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.
Keywords
List of abbreviations:
MD (mean difference), NNT (number needed to treat), OR (odds ratio), PEDro (Physiotherapy Evidence Database), RR (relative risk)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 26, 2018
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
