/10 (SD 1.26).

Strengths and limitations

This is the first longitudinal study demonstrating the feasibility of a DCP for patients with acute MSK conditions involving several body areas. Major strengths of this study are the large sample size, the wide range of MSK conditions studied, the breadth of outcomes measured, and the very high retention rate and adherence level. The major limitation regards to the absence of a control group.

Conclusions

We observed very high completion and engagement rates, as well as clinically relevant changes in all health-related outcomes and productivity recovery. We believe this DCP holds great potential in the delivery of effective and scalable MSK care.

Trial registration

NCT, NCT04092946. Registered 17/09/2019;

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04891-5.

Methods for assessment of patient adherence to removable orthoses used after surgery or trauma to the appendicular skeleton: a systematic review

Background

Patient adherence to treatment is a key determinant of outcome for healthcare interventions. Whilst non-adherence has been well evidenced in settings such as drug therapy, information regarding patient adherence to orthoses, particularly in the acute setting, is lacking. The aim of this systematic review was to identify, summarise, and critically appraise reported methods for assessing adherence to removable orthoses in adults following acute injury or surgery.

Methods

Comprehensive searches of the Ovid versions of MEDLINE, Embase, AMED, CINAHL, Central, the Cochrane Database of Systematic Reviews, and SPORTDiscus identified complete papers published in English between 1990 and September 2018 reporting measurement of adherence to orthoses in adults following surgery or trauma to the appendicular skeleton. Only primary studies with reference to adherence in the title/abstract were included to maintain the focus of the review. Data extraction included study design, sample size, study population, orthosis studied, and instructions for use. Details of methods for assessing adherence were extracted, including instrument/method used, frequency of completion, number of items (if applicable), and score (if any) used to evaluate adherence overall. Validity and reliability of identified methods were assessed together with any conclusions drawn between adherence and outcomes in the study.

Results

Seventeen papers (5 randomised trials, 10 cohort studies, and 2 case series) were included covering upper (n = 13) and lower (n = 4) limb conditions. A variety of methods for assessing adherence were identified, including questionnaires (n = 10) with single (n = 3) or multiple items (n = 7), home diaries (n = 4), and discussions with the patient (n = 3). There was no consistency in the target behaviour assessed or in the timing or frequency of assessment or the scoring systems used. None of the measures was validated for use in the target population.

Conclusions

Measurement and reporting of adherence to orthosis use is currently inconsistent. Further research is required to develop a measurement tool that provides a rigorous and reproducible assessment of adherence in this acute population.

Trial registration

PROSPERO: CRD42016048462. Registered on 17/10/2016.

Prognostic factors for recovery following acute lateral ankle ligament sprain: a systematic review

Background

One-third of individuals who sustain an acute lateral ankle ligament sprain suffer significant disability due to pain, functional instability, mechanical instability or recurrent sprain after recovery plateaus at 1 to 5 years post injury. The identification of early prognostic factors associated with poor recovery may provide an opportunity for early-targeted intervention and improve outcome.

Methods

We performed a comprehensive search of AMED, EMBASE, Psych Info, CINAHL, SportDiscus, PubMed, CENTRAL, PEDro, OpenGrey, abstracts and conference proceedings from inception to September 2016. Prospective studies investigating the association between baseline prognostic factors and recovery over time were included. Two independent assessors performed the study selection, data extraction and quality assessment of the studies. A narrative synthesis is presented due to inability to meta-analyse results due to clinical and statistical heterogeneity.

Results

The search strategy yielded 3396 titles/abstracts after duplicates were removed. Thirty-six full text articles were then assessed, nine of which met the study inclusion criteria. Six were prospective cohorts, and three were secondary analyses of randomised controlled trials. Results are presented for nine studies that presented baseline prognostic factors for recovery after an acute ankle sprain. Age, female gender, swelling, restricted range of motion, limited weight bearing ability, pain (at the medial joint line and on weight-bearing dorsi-flexion at 4 weeks, and pain at rest at 3 months), higher injury severity rating, palpation/stress score, non-inversion mechanism injury, lower self-reported recovery, re-sprain within 3 months, MRI determined number of sprained ligaments, severity and bone bruise were found to be independent predictors of poor recovery. Age was one prognostic factor that demonstrated a consistent association with outcome in three studies, however cautious interpretation is advised.

Conclusions

The associations between prognostic factors and poor recovery after an acute lateral ankle sprain are largely inconclusive. At present, there is insufficient evidence to recommend any factor as an independent predictor of outcome. There is a need for well-conducted prospective cohort studies with adequate sample size and long-term follow-up to provide robust evidence on prognostic factors of recovery following an acute lateral ankle sprain.

Trial registration

Prospero registration: CRD42014014471

Electronic supplementary material

The online version of this article (10.1186/s12891-017-1777-9) contains supplementary material, which is available to authorized users.

Joint stability characteristics of the ankle complex in female athletes with histories of lateral ankle sprain, part II: clinical experience using arthrometric measurement

CONTEXT

This is part II of a 2-part series discussing stability characteristics of the ankle complex. In part I, we used a cadaver model to examine the effects of sectioning the lateral ankle ligaments on anterior and inversion motion and stiffness of the ankle complex. In part II, we wanted to build on and apply these findings to the clinical assessment of ankle-complex motion and stiffness in a group of athletes with a history of unilateral ankle sprain.

OBJECTIVE

To examine ankle-complex motion and stiffness in a group of athletes with reported history of lateral ankle sprain.

DESIGN

Cross-sectional study.

SETTING

University research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Twenty-five female college athletes (age = 19.4 ± 1.4 years, height = 170.2 ± 7.4 cm, mass = 67.3 ± 10.0 kg) with histories of unilateral ankle sprain.

INTERVENTION(S)

All ankles underwent loading with an ankle arthrometer. Ankles were tested bilaterally.

MAIN OUTCOME MEASURE(S)

The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness.

RESULTS

Anterior displacement of the ankle complex did not differ between the uninjured and sprained ankles (P = .37), whereas ankle-complex rotation was greater for the sprained ankles (P = .03). The sprained ankles had less anterior and inversion end-range stiffness than the uninjured ankles (P < .01).

CONCLUSIONS

Changes in ankle-complex laxity and end-range stiffness were detected in ankles with histories of sprain. These results indicate the presence of altered mechanical characteristics in the soft tissues of the sprained ankles.