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Butler JJ, Brash AI, Azam MT, DeClouette B, Kennedy JG. The Role of Needle Arthroscopy in the Assessment and Treatment of Ankle Sprains. Foot Ankle Clin 2023; 28:345-354. [PMID: 37137628 DOI: 10.1016/j.fcl.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Lateral ankle ligament complex injuries are most commonly managed nonoperatively. If no improvements have been made following conservative management, surgical intervention is warranted. Concerns have been raised regarding complication rates following open and traditional arthroscopic anatomical repair. In-office needle arthroscopic anterior talo-fibular ligament repair provides a minimally invasive arthroscopic approach to the diagnosis and treatment of chronic lateral ankle instability. The limited soft tissue trauma facilitates rapid return to daily and sporting activities making this an attractive alternative approach to lateral ankle ligament complex injuries.
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Affiliation(s)
- James J Butler
- Foot and Ankle Division, Department of Orthopedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY 10002, USA
| | - Andrew I Brash
- Foot and Ankle Division, Department of Orthopedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY 10002, USA
| | - Mohammad T Azam
- Foot and Ankle Division, Department of Orthopedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY 10002, USA
| | - Brittany DeClouette
- Foot and Ankle Division, Department of Orthopedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY 10002, USA
| | - John G Kennedy
- Foot and Ankle Division, Department of Orthopedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY 10002, USA.
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Wang F, Guan Y, Bamber Z, Cao X, Qi Q, Niu W, Chen B. Preventive interventions for lateral ankle sprains: A systematic review and meta-analysis. Clin Rehabil 2023; 37:585-602. [PMID: 36630892 DOI: 10.1177/02692155221137640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the effect of preventive interventions for lateral ankle sprain in the general population. DATA SOURCES A search of PubMed, EMBASE, Cochrane CENTRAL, Medline, CINAHL, and ClinicalTrials.gov was conducted up to August 2022. REVIEW METHODS Randomized controlled trials and prospective cohort studies that evaluated any interventions for preventing lateral ankle sprain were included. Two reviewers independently conducted the search, screening, and data extraction. The methodological quality of each study was assessed using the revised Cochrane risk-of-bias tool for randomized trials or using the Cochrane Risk Of Bias In Non-Randomized Studies tool for prospective cohort studies. RESULTS Seventeen studies met the inclusion criteria. Proprioceptive training exhibited better effects on preventing future lateral ankle sprain compared with the control group (risk ratio = 0.59, p < 0.001), and a stronger preventive effect was observed in participants with a history of lateral ankle sprain in the subgroup analysis (risk ratio = 0.49, p = 0.02). Compared with no bracing, ankle bracing had no significant better effect in preventing lateral ankle sprain (risk ratio = 0.43, p = 0.05). Proprioceptive training and ankle bracing had similar preventive effects (risk ratio = 0.98, p = 0.97). Limited evidence hindered the synthesis of data on pain, swelling, costs, and time loss. CONCLUSION Proprioceptive training is recommended for preventing lateral ankle sprain, especially for people with a history of lateral ankle sprain. Bracing seems to have an ambiguous preventive effect and requires more further investigation.
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Affiliation(s)
- Fanjia Wang
- Department of Physical Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Yonghao Guan
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zoe Bamber
- Division of Orthopaedics, Trauma and Sports Medicine, Faculty of Medicine and Health Sciences, School of Medicine, 6123University of Nottingham, Nottingham, UK
| | - Xianxin Cao
- Department of Physical Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Qi Qi
- Department of Physical Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Wenxin Niu
- Department of Rehabilitation Sciences, 481875Tongji University School of Medicine, Shanghai, China
| | - Bin Chen
- Department of Physical Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
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Wagemans J, Bleakley C, Taeymans J, Kuppens K, Schurz AP, Baur H, Vissers D. Rehabilitation strategies for lateral ankle sprain do not reflect established mechanisms of re-injury: A systematic review. Phys Ther Sport 2023; 60:75-83. [PMID: 36716507 DOI: 10.1016/j.ptsp.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVES 1) determine the primary impairment addressed by each exercise included in exercise-based rehabilitation programs for patients with an acute ankle sprain; 2) Determine whether prescribed exercises incorporate complex tasks associated with ankle sprain injury mechanisms? METHODS We searched databases CINAHL, Web of Science, SPORTDiscus, Cochrane Register of Controlled Trials, PEDro, Google Scholar for RCT's including patients with acute ankle sprains, managed through exercise-based rehabilitation. Risk of bias was assessed by the Risk of Bias 2 tool. Exercises were analysed based on: the primary impairment(s) addressed; direction of movement; base of support; weightbearing status; flight phase. (PROSPERO: CRD42020210858) RESULTS: We included fourteen RCT's comprising 177 exercises. Neuromuscular function was addressed in 44% of exercises, followed by performance tasks (23%), and muscle strengthening (20%). Exercises were limited to movements across the sagittal plane (48%), with 31% incorporating multiplanar movements. Weight bearing exercises were almost divided equally between single-limb (59/122) and double leg stance exercises (61/122). Eighteen percent of all exercises incorporated a flight phase. CONCLUSIONS Rehabilitation after LAS comprises simple exercises in the sagittal plane that do not reflect mechanisms of re-injury. Future interventions should incorporate more open chain joint position sense training, multiplanar single limb challenges, and jumping and landing exercises.
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Affiliation(s)
- Jente Wagemans
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland. https://twitter.com/jentewagemans
| | - Chris Bleakley
- School of Health Science, Ulster University, Newtownabbey, Northern Ireland, UK
| | - Jan Taeymans
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kevin Kuppens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; SOMT University of Physiotherpy Education, Amersfort, the Netherlands
| | | | - Heiner Baur
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Kawabata S, Murata K, Iijima H, Nakao K, Kawabata R, Terada H, Kojima T, Takasu C, Kano T, Kanemura N. Ankle instability as a prognostic factor associated with the recurrence of ankle sprain: A systematic review. Foot (Edinb) 2023; 54:101963. [PMID: 36709590 DOI: 10.1016/j.foot.2023.101963] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
DESIGN Systematic review using PRISMA guidelines. PURPOSE To explore Relationship between ankle instability and ankle sprain recurrence in preventing recurrence of ankle sprains and to provide appropriate treatment. METHODS MEDLINE (the Cochrane Library) and the Physiotherapy Evidence Database (PEDro) were explored using key words related to ankle instability and ankle sprains in for April 2022. According to the inclusion criteria, studies that 1) targeted patients with ankle sprains, 2) assessed ankle instability, and 3) investigated ankle sprain recurrence rates, were extracted. The author names, publication year, patient characteristics, comparison groups, intervention methods, and outcome data (ankle instability and recurrence) were extracted. A correlation analysis between recurrence rate and ankle instability was conducted. In addition, A meta-analysis was performed on the correlation coefficients within each article. RESULTS Eight studies were extracted from 149 studies. A correlation analysis was conducted on five studies and meta-analysis was on three studies with the same post-intervention follow-up period and the same assessment methods for ankle instability and recurrence rate. Strong positive correlations were found for the same follow-up periods (r = 0.95: 95%CI [0.62-0.99]; 3-month, r = 0.97: 95%CI [0.75-0.10]; 1 year, p < .05). The correlation became stronger as the follow-up period increased. Furthermore, the meta-analysis showed that ankle instability as well as the main symptoms of sprain, such as pain and swelling, tended to be positively correlated with the recurrent rate of ankle sprains. These results suggest that ankle instability is strongly related to recurrence, and the longer the time since onset, the stronger the relationship. CONCLUSIONS Ankle instability was a prognostic factor associated with recurrence of ankle sprains in patients with ankle sprains. Therefore, ankle instability is one of important factor in preventing recurrence of ankle sprains.
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Affiliation(s)
- Sora Kawabata
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Kenji Murata
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan.
| | - Hirotaka Iijima
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan; Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kouki Nakao
- Department of Rehabilitation, Amakusa Rehabilitation Hospital, Saitama, Japan
| | - Riku Kawabata
- Department of Rehabilitation, Minami-Koshigaya Hospital, Saitama, Japan
| | - Hidenobu Terada
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Takuma Kojima
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Chiharu Takasu
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Takuma Kano
- Department of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Naohiko Kanemura
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan
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Segal AD, Adamczyk PG, Petruska AJ, Silverman AK. Balance Therapy With Hands-Free Mobile Robotic Feedback for At-Home Training Across the Lifespan. IEEE Trans Neural Syst Rehabil Eng 2022; 30:2671-2681. [PMID: 36094982 DOI: 10.1109/tnsre.2022.3205850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Providing aging adults with engaging, at-home balance therapy is essential to promote long-term adherence to unsupervised training and to foster independence. We developed a portable interactive balance training system that provides real-world visual cues on balance performance using wobble board tilt angles to control the speed of a robotic car platform in a three-dimensional environment. The goal of this study was to validate this mobile balance therapy system for home use across the lifespan. Twenty younger (18-39 years) and nineteen older (58-74 years) healthy adults performed balance training with and without visual feedback while standing on a wobble board instrumented with a consumer-grade inertial measurement unit (IMU) and optical motion tracking markers. Participants performed feedback trials based on either the robotic car's movements or a commercially-available virtual game. Wobble board tilt measurements were highly correlated between IMU and optical measurement systems ( [Formula: see text]), with high agreement in outcome metrics ( [Formula: see text]) and small bias ( [Formula: see text]). Both measurement systems identified similar aging, feedback, and stance type effects including (1) altered movement control when older adults performed tilting trials with either robotic or virtual feedback compared to without feedback, (2) two-fold greater wobble board oscillations in older vs. younger adults during steady standing, (3) no difference in board oscillations during steady standing in narrow vs. wide double support, and (4) greater wobble board oscillations for single compared to double support. These findings demonstrate the feasibility of implementing goal-directed robotic balance training with mobile tracking of balance performance in home environments.
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Wagemans J, Bleakley C, Taeymans J, Schurz AP, Kuppens K, Baur H, Vissers D. Exercise-based rehabilitation reduces reinjury following acute lateral ankle sprain: A systematic review update with meta-analysis. PLoS One 2022; 17:e0262023. [PMID: 35134061 PMCID: PMC8824326 DOI: 10.1371/journal.pone.0262023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/15/2021] [Indexed: 12/26/2022] Open
Abstract
Research questions 1) Do exercise-based rehabilitation programs reduce re-injury following acute ankle sprain?; 2) Is rehabilitation effectiveness moderated by the exercise’s therapeutic quality, content and volume? Methods This systematic review with meta-analysis (PROSPERO: CRD42020210858) included randomized controlled trials in which adults who sustained an acute ankle sprain received exercise-based rehabilitation as an intervention. Databases CINAHL, Web of Science, SPORTDiscus, Cochrane Central Register of Controlled Trials, PEDro and Google Scholar were searched for eligible articles (last search: March 2021). ROB II screening tool by Cochrane was used to assess risk of bias and the i-CONTENT tool was used to assess quality of interventions. Both qualitative analysis and quantitative data synthesis were performed. Results Fourteen randomized controlled trials comprising 2182 participants were included. Five studies were judged overall low risk of bias and i-CONTENT assessment showed poor to moderate therapeutic quality of exercise across all included articles. Pooled data found significant reductions in re-injury prevalence at 12 months, in favour of the exercise-based rehabilitation group vs usual care (OR: 0.60; 95%CI: 0.36 to 0.99). Pooled data for re-injury incidence showed not-significant results (MD: 0.027; 95%CI: -2.14 to 2.19). Meta-regression displayed no statistically significant association between training volume and odds of re-injury (r = -0.00086; SD: 0.00057; 95%CI: -0.00197 to 0.00025). Results from patient-reported outcomes and clinical outcomes were inconclusive at 1 month, 3–6 months and 7–12 months of follow up. Conclusion Exercise-based rehabilitation reduces the risk of recurrent ankle sprain compared to usual care, but there is insufficient data to determine the optimal content of exercise-based interventions. Training volume varied considerably across studies but did not affect the odds of sustaining a re-injury. Effects on patient-reported outcomes and clinical outcomes are equivocal. Future research should compare different exercise contents, training volumes and intensities after ankle sprain.
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Affiliation(s)
- Jente Wagemans
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- * E-mail: ,
| | - Chris Bleakley
- School of Health Science, Ulster University, Newtownabbey, Northern Ireland
| | - Jan Taeymans
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Kevin Kuppens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Heiner Baur
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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7
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Costa F, Janela D, Molinos M, Lains J, Francisco GE, Bento V, Dias Correia F. Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study. BMC Musculoskelet Disord 2022; 23:29. [PMID: 34983488 PMCID: PMC8728982 DOI: 10.1186/s12891-021-04891-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/18/2021] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
| | - Dora Janela
- SWORD Health Technologies, Inc, Draper, UT, USA
| | | | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center McGovern Medical School, and TIRR Memorial Hermann, Houston, TX, USA
| | | | - Fernando Dias Correia
- SWORD Health Technologies, Inc, Draper, UT, USA. .,Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.
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Stephenson SD, Kocan JW, Vinod AV, Kluczynski MA, Bisson LJ. A Comprehensive Summary of Systematic Reviews on Sports Injury Prevention Strategies. Orthop J Sports Med 2021; 9:23259671211035776. [PMID: 34734094 PMCID: PMC8558815 DOI: 10.1177/23259671211035776] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/03/2021] [Indexed: 12/26/2022] Open
Abstract
Background A large volume of systematic reviews and meta-analyses has been published on the effectiveness of sports injury prevention programs. Purpose To provide a qualitative summary of published systematic reviews and meta-analyses that have examined the effectiveness of sports injury prevention programs on reducing musculoskeletal injuries. Study Design Systematic review; Level of evidence, 4. Methods We searched the PubMed, CINAHL, EMBASE, and the Cochrane databases for systematic reviews and meta-analyses that evaluated the effectiveness of sports injury prevention programs. We excluded published abstracts, narrative reviews, articles not published in English, commentaries, studies that described sports injury prevention strategies but did not assess their effectiveness, studies that did not assess musculoskeletal injuries, and studies that did not assess sports-related injuries. The most relevant results were extracted and summarized. Levels of evidence were determined per the Oxford Centre for Evidence-Based Medicine, and methodological quality was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, revised version). Results A total of 507 articles were retrieved, and 129 were included. Articles pertaining to all injuries were divided into 9 topics: sports and exercise in general (n = 20), soccer (n = 13), ice hockey (n = 1), dance (n = 1), volleyball (n = 1), basketball (n = 1), tackle collision sports (n = 1), climbing (n = 1), and youth athletes (n = 4). Articles on injuries by anatomic site were divided into 11 topics: general knee (n = 8), anterior cruciate ligament (n = 34), ankle (n = 14), hamstring (n = 11), lower extremity (n = 10), foot (n = 6), groin (n = 2), shoulder (n = 1), wrist (n = 2), and elbow (n = 1). Of the 129 studies, 45.7% were ranked as evidence level 1, and 55.0% were evidence level 2. Based on the AMSTAR-2, 58.9% of the reviews reported a priori review methods, 96.1% performed a comprehensive literature search, 47.3% thoroughly described excluded articles, 79.1% assessed risk of bias for individual studies, 48.8% reported a valid method for statistical combination of data (ie, meta-analysis), 45.0% examined the effect of risk of bias on pooled study results, and 19.4% examined the risk for publication bias. Conclusion This comprehensive review provides sports medicine providers with a single source of the most up-to-date publications in the literature on sports injury prevention.
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Affiliation(s)
- Samuel D Stephenson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Joseph W Kocan
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Amrit V Vinod
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York at Buffalo, New York, USA
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Correia FD, Molinos M, Neves C, Janela D, Carvalho D, Luis S, Francisco GE, Lains J, Bento V. Digital Rehabilitation for Acute Ankle Sprains: Prospective Longitudinal Cohort Study. JMIR Rehabil Assist Technol 2021; 8:e31247. [PMID: 34499038 PMCID: PMC8517823 DOI: 10.2196/31247] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/16/2021] [Accepted: 07/30/2021] [Indexed: 12/21/2022] Open
Abstract
Background Ankle sprains are one of the most prevalent soft-tissue injuries worldwide. Physical therapy, especially progressive exercise, has proven effective in improving function, while preventing recurrence. Objective We aim to present the results of a fully remote and digitally guided rehabilitation program for acute ankle sprains. Methods We performed a prospective longitudinal cohort study of individuals eligible for workers’ compensation, who were referred for digital rehabilitation therapy for a sprained ankle. Therapeutic exercise sessions were to be performed independently by the patient at home using the biofeedback device provided by SWORD Health. Primary endpoints were the change in self-reported Numerical Pain Rating Scale (NPRS) and Foot and Ankle Ability Measure–activities of daily living (FAAM–ADL) and FAAM–Sports scores. Participants were assessed at baseline, end of the program, and 6 months after program completion. Secondary outcomes included digital therapy dosage, pain and fatigue during sessions, and satisfaction. Results In total, 93 (89.4%) patients completed the program and 79 (76.0%) were available for follow-up. Changes in the primary outcomes between baseline and the 6-month follow-up were both significant (P<.001) and clinically meaningful: mean difference of –2.72 points (95% CI –3.31 to –2.13) on the NPRS (49.8% reduction), 21.7 points (95% CI 17.13-26.27) on the FAAM–ADL (41.1% increase), and 37.8 points (95% CI 30.45-45.15) on the FAAM-Sports (151.8% increase). Longer waiting periods between the accident date and treatment initiation were found to negatively impact functional status at baseline and at the end of the program, triggering an extension in the program duration. The total training volume (12.5 hours, SD 10.5 hours) was similar to that of other interventions for ankle sprains, but the dosage per week was much higher (2.4 hours per week, SD 0.87 hours per week). The mean patient satisfaction score was 8.8 (SD 1.57) out of 10. Among program completers, 83.9% attained full recovery and were discharged with no residual disability. Conclusions Being far less demanding in terms of human resources, the digital program presented constituted a viable, clinically effective, and convenient solution for ankle sprain rehabilitation, particularly during the pandemic. This is the first study presenting a fully remote home-based rehabilitation program for acute ankle sprains, with patients achieving sustained long-term results. This was a prospective cohort study and, as such, did not include a control group, but the results appear comparable to those published for face-to-face interventions. Trial Registration ClinicalTrials.gov NCT04819022; https://clinicaltrials.gov/ct2/show/NCT04819022
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Affiliation(s)
- Fernando D Correia
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal.,Escola de Medicina, Universidade do Minho, Braga, Portugal
| | - Maria Molinos
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Carlos Neves
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Dora Janela
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Diana Carvalho
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Sara Luis
- SWORD Health Technologies, Inc, Draper, UT, United States
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center, Houston, TX, United States.,TIRR Memorial Hermann, Houston, TX, United States
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Virgilio Bento
- SWORD Health Technologies, Inc, Draper, UT, United States
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10
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Alahmari KA, Kakaraparthi VN, Reddy RS, Silvian P, Tedla JS, Rengaramanujam K, Ahmad I. Combined Effects of Strengthening and Proprioceptive Training on Stability, Balance, and Proprioception Among Subjects with Chronic Ankle Instability in Different Age Groups: Evaluation of Clinical Outcome Measures. Indian J Orthop 2021; 55:199-208. [PMID: 34122771 PMCID: PMC8149549 DOI: 10.1007/s43465-020-00192-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lateral ankle sprains are among the common injuries in the physically active population in different age groups and progress to chronic ankle instability (CAI). Accordingly, the current study assesses the effectiveness of strengthening and proprioceptive training programs on proprioception and balance in those suffering from CAI. DESIGN Quasi-experimental design. METHODS Thirty-six individuals with self-reported CAI were assigned into three groups based on age: group 1 (23 ± 1.84), group 2 (35.80 ± 1.68), group 3 (44.25 ± 4.86), then performed strength and balance exercises for 6 weeks. The study furthermore measured pre- and post-training of joint position sense (JPS), static balance, dynamic balance, chronic ankle instability tool (CAIT) and lower extremity functional scale (LEFS). RESULTS Statistical analysis showed significant improvement (P < 0.01) on all outcome measures among all groups. In group 1, mainly the plantar flexion JPS improved to 3.7°, while in group 2 and group 3 the eversion JPS improved to 3.1° and 1.78° (P < 0.01). With reference to static balance with one's eyes closed and eyes open, the improvement in group 1 was 4.46, 11.05 s, group 2 was 2.23, 7.85 s and group 3 was 1.69, 4.68 s. In relation to dynamic balance, the development in group 1 was 5.85 cm, while group 2 was 4.71 cm and group 3 was 2.49 cm. Moreover, both CAIT and LEFS showed significant differences (P < 0.01) after training. CONCLUSION This study found that combined strengthening and proprioceptive training effectively improves stability, proprioception, balance, and self-reported functional outcomes.
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Affiliation(s)
- Khalid A Alahmari
- C/3/139, Department of Medical Rehabilitation (Physical Therapy), College of Applied Medical Sciences, King Khalid University, Guraiger Campus, Abha, Kingdom of Saudi Arabia
| | - Venkata Nagaraj Kakaraparthi
- C/3/139, Department of Medical Rehabilitation (Physical Therapy), College of Applied Medical Sciences, King Khalid University, Guraiger Campus, Abha, Kingdom of Saudi Arabia
| | - Ravi Shankar Reddy
- C/3/139, Department of Medical Rehabilitation (Physical Therapy), College of Applied Medical Sciences, King Khalid University, Guraiger Campus, Abha, Kingdom of Saudi Arabia
| | - Paul Silvian
- C/3/139, Department of Medical Rehabilitation (Physical Therapy), College of Applied Medical Sciences, King Khalid University, Guraiger Campus, Abha, Kingdom of Saudi Arabia
| | - Jaya Shanker Tedla
- C/3/139, Department of Medical Rehabilitation (Physical Therapy), College of Applied Medical Sciences, King Khalid University, Guraiger Campus, Abha, Kingdom of Saudi Arabia
| | - Kanagaraj Rengaramanujam
- C/3/139, Department of Medical Rehabilitation (Physical Therapy), College of Applied Medical Sciences, King Khalid University, Guraiger Campus, Abha, Kingdom of Saudi Arabia
| | - Irshad Ahmad
- C/3/139, Department of Medical Rehabilitation (Physical Therapy), College of Applied Medical Sciences, King Khalid University, Guraiger Campus, Abha, Kingdom of Saudi Arabia
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Bowers LC, Gribble PA, Hoch MC, Villasante Tezanos AG, Kosik KB. Physical therapy referral and medication for ankle sprain visits to physician offices: an analysis of the national ambulatory medical care survey. PHYSICIAN SPORTSMED 2021; 49:176-181. [PMID: 32729762 DOI: 10.1080/00913847.2020.1800369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Supervised physical therapy is the recommended care for an ankle sprain. Yet, recent evidence indicates some ankle sprain patients may not receive the recommended care, and instead, prescribed medication to alleviate symptoms. Therefore, the purpose of this study is to describe the percentage of patients reporting to an office-based physician in the U.S. that were or were not referred to physical therapy. Secondly, to describe the percentage of ankle sprain patients with or without medication administered, supplied or ordered. METHODS This was a secondary analysis of the cross-sectional National Ambulatory Medical Care Survey (NAMCS) from 2007 to 2016. The NAMCS is a multi-stage probability sample survey of visits to office-based physicians. The percentage and associated 95% confidence intervals (CI) were calculated for visits that had a physical therapy referral or a non-steroidal anti-inflammatory drug (NSAID), opioid and non-opioid analgesics administered, supplied or ordered. Sampled data were weighted to produce national-level estimates. RESULTS A physical therapy referral was given for 16.8% (95% CI: 13.2, 21.2) of ankle sprain visits. Approximately 34.5% (95%CI: 30.5, 38.7) of all ankle sprain visits had a medication administered, supplied or ordered. NSAIDs (72.1%; 95% CI: 66.9,76.8) and opioids (21.0%; 95% CI: 16.3, 26.5) were the two most common types of medication. CONCLUSIONS NSAIDs and opioid medication combined were administered, supplied or ordered more frequently than a referral to physical therapy. These findings provide evidence that suggests many ankle sprain patients reporting to an office-based physician are not receiving the recommended care; physical therapy. Rather, medication appears to be the primary type of care provided to patients. These data are important because it gives a focused area to improve the treatment of an ankle sprain by developing strategies that ensure all patients are provided the recommended care from the onset of entering the healthcare system.
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Affiliation(s)
- Lucy C Bowers
- Department of Athletic Training & Clinical Nutrition, University of Kentucky, Lexington, KY, USA
| | - Phillip A Gribble
- Department of Athletic Training & Clinical Nutrition, University of Kentucky, Lexington, KY, USA
| | - Matthew C Hoch
- Department of Athletic Training & Clinical Nutrition, University of Kentucky, Lexington, KY, USA
| | | | - Kyle B Kosik
- Department of Athletic Training & Clinical Nutrition, University of Kentucky, Lexington, KY, USA
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12
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The Effect of Attending Physical Rehabilitation After the First Acute Lateral Ankle Sprain on Static Postural Control in Patients With Chronic Ankle Instability. J Sport Rehabil 2021; 30:1000-1007. [PMID: 33761463 DOI: 10.1123/jsr.2020-0346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Static postural control deficits are commonly documented among individuals with chronic ankle instability (CAI). Evidence suggests individuals with CAI who seek medical attention after an ankle sprain report fewer subjective symptoms. It is unknown if seeking medical attention and receiving supervised physical rehabilitation has a similar effect on objective outcomes, such as static postural control. OBJECTIVE To compare measures of single-limb postural control and center of pressure (COP) location between participants with CAI who did or did not self-report attending supervised rehabilitation at the time of their first lateral ankle sprain. DESIGN Retrospective cohort. SETTING Laboratory. Patients (or Other Participants): Twenty-nine participants with CAI who did (n = 14) or did not (n = 15) self-report attending supervised rehabilitation. INTERVENTION(S) Self-reported attendance or not of supervised rehabilitation at the time of initial injury. MAIN OUTCOME MEASURES Participants performed three 20-second trials of single-limb stance on a force plate with eyes open. Main outcome measures included the COP velocities, time-to-boundary (TTB) absolute minima, mean of TTB minima, and SD of TTB minima in the anteroposterior and mediolateral directions. The spatial distribution of the COP data points under the foot was quantified within 4 equally proportional sections labeled anteromedial, anterolateral, posteromedial, and posterolateral. RESULTS Participants who reported attending supervised rehabilitation after their initial ankle sprain had a lower COP velocity in the anterior-posterior direction (P = .030), and higher TTB anterior-posterior absolute minimum (P = .033) and mean minima (P = .050) compared with those who did not attend supervised rehabilitation. CONCLUSIONS Among individuals with CAI, not attending supervised rehabilitation at the time of initial injury may lead to worse static postural control outcomes. Clinicians should continue advocating for patients recovering from an acute ankle sprain to seek medical attention and provide continued care in the form of physical rehabilitation.
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Halabchi F, Hassabi M. Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World J Orthop 2020; 11:534-558. [PMID: 33362991 PMCID: PMC7745493 DOI: 10.5312/wjo.v11.i12.534] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/04/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023] Open
Abstract
Acute ankle sprain is the most common lower limb injury in athletes and accounts for 16%-40% of all sports-related injuries. It is especially common in basketball, American football, and soccer. The majority of sprains affect the lateral ligaments, particularly the anterior talofibular ligament. Despite its high prevalence, a high proportion of patients experience persistent residual symptoms and injury recurrence. A detailed history and proper physical examination are diagnostic cornerstones. Imaging is not indicated for the majority of ankle sprain cases and should be requested according to the Ottawa ankle rules. Several interventions have been recommended in the management of acute ankle sprains including rest, ice, compression, and elevation, analgesic and anti-inflammatory medications, bracing and immobilization, early weight-bearing and walking aids, foot orthoses, manual therapy, exercise therapy, electrophysical modalities and surgery (only in selected refractory cases). Among these interventions, exercise and bracing have been recommended with a higher level of evidence and should be incorporated in the rehabilitation process. An exercise program should be comprehensive and progressive including the range of motion, stretching, strengthening, neuromuscular, proprioceptive, and sport-specific exercises. Decision-making regarding return to the sport in athletes may be challenging and a sports physician should determine this based on the self-reported variables, manual tests for stability, and functional performance testing. There are some common myths and mistakes in the management of ankle sprains, which all clinicians should be aware of and avoid. These include excessive imaging, unwarranted non-weight-bearing, unjustified immobilization, delay in functional movements, and inadequate rehabilitation. The application of an evidence-based algorithmic approach considering the individual characteristics is helpful and should be recommended.
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Affiliation(s)
- Farzin Halabchi
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran 14167-53955, Iran
| | - Mohammad Hassabi
- Department of Sports and Exercise Medicine, Shahid Beheshti University of Medical Sciences, Tehran 19979-64151, Iran
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14
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Hijazi H, O'Reilly M, Moloney DP, Bayer T. Acute compartment syndrome of the foot due to a twisting injury while playing sports. BMJ Case Rep 2020; 13:13/10/e232541. [PMID: 33127720 DOI: 10.1136/bcr-2019-232541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute compartment syndrome (ACS) of the foot is one of the most severe injuries of the foot and typically results from a fracture, crush or vascular injury. ACS, isolated to a single foot compartment, is a rare complication following a simple twisting injury of the ankle. In this article, the authors present the case report of a 25-year-old man who developed ACS, isolated to the lateral compartment of the foot, secondary to rupture of the lateral ligament complex and subsequent haematoma formation. An emergency fasciotomy was performed and the patient had complete resolution of his symptoms. ACS is usually associated with significant trauma, however, there are reported cases in the literature associated with a minor injury. In this case report, the authors describe how ACS developed following a simple ankle sprain playing sports in the absence of a high-energy insult or fracture.
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Affiliation(s)
- Humayun Hijazi
- Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Offaly, Ireland
| | - Marc O'Reilly
- Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Offaly, Ireland
| | - Darren Patrick Moloney
- Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Offaly, Ireland
| | - Thomas Bayer
- Trauma and Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Offaly, Ireland
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Montalibet A, Rastel D, Chaigneau C, Grenier E, McAdams E. Swollen Lower Limbs in Patients with Negative Pitting Test Leg Oedema: Prediction of Water Displacement Changes by Anthropometry and Bioimpedance Spectroscopy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:3969-3972. [PMID: 33018869 DOI: 10.1109/embc44109.2020.9175716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The assessment of lower limb oedema almost always involves measuring leg volume, and the gold-standard for this is the water displacement technique. As it is not very practical to use in a clinical routine, physicians prefer indirect methods such as anthropometric or bioimpedance measurements. In the case of "non-pitting" leg oedema, i.e. where the presence of oedema is not obvious, it may be challenging to estimate changes in leg volume using these methods separately. The combination of these two methods, however, gives interesting results, such as a new composite parameter that is much more robust and efficient than commonly used parameters.Clinical Relevance- This study demonstrates the benefit of using a composite anthropometric-impedimetric parameter to predict water displacement variations in the leg over the course of a day, rather than using parameters based solely on anthropometry or impedance. Our new parameter (C²-A²)/R0 showed a robust r² value of 61%, which is more than twice the r² values obtained using other simple or composite parameters.
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16
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Montalibet A, Rastel D, Chaigneau C, Grenier E, McAdams E. Comparison between bioelectrical impedance spectroscopy measurements and water volume displacement of ankle oedema variations during the course of a day. Physiol Meas 2020; 41:085004. [PMID: 32726768 DOI: 10.1088/1361-6579/abaa57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The purpose of this study was to find relationships between variations in bioelectrical impedance spectroscopy (BIS) measurements and those obtained by water displacement (WD) and calf (C) and ankle (A) perimetry on legs of patients with venous insufficiency and lower limb oedema, some with positive pitting test (PPT), others with negative pitting test (NPT). APPROACH Twenty-nine (29) female subjects were clinically examined prior to inclusion in the trial. Measurements were taken once in the morning and then 6 h later, using perimetry, WD, and then BIS; subjects were standing. Leg volume was assessed using two WD volumeters, one 'Tall' (TWD) and one 'Short' (SWD). BIS was performed using a SFB7 impedance meter device (Impedimed®). MAIN RESULTS Forty-three (43) legs with oedema were included. The results showed that 61% of the TWD variations variance was explained by SWD variations; less than 30% of the TWD variations variance was explained using BIS or perimetry alone, and 45% at best when used in combination. R0, related to extracellular water, was the key BIS parameter. For NPT subpopulation (32 legs), the composite parameter (C2 - A2)/R0 explained more than 60% of the TWD variations variance. For PPT subpopulation (11 legs), small or statistically non-significant variance explanations were found. SIGNIFICANCE Combination of anthropometric and BIS parameters gave a better forecast of WD results than using only one or other. A novel composite parameter, (C2 - A2)/R0, better predicted TWD changes than other parameters hitherto used in literature, with improved estimates for the NPT subpopulation. Study n°ANSM 2017-A01063-50.
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17
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Breloff SP, Bachman JL, Lugade VA, Stuka AD. THE EFFECT OF BLOOD GLUCOSE ON QUIET STANDING BALANCE IN YOUNG HEALTHY INDIVIDUALS. BIOMEDICAL ENGINEERING-APPLICATIONS BASIS COMMUNICATIONS 2020; 32. [PMID: 32831529 DOI: 10.4015/s1016237220500167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Falling is one of the leading causes of accidental injury and death among elderly adults and construction workers, with costs exceeding US$31 billion each year. Having good balance reduces the likelihood of falling - therefore it is important to determine which possible factors might influence balance. The purpose of this study was to determine if consuming three different types of breakfast altered blood glucose levels in such a way that young healthy individual's balance control was compromised. Balance was then measured while the subjects completed single- and dual-task standing trials with eyes open and closed. Although changing blood glucose did alter quiet standing balance - as measured by the separation distance between the COG and COP, the velocity of the COM, and the total distance traveled by the COG and COP along the anterior-posterior (AP) and medial-lateral (ML) axes - the results were contradictory to what was hypothesized. Subjects with lower blood glucose swayed less than those with higher blood glucose. This could potentially be due to the habitual skipping of breakfast in young adults. Though the changing of blood glucose did influence quiet standing balance of young healthy adults, it was not in a way which increased the risk of falling.
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Affiliation(s)
- Scott P Breloff
- National Institute for Occupational Safety and Health 1095 Willowdale Road, MS L-2027 Morgantown, WV 26505, USA.,The University of Scranton Scranton, PA 18510, USA
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18
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Lee K, Kim YH, Lee S, Seo SG. Characteristics of the balance ability and isokinetic strength in ankle sprain. ISOKINET EXERC SCI 2020. [DOI: 10.3233/ies-194223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Kyujin Lee
- Institute of Sports Science, Seoul National University, Seoul, Korea
| | - Yong Hwan Kim
- Department of Physical Education, Gangneung-Wonju National University, Gangneung-si, Korea
| | - Sahnghoon Lee
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, Korea
| | - Sang Gyo Seo
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, Korea
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Alghadir AH, Iqbal ZA, Iqbal A, Ahmed H, Ramteke SU. Effect of Chronic Ankle Sprain on Pain, Range of Motion, Proprioception, and Balance among Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5318. [PMID: 32718066 PMCID: PMC7432694 DOI: 10.3390/ijerph17155318] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/26/2022]
Abstract
Background: Ankle sprains are common among physically active individuals, especially among athletes. Majority of those who suffer ankle sprains have residual symptoms including pain, episodes of giving way, compromised proprioception and neuromuscular control, and re-injury leading to chronic ankle instability. The aim of this study was to see the effect of chronic ankle sprain on pain, range of motion, proprioception, and, static and dynamic balance among athletes. Methods: A total of 80 athletes, aged 18 to 25 years, involved in track-and-field sports were invited to participate in this study. They were divided in two groups. Athletes with history of grade 1 or 2 ankle sprain on either side requiring medical care who reported at least three episodes of ankle giving way in past 12 months were included in group A. An equal number of healthy athletes without any history of ankle sprain or injury in the lower limbs in the past one year matched by sex, age, height, weight, and limb dominance, were included in group B (control). Outcome measures: Participant's pain, range of motion, proprioception and balance (static and dynamic) was measured using visual analog scale, half circle goniometer, degree of foot position sense, single leg stance time and Y-balance test respectively. Results: Although there were no differences in the active ankle joint range of motion (p > 0.05) in comparison to the control group, athletes with chronic ankle sprain reported mild pain and statistically significant (p < 0.05) deficits in foot proprioception, static and dynamic balance. Conclusions: Deficits in foot proprioception, static and dynamic balance even one year after the ankle sprain could be the reason for limitations in the dynamic defense system of the joint that predisposes to recurrent injury and instability. It is essential to understand the normal clinical course and risk factors for athletes who sustain sprain before devising a long term comprehensive rehabilitation program that focuses on mechanical and functional insufficiencies in order to improve their functional performance and prevent the risk of recurrent sprain.
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Affiliation(s)
- Ahmad H. Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia; (A.H.A.); (A.I.)
| | - Zaheen A. Iqbal
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia; (A.H.A.); (A.I.)
| | - Amir Iqbal
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia; (A.H.A.); (A.I.)
| | - Hashim Ahmed
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, Najran University, Najran 1988, Saudi Arabia;
| | - Swapnil U. Ramteke
- Department of Musculoskeletal & Sports Physiotherapy, Sancheti Institute College of Physiotherapy, Shivaji Nagar, Pune 411005, Maharashtra, India;
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Green T, Willson G, Martin D, Fallon K. What is the quality of clinical practice guidelines for the treatment of acute lateral ankle ligament sprains in adults? A systematic review. BMC Musculoskelet Disord 2019; 20:394. [PMID: 31470826 PMCID: PMC6717337 DOI: 10.1186/s12891-019-2750-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/02/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Acute lateral ankle ligament sprains (LALS) are a common injury seen by many different clinicians. Knowledge translation advocates that clinicians use Clinical Practice Guidelines (CPGs) to aid clinical decision making and apply evidence-based treatment. The quality and consistency of recommendations from these CPGs are currently unknown. The aims of this systematic review are to find and critically appraise CPGs for the acute treatment of LALS in adults. METHODS Several medical databases were searched. Two authors independently applied inclusion and exclusion criteria. The content of each CPG was critically appraised independently, by three authors, using the Appraisal of Guidelines for REsearch and Evaluation (AGREE II) instrument online version called My AGREE PLUS. Data related to recommendations for the treatment of acute LALS were abstracted independently by two reviewers. RESULTS This study found CPGs for physicians and physical therapists (Netherlands), physical therapists, athletic trainers, physicians, and nurses (USA) and nurses (Canada and Australia). Seven CPGs underwent a full AGREE II critical appraisal. None of the CPGs scored highly in all domains. The lowest domain score was for domain 5, applicability (discussion of facilitators and barriers to application, provides advice for practical use, consideration of resource implications, and monitoring/auditing criteria) achieving an exceptionally low joint total score of 9% for all CPGs. The five most recent CPGs scored a zero for applicability. Other areas of weakness were in rigour of development and editorial independence. CONCLUSIONS The overall quality of the existing LALS CPGs is poor and majority are out of date. The interpretation of the evidence between the CPG development groups is clearly not consistent. Lack of consistent methodology of CPGs is a barrier to implementation. SYSTEMATIC REVIEW Systematic review registered with PROSPERO ( CRD42015025478 ).
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Affiliation(s)
- Toni Green
- ANU Medical School, College of Health and Medicine, Australian National University, ACT, Acton, Australia
- Discipline of Physiotherapy, University of Canberra, ACT, Bruce, 2617 Australia
| | - Grant Willson
- Discipline of Physiotherapy, University of Canberra, ACT, Bruce, 2617 Australia
| | - Donna Martin
- Elite Rehab and Sports Physiotherapy, Deakin, Canberra, Australia
| | - Kieran Fallon
- ANU Medical School, College of Health and Medicine, Australian National University, ACT, Acton, Australia
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Activation of Scapular and Lumbopelvic Muscles During Core Exercises Executed on a Whole-Body Wobble Board. J Sport Rehabil 2019; 28:623-634. [DOI: 10.1123/jsr.2018-0089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/09/2018] [Accepted: 08/13/2018] [Indexed: 11/18/2022]
Abstract
Context: Previous studies highlighted that exercises executed on unstable surfaces can yield important benefits to the function of the core musculature in rehabilitation settings, general conditioning settings, and athletic training when properly introduced within a periodized training schedule. No previous study has analyzed core-stability exercises executed in lying, quadruped, plank, and bridge positions on a whole-body wobble board (WWB) specifically designed to accommodate the exerciser’s entire body and promote whole-body instability. We have designed a WWB allowed to roll in a plane perpendicular to its longitudinal axis to promote proactive and reactive activation of the core muscles with a transverse or diagonal line of action, which provides trunk and pelvic stability with low spine compression forces. Purpose: To determine the effect of the use of this newly designed WWB by assessing differences in core-muscle activity during core-stability exercises performed on the ground, in a stable condition, and on the WWB. Design: Controlled laboratory study. Setting: Research laboratory. Patients or Other Participants: Eighteen participants recruited from fitness centers. Intervention(s): The electromyographic (EMG) activity of lumbopelvic and scapular muscles has been recorded during core-stability exercises executed on the WWB (unstable condition) and on ground (stable condition). Main Outcome Measure(s): Mean and peak EMG activity were compared between stable and unstable condition with paired t tests or Wilcoxon signed-rank tests. Results: Overall, exercises performed on the WWB yielded significantly higher EMG activity in the serratus anterior and anterolateral abdominal muscles compared with the same exercises executed on the ground. Conversely, for the bird dog exercise, lower-back muscle activity was significantly higher on the ground. Conclusions: Compared with the ground, core-stability exercises executed on WWB constitute a simple and effective strategy to increase the activity level of the core muscles that control transverse-plane lumbopelvic and trunk stability, avoiding the use of external overload.
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Madhuranga PVH, Mathangasinghe Y, Anthony DJ. Improving balance with wobble board exercises in stroke patients: single-blind, randomized clinical trial. Top Stroke Rehabil 2019; 26:595-601. [PMID: 31348727 DOI: 10.1080/10749357.2019.1645439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: A primary objective in stroke rehabilitation is to restore functional balance, in order to reduce falls.Objectives: To identify the efficacy and safety of wobble board exercises when combined with conventional physiotherapy, in improving balance in hemiplegic patients following ischemic strokes.Methods: A block-randomized, controlled, observer blinded, superiority trial was conducted on ambulatory hemiplegic patients following ischemic strokes of middle cerebral artery territory. Subjects in the control group received a conventional physiotherapy regime. Subjects in the intervention group received training on a wobble board combined with conventional physiotherapy. Main Outcome measures were the improvement of Four-Square Step Test (FSST) and the Berg Balance Scale (BBS), both of which assess functional balance at the end of 6 weeks.Results: Thirty patients were randomly assigned for intervention (n = 15) and control (n = 15) groups. One patient dropped out from the study, leaving 29 eligible for the analysis. Intervention and control groups were comparable in sociodemographic characteristics and pre-test scores of balance. A repeated-measures MANOVA showed a significant difference in improvement of balance between the two study groups after 6 weeks [F(1,28) = 32.6,p = .000; Wilk's lambda = .46]. The improvement of mean score of balance in interventional group was greater than in the control group [BBS:9.5 (intervention group),5.5 (control group); FSST:3.9 (intervention group),1.7 (control group)]. There were no injuries in both groups.Conclusions: Wobble board exercises, when combined with the conventional physiotherapy, are safe and effective in restoring functional balance in patients with hemiplegia following ischemic strokes.
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Affiliation(s)
| | - Yasith Mathangasinghe
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Dimonge Joseph Anthony
- Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.,Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Al Bimani SA, Gates LS, Warner M, Bowen C. Factors influencing return to play following conservatively treated ankle sprain: a systematic review. PHYSICIAN SPORTSMED 2019; 47:31-46. [PMID: 30324860 DOI: 10.1080/00913847.2018.1533392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ankle sprain is a very common injury, yet uncertainty exists in what is appropriate time to return to play (RTP). Such guidance may inform treatment pathways and effective practice. OBJECTIVES To determine if consensus exist about potential influencing factors for time to RTP in conservatively treated ankle sprain. METHODS We searched AMED, CINAHL Plus, Cochrane library, EMBASE, MEDLINE (EBSCO), SPOERDiscus, PsycINFO, PEDro, Scopus, unpublished literature and ongoing trials and Google Scholar from inception until April 2017. The quality of the eligible papers was assessed using the Downs and Black tool for randomized controlled trials (RCTs) and Critical Appraisal Skills Program (CASP) for observational studies. RESULTS The initial search identified 1885 articles. After screening, 14 articles were included. Of these, 11 were RCTs and 3 were prospective observational studies. Individual treatment methods that resulted in a shorter time to RTP were functional treatment, compression stockings, anteroposterior joint mobilization, hyaluronic acid injection (HA), Jump Stretch Flex Band programme (JSFB) and diclofenac medication. Prognostic factors for determining time to RTP in the included prospective observational studies were measures of Global function, SF 36PF, athlete's ambulation status, weight-bearing activity scores and self-reported athletic ability. CONCLUSION To our knowledge, this is the first review to report influencing factors for time to RTP following conservatively treated ankle sprain. Findings from this review identified factors that influence time to RTP. However, caution should be taken in generalizing these results due to the heterogeneity of studies and inability to clearly define and list the criteria for safe RTP. The inclusion of factors such as age, sex, BMI, level of sport, injury related factors in future studies might help to understand the course of injury and therefore assist in constructing safer criteria.
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Affiliation(s)
- Saed A Al Bimani
- a Faculty of Health Sciences , University of Southampton , Southampton , UK.,b Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Southampton , Southampton , UK.,c Department of Physiotherapy , College of Health Sciences , Muscat , Oman
| | - Lucy S Gates
- a Faculty of Health Sciences , University of Southampton , Southampton , UK.,b Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Southampton , Southampton , UK
| | - Martin Warner
- a Faculty of Health Sciences , University of Southampton , Southampton , UK.,b Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Southampton , Southampton , UK
| | - Catherine Bowen
- a Faculty of Health Sciences , University of Southampton , Southampton , UK.,b Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Southampton , Southampton , UK
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Lee E, Cho J, Lee S. Short-Foot Exercise Promotes Quantitative Somatosensory Function in Ankle Instability: A Randomized Controlled Trial. Med Sci Monit 2019; 25:618-626. [PMID: 30665229 PMCID: PMC6350454 DOI: 10.12659/msm.912785] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Ankle sprain reduces capacity for neurosensory information processing, and these patients commonly progress to chronic ankle instability (CAI). To address this problem, the short-foot exercise (SFE) may be used. However, there has been no previous research on the neurosensory impact of SFE. Therefore, the aim of this study was to assess improvement of quantitative neurosensory indicators after SFE and to determine the effect of proprioceptive sensory exercise (PSE) in patients with CAI. Material/Methods The present study included 30 adults (age range: 19–29 years; 50% female). Selection criteria for CAI (Cumberland Ankle Instability Tool ≤24) were implemented, and participants were randomly allocated to 2 groups: SFE (n1=15) and PSE (n2=15). Exercises were conducted 3 times per week for 8 weeks. Measurements of quantitative somatosensory of joint position sense and vibration sensory thresholds, dynamic balance, and ankle instability assessment were evaluated before and after completion of each intervention. Data were analyzed using a repeated- measures analysis of variance. Results In a time-by-group comparison, the SFE group showed a more significant improvement with regards to eversion joint position sense (F1,28=4.543, p<0.05). For vibration sensory threshold, the SFE group showed a more significant improvement (F1,28=8.280, p<0.01). Balance index according to anterio-posterior, mediolateral, and overall index the SFE group a more significant improvement (F1,28=6.666, 4.585, 5.207, p<0.05). And ankle instability SFE group showed a more significant improvement (F1,28=6.890, p<0.05). Conclusions SFE is more effective than PSE for treating ankle sprain patients. There is a need to develop and promote an effective and controlled exercise program to facilitate the return of ankle sprain patients to normal daily life.
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Affiliation(s)
- Eunsang Lee
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, South Korea
| | - Juchul Cho
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, South Korea
| | - Seungwon Lee
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, South Korea
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Poor static balance is a risk factor for non-contact anterior cruciate ligament injury. Arch Orthop Trauma Surg 2018; 138:1713-1718. [PMID: 30027482 DOI: 10.1007/s00402-018-2984-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND This prospective study aimed to investigate the relationship between static balance and the incidence of non-contact anterior cruciate ligament (ACL) injury in female high school athletes. METHODS This study included 276 female high school handball or basketball players. At the time of admission, each subject's static balance was measured with a gravicorder, and the incidence of non-contact ACL injury was investigated in the 3 years until the student graduated. The measured parameters of postural sway were locus length per time (the distance that a center of gravity of the foot pressure moves per second) and environmental area (AR: the area surrounded by the integumentary covering of the trace of the center of gravity). Twenty-seven players (9.8%) experienced an ACL injury during the 3-year observation period. Twenty-four injured players sustained a non-contact injury and three injured players sustained a contact injury. In this study, the three contact injury players were excluded. We compared the differences in the static balance between injured and uninjured players. RESULTS The locus length per time was significantly longer in injured than in uninjured players (p = 0.046). Though there was no statistically significant difference between the two groups in AR (p = 0.190), AR tended to be larger in the ACL injured group. CONCLUSIONS This result shows that poor static balance is a risk factor for non-contact ACL injury.
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Mohd Salim NS, Umar MA, Shaharudin S. Effects of the standard physiotherapy programme on pain and isokinetic ankle strength in individuals with grade I ankle sprain. J Taibah Univ Med Sci 2018; 13:576-581. [PMID: 31435381 PMCID: PMC6694912 DOI: 10.1016/j.jtumed.2018.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 10/19/2018] [Accepted: 10/20/2018] [Indexed: 12/26/2022] Open
Abstract
Objectives The isokinetic evaluation of the ankle joint is important in determining the effectiveness of the rehabilitation programme for the management of ankle sprains. This study aimed to determine the effects of physiotherapy programme on isokinetic variables in individuals with grade I ankle sprains. Methods Seven patients with acute grade 1 ankle sprain (15 days of ankle sprain) were recruited. They were provided with 7 days of protection, optimal loading, ice, compression, and elevation (POLICE) treatment, and the standard physiotherapy programme consisted of towel stretching and balancing exercises on one leg. Pain scale score was recorded daily during the physiotherapy programme. The isokinetic ankle strengths of the patient's injured and uninjured legs were compared before and after the physiotherapy programme. Isokinetic tests were conducted in painless range of motion for the injured leg. Results Pain was significantly reduced after the patients underwent the standard physiotherapy programme. No significant differences were observed in terms of the ankle peak torque, time to peak torque, and ankle plantar flexion-to-dorsiflexion ratio of the injured and uninjured legs. The injured leg showed significant improvement in terms of ankle eversion-to-inversion ratio (E:I) after 7 days of performing the standard physiotherapy programme. Conclusion Performing the standard physiotherapy programme for 1 week reduces pain and improves the ankle E:I in patients with grade 1 ankle sprain.
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Affiliation(s)
- Nor S Mohd Salim
- Exercise & Sports Science Program, School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Muhammad A Umar
- Exercise & Sports Science Program, School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Shazlin Shaharudin
- Exercise & Sports Science Program, School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
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27
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Vriend I, Gouttebarge V, Finch CF, van Mechelen W, Verhagen EALM. Intervention Strategies Used in Sport Injury Prevention Studies: A Systematic Review Identifying Studies Applying the Haddon Matrix. Sports Med 2018; 47:2027-2043. [PMID: 28303544 PMCID: PMC5603636 DOI: 10.1007/s40279-017-0718-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Prevention of sport injuries is crucial to maximise the health and societal benefits of a physically active lifestyle. To strengthen the translation and implementation of the available evidence base on effective preventive measures, a range of potentially relevant strategies should be considered. OBJECTIVE Our aim was to identify and categorise intervention strategies for the prevention of acute sport injuries evaluated in the scientific literature, applying the Haddon matrix, and identify potential knowledge gaps. METHODS Five electronic databases were searched (PubMed, EMBASE, SPORTDiscus, CINAHL, Cochrane) for studies that evaluated the effect of interventions on the occurrence of acute sport injuries. Studies were required to include a control group/condition, prospective data collection, and a quantitative injury outcome measure. RESULTS A total of 155 studies were included, mostly randomised controlled trials (43%). The majority of studies (55%) focussed on strategies requiring a behavioural change on the part of athletes. Studies predominantly evaluated the preventive effect of various training programmes targeted at the 'pre-event' phase (n = 73) and the use of equipment to avoid injury in the 'event phase' (n = 29). A limited number of studies evaluated the preventive effect of strategies geared at rules and regulations (n = 14), and contextual modifications (n = 18). Studies specifically aimed at preventing re-injuries were a minority (n = 8), and were mostly related to ankle sprains (n = 5). CONCLUSIONS Valuable insight into the extent of the evidence base of sport injury prevention studies was obtained for 20 potential intervention strategies. This approach can be used to monitor potential gaps in the knowledge base on sport injury prevention.
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Affiliation(s)
- Ingrid Vriend
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands.,Consumer Safety Institute VeiligheidNL, Amsterdam, The Netherlands
| | - Vincent Gouttebarge
- Amsterdam Collaboration on Health and Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands.,Consumer Safety Institute VeiligheidNL, Amsterdam, The Netherlands.,Division of 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 Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Australia
| | - Willem van Mechelen
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and 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.,Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Evert A L M Verhagen
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Amsterdam Collaboration on Health and Safety in Sports, IOC Research Center, AMC/VUmc, Amsterdam, The Netherlands. .,Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. .,Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Australia.
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Bleakley CM, Taylor JB, Dischiavi SL, Doherty C, Delahunt E. Rehabilitation Exercises Reduce Reinjury Post Ankle Sprain, But the Content and Parameters of an Optimal Exercise Program Have Yet to Be Established: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2018; 100:1367-1375. [PMID: 30612980 DOI: 10.1016/j.apmr.2018.10.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 08/03/2018] [Accepted: 10/11/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To determine if exercise-based rehabilitation reduces reinjury following acute ankle sprain. Our secondary objective was to assess if rehabilitation efficacy varies according to exercise content and training volume. DATA SOURCES The following electronic databases were searched: EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials, and Physiotherapy Evidence Database (PEDro). STUDY SELECTION Randomized controlled trials investigating the effect of exercise-based rehabilitation programs on reinjury and patient-reported outcomes (perceived instability, function, pain) in people with an acute ankle sprain. No restrictions were made on the exercise type, duration, or frequency. Exercise-based programs could have been administered in isolation or as an adjunct to usual care. Comparisons were made to usual care consisting of 1 or all components of PRICE (protection, rest, ice, compression, elevation). DATA EXTRACTION Effect sizes with 95% CIs were calculated in the form of mean differences for continuous outcomes and odds ratios (ORs) for dichotomous outcomes. Pooled effects were calculated for reinjury prevalence with meta-analysis undertaken using RevMan software. DATA SYNTHESIS Seven trials (n=1417) were included (median PEDro score, 8/10). Pooled data found trends toward a reduction in reinjury in favor of the exercise-based rehabilitation compared with usual care at 3-6 months (OR, 0.87; 95% CI, 0.48-1.58) with significant reductions reported at 7-12 months (OR, 0.53; 95% CI, 0.38-0.73). Sensitivity analysis based on pooled reinjury data from 2 high quality studies (n=629) also found effects in favor of exercise-based rehabilitation at 12 months (OR, 0.60; 95% CI, 0.49-0.89). Training volume differed substantially across rehabilitation programs with total rehabilitation time ranging from 3.5-21 hours. The majority of rehabilitation programs focused primarily on postural balance or strength training. CONCLUSIONS Exercise-based rehabilitation reduces the risk of reinjury following acute ankle sprain when compared with usual care alone. There is no consensus on optimal exercise content and training volume in this field. Future research must explicitly report all details of administered exercise-based rehabilitation programs.
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Affiliation(s)
- Chris M Bleakley
- Congdon School of Health Sciences, High Point University, High Point, NC.
| | - Jeffrey B Taylor
- Congdon School of Health Sciences, High Point University, High Point, NC
| | - Steven L Dischiavi
- Congdon School of Health Sciences, High Point University, High Point, NC
| | - Cailbhe Doherty
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Eamonn Delahunt
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
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29
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Burger M, Dreyer D, Fisher RL, Foot D, O'Connor DH, Galante M, Zalgaonkir S. The effectiveness of proprioceptive and neuromuscular training compared to bracing in reducing the recurrence rate of ankle sprains in athletes: A systematic review and meta-analysis. J Back Musculoskelet Rehabil 2018; 31:221-229. [PMID: 29154263 DOI: 10.3233/bmr-170804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankle sprains are common musculoskeletal injuries in which the ligaments of the ankle partially or completely tear due to sudden stretching. OBJECTIVES To critically appraise, evaluate and establish the best available evidence to determine the effectiveness of proprioceptive and neuromuscular training (PNT) compared to bracing in reducing the recurrence rate of ankle sprains in athletes. METHODOLOGY The following seven databases were searched in June 2017: PubMed, Cochrane Library, PEDro, ScienceDirect, Scopus, SPORTDiscus, EBSCO Host: CINAHL. The main search terms used were "ankle sprains", "proprioceptive training", "neuromuscular training" and "bracing". The quality of the trials were critically appraised according to the PEDro scale. The RevMan 5© software was used to pool results. RESULTS Three studies met the inclusion criteria and the quality according to the PEDro scale ranged from 4/10-7/10. The pooled data showed no difference between PNT and bracing in reducing the recurrence rate of ankle sprains in athletes at 12 months after initiation of the study. CONCLUSION This systematic review of the overall effect suggested that current evidence (Level II) does not favour the use of PNT over bracing in reducing the recurrence rate of ankle sprains. Physiotherapists are advised to use either PNT or bracing according to the patients preference and their own expertise.
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30
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Blair S, Lake MJ, Ding R, Sterzing T. Magnitude and variability of gait characteristics when walking on an irregular surface at different speeds. Hum Mov Sci 2018; 59:112-120. [PMID: 29653340 DOI: 10.1016/j.humov.2018.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 04/04/2018] [Accepted: 04/04/2018] [Indexed: 12/26/2022]
Abstract
Different modes of perturbations have been used to understand how individuals negotiate irregular surfaces, with a general notion that increased locomotion variability induces a positive training stimulus. Individuals tend to walk slower when initially exposed to such locomotion tasks, potentially influencing the magnitude and variability of biomechanical parameters. This study investigated theeffects of gait speed on lower extremity biomechanics when walking on an irregular (IS) and regular surface (RS). Twenty physically active males walked on a RS and IS at three different speeds (4 km/h, 5 km/h, 6 km/h). Lower extremity kinematics (300 Hz) and surface electromyography (3000 Hz) were recorded during the first 90 s of gait. Two-factor repeated measures ANOVA was used to determine surface and speed effects (p < 0.05). Gait speed influences walking biomechanics (kinematic and muscle activity parameters) the same irrespective of surface condition. As walking speed increased, sagittal shoe-surface angle, maximum ankle inversion, ankle abduction, knee and hip flexion increased during stance phase when walking on the IS and RS (p < 0.05). Increasing walking speed caused increased muscle activity of the tibialis anterior, peroneus longus, gastrocnemius medialis, vastus medialis and biceps femoris (p < 0.05) on the IS and RS during the gait cycle. Increased gait, kinematic and muscle activity variability was reported at lower walking speed on both the IS and RS. Further, irrespective of gait speed, walking on an IS triggers postural adjustments, higher muscle activity and increased gait variability compared to RS walking. Our findings suggest the benefits of training on the irregular surface may be further enhanced at slower gait speeds.
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Affiliation(s)
- Stephanie Blair
- Institute for Health and Sport (IHES), Victoria University, Footscray Park Campus, Melbourne, Victoria, Australia; School of Sport and Exercise Sciences, Liverpool John Moore University, Tom Reilly Building, Liverpool, United Kingdom; Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Co., Ltd, Beijing, China.
| | - Mark J Lake
- School of Sport and Exercise Sciences, Liverpool John Moore University, Tom Reilly Building, Liverpool, United Kingdom
| | - Rui Ding
- Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Co., Ltd, Beijing, China
| | - Thorsten Sterzing
- Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Co., Ltd, Beijing, China
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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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32
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Herold F, Wiegel P, Scholkmann F, Thiers A, Hamacher D, Schega L. Functional near-infrared spectroscopy in movement science: a systematic review on cortical activity in postural and walking tasks. NEUROPHOTONICS 2017; 4:041403. [PMID: 28924563 PMCID: PMC5538329 DOI: 10.1117/1.nph.4.4.041403] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 06/23/2017] [Indexed: 05/07/2023]
Abstract
Safe locomotion is a crucial aspect of human daily living that requires well-functioning motor control processes. The human neuromotor control of daily activities such as walking relies on the complex interaction of subcortical and cortical areas. Technical developments in neuroimaging systems allow the quantification of cortical activation during the execution of motor tasks. Functional near-infrared spectroscopy (fNIRS) seems to be a promising tool to monitor motor control processes in cortical areas in freely moving subjects. However, so far, there is no established standardized protocol regarding the application and data processing of fNIRS signals that limits the comparability among studies. Hence, this systematic review aimed to summarize the current knowledge about application and data processing in fNIRS studies dealing with walking or postural tasks. Fifty-six articles of an initial yield of 1420 publications were reviewed and information about methodology, data processing, and findings were extracted. Based on our results, we outline the recommendations with respect to the design and data processing of fNIRS studies. Future perspectives of measuring fNIRS signals in movement science are discussed.
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Affiliation(s)
- Fabian Herold
- Otto von Guericke University Magdeburg, Institute III, Department of Sport Science, Magdeburg, Germany
- Address all correspondence to: Fabian Herold, E-mail:
| | - Patrick Wiegel
- University of Freiburg, Department of Sport Science, Freiburg, Germany
| | - Felix Scholkmann
- University of Zurich, University Hospital Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Zurich, Switzerland
| | - Angelina Thiers
- Otto von Guericke University Magdeburg, Institute III, Department of Sport Science, Magdeburg, Germany
| | - Dennis Hamacher
- Otto von Guericke University Magdeburg, Institute III, Department of Sport Science, Magdeburg, Germany
| | - Lutz Schega
- Otto von Guericke University Magdeburg, Institute III, Department of Sport Science, Magdeburg, Germany
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34
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Bizovska L, Janura M, Svoboda Z, Cerny M, Krohova J, Smondrk M. Intra- and inter-session reliability of traditional and entropy-based variables describing stance on a wobble board. Med Eng Phys 2017; 50:29-34. [PMID: 28916208 DOI: 10.1016/j.medengphy.2017.08.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 07/04/2017] [Accepted: 08/28/2017] [Indexed: 12/26/2022]
Abstract
A wobble board (WB) is a balance rehabilitation tool that is used in physiotherapy to improve strength and stability. The WB tested in this study includes a sensory module for measuring patients' tilt and rotation during stance. The aim of this study was to assess the reliability and validity of a balance measurement using a WB. Thirty healthy young adults participated in this study. The participants stood on the WB to simultaneously record the tilt of the WB and the center of pressure data using a force plate. The data were recorded during five measurement sessions on various days, with four trials each. Sways, velocities and indexes of complexity (CI) were computed. For reliability assessment, we used intra-class correlation coefficients within and between sessions; for validity, we computed Spearman correlation coefficients. The velocities and CI showed good intra-session reliability, and the sways showed mostly poor intra-session reliability. The results of inter-session reliability showed good to excellent reliability for CI, poor reliability for sways and poor to good reliability for velocities. The Spearman correlation coefficient showed excellent agreement between the mean velocities computed from the force plate and the WB. Our results confirm that the WB tested is suitable for stability assessment in young adults.
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Affiliation(s)
- Lucia Bizovska
- Department of Natural Sciences in Kinathropology, Faculty of Physical Culture, Palacky University Olomouc, Trida Miru 117, Olomouc 77111, Czech Republic.
| | - Miroslav Janura
- Department of Natural Sciences in Kinathropology, Faculty of Physical Culture, Palacky University Olomouc, Trida Miru 117, Olomouc 77111, Czech Republic
| | - Zdenek Svoboda
- Department of Natural Sciences in Kinathropology, Faculty of Physical Culture, Palacky University Olomouc, Trida Miru 117, Olomouc 77111, Czech Republic
| | - Martin Cerny
- Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, 17. listopadu 15, Ostrava 70833, Czech Republic
| | - Jana Krohova
- Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, 17. listopadu 15, Ostrava 70833, Czech Republic
| | - Maros Smondrk
- Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, 17. listopadu 15, Ostrava 70833, Czech Republic
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Fautrelle L, Kubicki A, Babault N, Paizis C. Immediate effects of shoes inducing ankle-destabilization around Henke's axis during challenging walking gaits: Gait kinematics and peroneal muscles activities. Gait Posture 2017; 54:259-264. [PMID: 28371739 DOI: 10.1016/j.gaitpost.2017.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 03/09/2017] [Accepted: 03/21/2017] [Indexed: 02/02/2023]
Abstract
Due to its high frequency of occurrence, as well as possible residual symptoms, proper treatment of lateral ankle sprains (LAS) is important. From a physiological point of view, increasing the quantity of electromyographic (EMG) activity in the peroneal muscles will mechanically improve the functional stability of the ankle joint. The present study investigated the immediate effects of an ankle destabilization device (ADD) specifically designed to induce imbalances along the Henke's axis during 3 challenging walking tasks. As the effects of such a device have to be tested on healthy participants before being implemented in rehabilitation programs, 12 healthy participants performed 3 different types of walking (normal, aligned, and jumping walking) while the EMG activities in four peroneal muscles and the main gait kinematics parameters were recorded. Our results clearly demonstrated that wearing the ADD during these different walking tasks significantly increased EMG activities in the four peroneal muscles (increases from 9 to 33% on average depending on the muscle and the walking condition) while maintaining previous gait kinematic patterns. Our study shows that an ADD coupled with walking or jumping tasks is able to improve neuromuscular activity. It should therefore be useful for ankle rehabilitation therapy and the prevention of LAS.
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Affiliation(s)
- Lilian Fautrelle
- Institut National de la Santé et de la Recherche Médicale, Unité 1093, Cognition, Action et Plasticité Sensori-Motrice, F-21078 Dijon, France; Laboratoire EA 2931 CeRSM, Centre de Recherches sur le Sport et le Mouvement, UFR STAPS, 200 Avenue de la République, 92000 Nanterre, France; Université de Paris Ouest, Nanterre La Défense, Unité de Formation et de Recherche en Sciences et Techniques des Activités Physiques et Sportives, 200 Avenue de la République, 92001 Nanterre, France.
| | - Alexandre Kubicki
- Institut National de la Santé et de la Recherche Médicale, Unité 1093, Cognition, Action et Plasticité Sensori-Motrice, F-21078 Dijon, France
| | - Nicolas Babault
- Institut National de la Santé et de la Recherche Médicale, Unité 1093, Cognition, Action et Plasticité Sensori-Motrice, F-21078 Dijon, France; Centre d'Expertise de la Performance G. Cometti, Faculté des Sciences du Sport, Université de Bourgogne Franche-Comté, BP 27887, 21078, Dijon Cedex, France
| | - Christos Paizis
- Institut National de la Santé et de la Recherche Médicale, Unité 1093, Cognition, Action et Plasticité Sensori-Motrice, F-21078 Dijon, France; Centre d'Expertise de la Performance G. Cometti, Faculté des Sciences du Sport, Université de Bourgogne Franche-Comté, BP 27887, 21078, Dijon Cedex, France
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Briet JP, Houwert RM, Hageman MGJS, Hietbrink F, Ring DC, Verleisdonk EJJM. Factors associated with pain intensity and physical limitations after lateral ankle sprains. Injury 2016; 47:2565-2569. [PMID: 27659849 DOI: 10.1016/j.injury.2016.09.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/07/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Swelling, tenderness, and ecchymosis don't correlate with time to functional recovery in patients with a lateral ankle sprain. It is established that psychosocial factors such as symptoms of depression and low pain self-efficacy correlate with pain intensity and magnitude of limitations in patients with musculoskeletal disorders. OBJECTIVE We studied the correlation between pain self-efficacy or symptoms of depression and (1) ankle specific limitations and (2) pain intensity in patients with a lateral ankle sprain. Further we explored the correlation between estimation of sprain severity (grade) and (3) pain intensity or magnitude of ankle specific limitations. DESIGN Eighty-four patients with a lateral ankle sprain prospectively completed the Pain Self Efficacy Questionnaire, the Olerud Molander Ankle Score, Ordinal scale of Pain and the Patient Health Questionnaire-2 at enrollment and the Olerud Molander Ankle Score and the Ordinal scale of Pain three weeks after the injury. Factors associated with higher ankle specific limitations and symptoms were investigated in bivariable and multivariable analysis. RESULTS When accounting for confounding factors, greater self-efficacy (p=0.01) and older age (p<0.01) were significantly associated with greater ankle specific symptoms and limitations three weeks after the injury and explained 22% of the variability in ankle specific limitations and symptoms. There was no correlation between the grade of the sprain and pain intensity or ankle specific limitations or symptoms. CONCLUSIONS Psychosocial factors (adaptiveness in response to pain in particular) explain more of the variation in symptoms and limitations after ankle sprain than the degree of pathophysiology. The influence of adaptive illness descriptions and recovery strategies based on methods for improving self-efficacy (i.e. cognitive behavioral therapy) might enhance and speed recovery from ankle injuries and merit additional investigation. LEVEL OF EVIDENCE Level 2 prospective cohort study.
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Affiliation(s)
- Jan Paul Briet
- Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582KE, Utrecht, The Netherlands.
| | | | - Michiel G J S Hageman
- Department of Orthopaedic surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, United States
| | - Falco Hietbrink
- Department of Surgery UMC Utrecht, Heidelberglaan 100, PO 85500, 3508 GA Utrecht, The Netherlands
| | - David C Ring
- Department of Surgery and Perioperative Care, New Dell Medical Center, Austin, TX, United States
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Farjadian AB, Nabian M, Hartman A, Corsino J, Mavroidis C, Holden MK. Position versus force control: using the 2-DOF robotic ankle trainer to assess ankle's motor control. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2014:1186-9. [PMID: 25570176 DOI: 10.1109/embc.2014.6943808] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
An estimated of 2,000,000 acute ankle sprains occur annually in the United States. Furthermore, ankle disabilities are caused by neurological impairments such as traumatic brain injury, cerebral palsy and stroke. The virtually interfaced robotic ankle and balance trainer (vi-RABT) was introduced as a cost-effective platform-based rehabilitation robot to improve overall ankle/balance strength, mobility and control. The system is equipped with 2 degrees of freedom (2-DOF) controlled actuation along with complete means of angle and torque measurement mechanisms. Vi-RABT was used to assess ankle strength, flexibility and motor control in healthy human subjects, while playing interactive virtual reality games on the screen. The results suggest that in the task with 2-DOF, subjects have better control over ankle's position vs. force.
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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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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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Abstract
Study Design Systematic review. Background Soft tissue injuries to the lower limb bring a substantial health and economic burden to society. Physical agents are commonly used to treat these injuries. However, the effectiveness of many such physical agents is not clearly established in the literature. Objective To evaluate the effectiveness and safety of physical agents for soft tissue injuries of the lower limb. Methods We searched 5 databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort studies, and case-control studies. Paired reviewers independently screened the retrieved literature and appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a high risk of bias were excluded. We synthesized low-risk-of-bias studies according to principles of best-evidence synthesis. Results We screened 10261 articles. Of 43 RCTs identified, 20 had a high risk of bias and were excluded from the analysis, and 23 RCTs had a low risk of bias and were included in the analysis. The available higher-quality evidence suggests that patients with persistent plantar fasciitis may benefit from ultrasound or foot orthoses, while those with persistent midportion Achilles tendinopathy may benefit from shockwave therapy. However, the current evidence does not support the use of shockwave therapy for recent plantar fasciitis, low-Dye taping for persistent plantar fasciitis, low-level laser therapy for recent ankle sprains, or splints for persistent midportion Achilles tendinopathy. Finally, evidence on the effectiveness of the following interventions is not established in the current literature: (1) shockwave therapy for persistent plantar fasciitis, (2) cryotherapy or assistive devices for recent ankle sprains, (3) braces for persistent midportion Achilles tendinopathy, and (4) taping or electric muscle stimulation for patellofemoral pain syndrome. Conclusion Almost half the identified RCTs that evaluated the effectiveness of physical agents for the management of lower-limb soft tissue injuries had a high risk of bias. High-quality RCTs are still needed to assess the effectiveness of physical agents for managing the broad range of lower-limb soft tissue injuries. The effectiveness of most interventions remains unclear. Level of Evidence Therapy, 1a. Protocol registered July 10, 2014 with PROSPERO (CRD42014010621). J Orthop Sports Phys Ther 2016;46(7):523-554. Epub 6 Jun 2016. doi:10.2519/jospt.2016.6521.
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Heleno LR, da Silva RA, Shigaki L, Araújo CGA, Coelho Candido CR, Okazaki VHA, Frisseli A, Macedo CDSG. Five-week sensory motor training program improves functional performance and postural control in young male soccer players - A blind randomized clinical trial. Phys Ther Sport 2016; 22:74-80. [PMID: 27620862 DOI: 10.1016/j.ptsp.2016.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 04/19/2016] [Accepted: 05/02/2016] [Indexed: 12/26/2022]
Abstract
Sensory motor training programs are used in the rehabilitation and prevention of injuries among soccer players. Inconsistencies are found in the literature regarding the duration of the protocols and the exercises and equipment used. OBJECTIVE To evaluate the benefits of a five-week sensory motor training program on the functional performance and postural control of young soccer players. METHODS The study sample comprised 22 young male soccer players who were evaluated using: the Figure-of-Eight Test (F8), Side Hop Test (SHT), Star Excursion Balance Test (SEBT), and a force platform. The players were randomly divided into a control group (N = 10), who continued their soccer practice sessions and an intervention group (N = 12), who continued their soccer practice sessions and were also enrolled in a supervised five-week sensory motor training program. RESULTS After the five-week training program, the intervention group obtained significant results in the F8, SHT and SEBT, as well as in the following parameters: area of pressure of sway center (COP), mean velocity and mean frequency of COP. CONCLUSION The five-week sensory motor training program, carried out with easily available and low cost equipment, was effective at improving functional performance and postural control in young soccer players.
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Affiliation(s)
- Lucas Rafael Heleno
- Physiotherapy Department, Health Sciences Center, State University of Londrina (UEL), Londrina, PR, Brazil
| | - Rubens A da Silva
- Center for Health Science Research, Laboratory of Functional Evaluation and Human Motor Performance (LAFUP), North Paraná University (UNOPAR), Londrina, PR, Brazil; Doctoral and Masters Program in Rehabilitation Sciences UEL/UNOPAR, Londrina, PR, Brazil
| | - Leonardo Shigaki
- Center for Health Science Research, Laboratory of Functional Evaluation and Human Motor Performance (LAFUP), North Paraná University (UNOPAR), Londrina, PR, Brazil; Doctoral and Masters Program in Rehabilitation Sciences UEL/UNOPAR, Londrina, PR, Brazil
| | - Cynthia Gobbi Alves Araújo
- Center for Health Science Research, Laboratory of Functional Evaluation and Human Motor Performance (LAFUP), North Paraná University (UNOPAR), Londrina, PR, Brazil; Doctoral and Masters Program in Rehabilitation Sciences UEL/UNOPAR, Londrina, PR, Brazil
| | | | | | - Ariobaldo Frisseli
- Center of Physical Education and Sport, State University of Londrina, Londrina, PR, Brazil
| | - Christiane de S Guerino Macedo
- Physiotherapy Department, Health Sciences Center, State University of Londrina (UEL), Londrina, PR, Brazil; Doctoral and Masters Program in Rehabilitation Sciences UEL/UNOPAR, Londrina, PR, Brazil.
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Pourkazemi F, Hiller C, Raymond J, Black D, Nightingale E, Refshauge K. Using Balance Tests to Discriminate Between Participants With a Recent Index Lateral Ankle Sprain and Healthy Control Participants: A Cross-Sectional Study. J Athl Train 2016; 51:213-22. [PMID: 26967374 DOI: 10.4085/1062-6050-51.4.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT The first step to identifying factors that increase the risk of recurrent ankle sprains is to identify impairments after a first sprain and compare performance with individuals who have never sustained a sprain. Few researchers have restricted recruitment to a homogeneous group of patients with first sprains, thereby introducing the potential for confounding. OBJECTIVE To identify impairments that differ in participants with a recent index lateral ankle sprain versus participants with no history of ankle sprain. DESIGN Cross-sectional study. PATIENTS OR OTHER PARTICIPANTS We recruited a sample of convenience from May 2010 to April 2013 that included 70 volunteers (age = 27.4 ± 8.3 years, height = 168.7 ± 9.5 cm, mass = 65.0 ± 12.5 kg) serving as controls and 30 volunteers (age = 31.1 ± 13.3 years, height = 168.3 ± 9.1 cm, mass = 67.3 ± 13.7 kg) with index ankle sprains. MAIN OUTCOME MEASURE(S) We collected demographic and physical performance variables, including ankle-joint range of motion, balance (time to balance after perturbation, Star Excursion Balance Test, foot lifts during single-legged stance, demi-pointe balance test), proprioception, motor planning, inversion-eversion peak power, and timed stair tests. Discriminant analysis was conducted to determine the relationship between explanatory variables and sprain status. Sequential discriminant analysis was performed to identify the most relevant variables that explained the greatest variance. RESULTS The average time since the sprain was 3.5 ± 1.5 months. The model, including all variables, correctly predicted a sprain status of 77% (n = 23) of the sprain group and 80% (n = 56) of the control group and explained 40% of the variance between groups ([Formula: see text] = 42.16, P = .03). Backward stepwise discriminant analysis revealed associations between sprain status and only 2 tests: Star Excursion Balance Test in the anterior direction and foot lifts during single-legged stance ([Formula: see text] = 15.2, P = .001). These 2 tests explained 15% of the between-groups variance and correctly predicted group membership of 63% (n = 19) of the sprain group and 69% (n = 48) of the control group. CONCLUSIONS Balance impairments were associated with a recent first ankle sprain, but proprioception, motor control, power, and function were not.
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Affiliation(s)
| | - Claire Hiller
- The University of Sydney, Lidcombe, New South Wales, Australia
| | | | - Deborah Black
- The University of Sydney, Lidcombe, New South Wales, Australia
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Abstract
The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected structures should be obtained through history and objective assessment. From this information, an individualized evidence-based intervention plan can be developed to enable recovery while decreasing the risk of reinjury. An appropriate evaluation is needed not only to determine the correct diagnosis but also to allow for grading and determining the prognosis of the injury in those with an acute lateral ankle sprain. Examination should include an assessment of impairments as well as a measure of activity and participation. Evidence-based interventions for those with an acute lateral ankle sprain should include weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy. For those with chronic ankle instability (CAI), interventions should include manual therapy and a comprehensive rehabilitation program. It is essential to understand the normal clinical course for athletes who sustain a lateral ankle sprain as well as risk factors for an acute injury and CAI. Risk factors for both an acute lateral ankle sprain and CAI include not using an external support and not participating in an appropriate exercise program. Incorporating the latest evidence-based rehabilitation techniques provides the best course of treatment for athletes with an acute ankle sprain or CAI.
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Affiliation(s)
- Ryan P McGovern
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA
| | - RobRoy L Martin
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA; Centers for Sports Medicine - University of Pittsburgh, Pittsburgh, PA, USA
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Abstract
OBJECTIVE To quantify improvements in clinical impairments using a wobble board rehabilitation protocol for chronic ankle instability (CAI). DESIGN Prospective randomized controlled trial. SETTING Laboratory. PATIENTS Thirty-four participants with "giving way" and history of ankle sprains were randomly assigned to a rehabilitation group (REH) (170.22 ± 8.71 cm; 75.57 ± 13.55 kg; 22.94 ± 2.77 years) or control group (CON) (168.57 ± 9.81 cm; 77.19 ± 19.93 kg; 23.18 ± 3.64 years). INTERVENTIONS Four weeks with no intervention for CON or wobble board rehabilitation for REH, consisting of 3 sessions per week of 5 repetitions. MAIN OUTCOME MEASURES Dependent variables were preintervention and postintervention score on foot lift test (average number of errors), Time-in-Balance Test (TBT) (longest time), Star Excursion Balance Test (SEBT)-anteromedial, medial, and posteromedial (average reach distance normalized to leg length), side hop test (fastest time), and figure-of-eight hop test (fastest time). RESULTS Main effects for time were significant for all measures (P < 0.05); but main effects for groups were not (P > 0.05) except for SEBT-anteromedial reach direction. Significant interactions were found for all dependent measures (P < 0.05) except for TBT (P > 0.05). Post hoc testing of significant interactions showed REH improved performance at posttest, whereas CON did not. CONCLUSIONS These findings demonstrate that a single intervention using a wobble board improved static and dynamic balance deficits associated with CAI. CLINICAL RELEVANCE This approach provides a potentially more economical, time efficient, and space efficient means of improving clinical outcome measures associated with CAI in patients who are physically active.
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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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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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Richie DH, Izadi FE. Return to play after an ankle sprain: guidelines for the podiatric physician. Clin Podiatr Med Surg 2015; 32:195-215. [PMID: 25804710 DOI: 10.1016/j.cpm.2014.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The ankle sprain is the most common injury in sport and has a high incidence of long-term disability. This disability may be partly due to early return to sport before ligament healing has been completed. The podiatric physician can follow sound guidelines for making a return-to-play decision for athletes suffering from an ankle sprain. The decision-making process requires the podiatric physician to monitor the rehabilitation process and then administer patient self-reported questionnaires as well as functional performance tests to assess the status of ankle function after injury.
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Affiliation(s)
- Douglas H Richie
- Seal Beach Podiatry Group Inc, 550 Pacific Coast Highway, Suite 209, Seal Beach, CA 90174, USA.
| | - Faye E Izadi
- Seal Beach Podiatry Group Inc, 550 Pacific Coast Highway, Suite 209, Seal Beach, CA 90174, USA
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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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Winter T, Beck H, Walther A, Zwipp H, Rein S. Influence of a proprioceptive training on functional ankle stability in young speed skaters – a prospective randomised study. J Sports Sci 2014; 33:831-40. [DOI: 10.1080/02640414.2014.964751] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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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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