WITHDRAWN: Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults.
ABSTRACT Acute lateral ankle ligament injuries (ankle sprains) are common problems in acute medical care. The treatment variation observed for the acutely injured lateral ankle ligament complex suggests a lack of evidence-based management strategies for this problem.
The objective of this review was to assess the effectiveness of methods of immobilisation for acute lateral ankle ligament injuries and to compare immobilisation with functional treatment methods.
We searched the Cochrane Bone, Joint and Muscle Trauma Group specialised register (December 2001); the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), MEDLINE (1966-May 2000), EMBASE (1988-May 2000), reference lists of articles, and contacted organisations and researchers in the field.
Randomised and quasi-randomised controlled trials comparing either different types of immobilisation or immobilisation versus functional treatments for injuries to the lateral ligament complex of the ankle in adults were included. Trials which investigated the treatment of chronic instability or post-surgical treatment were excluded.
Data were independently extracted by two authors. Where appropriate, results of comparable studies were pooled using fixed effects models. Individual and pooled statistics were reported as relative risks with 95% confidence intervals for dichotomous outcomes and weighted (WMD) or standardised (SMD) mean differences and 95% confidence intervals for continuous outcome measures. Heterogeneity between trials was tested using a standard chi-squared test.
Twenty-one trials involving 2184 participants were included. The mean validity score of the included trials increased from 9.1 (SD 3.0) to 10 (SD 2.9) after retrieving further information (maximum 18 points). Statistically significant differences in favour of functional treatment when compared with immobilisation were found for seven outcome measures: more patients returned to sport in the long term (relative risk (RR) 1.86, 95% confidence interval (CI) 1.22 to 2.86); the time taken to return to sport was shorter (WMD 4.88 (days), 95% CI 1.50 to 8.25); more patients had returned to work at short term follow-up (RR 5.75, 95% CI 1.01 to 32.71); the time taken to return to work was shorter (WMD 8.23 days, 95% CI 6.31 to 10.16); fewer patients suffered from persistent swelling at short term follow-up (RR 1.74, 95% CI 1.17 to 2.59); fewer patients suffered from objective instability as tested by stress X-ray (WMD 2.60, 95% CI 1.24 to 3.96); and patients treated functionally were more satisfied with their treatment (RR 1.83, 95% CI 1.09 to 3.07). A separate analysis of trials that scored 50 per cent or more in quality assessment found a similar result for time to return to work only (WMD (days) 12.89, 95% CI 7.10 to 18.67). No significant differences between varying types of immobilisation, immobilisation and physiotherapy or no treatment were found, apart from one trial where patients returned to work sooner after treatment with a soft cast. In all analyses performed, no results were significantly in favour of immobilisation.
Functional treatment appears to be the favourable strategy for treating acute ankle sprains when compared with immobilisation. However, these results should be interpreted with caution, as most of the differences are not significant after exclusion of the low quality trials. Many trials were poorly reported and there was variety amongst the functional treatments evaluated.
Article: Acuut enkelbandletsel[Show abstract] [Hide abstract]
ABSTRACT: Snijders EM, Thomas S, Verhagen AP. Acuut enkelbandletsel. Literatuuronderzoek naar het effect van conservatieve behandelingen. Huisarts Wet 2008;51(1):17-23. Inleiding Zijn conservatieve behandelingen van acuut enkelbandletsel eigenlijk wel zinvol? Wij voerden een literatuuronderzoek uit om de effecten van de diverse behandelingen te evalueren. Methode We doorzochten Medline en de Cochrane Library op systematische reviews en gerandomiseerde onderzoeken over conservatieve behandelingen van acuut enkelbandletsel. We richtten ons op de uitkomstmaten pijn, werk- of sportherstel of recidief. Resultaten Medicatiegebruik bleek een meerwaarde te hebben boven een placebo of afwachten. Voor andere behandelingen is die meerwaarde niet aangetoond. We vonden sterk bewijs dat een stevige brace effectiever is dan een elastische bandage, dat een functionele behandeling beter is dan volledige immobilisatie, en dat oefentherapie meer doet dan alleen instructies of een bandage. Er was matig bewijs dat de combinatie van brace en bandage meer resultaat heeft dan alleen een brace en dat additionele oefentherapie beter werkt dan alleen een functionele behandeling. Verder was er matig bewijs voor een meerwaarde van piroxicam en Wobenzym boven een placebo. Beschouwing Voor pijn bleek medicatie de beste behandeling. Wat betreft werk- en sportherstel weten we niet of een interventie beter is dan afwachten. Bij functionele behandelingen geldt: ‘Hoe steviger, hoe beter’. Additionele oefentherapie lijkt sportherstel te bevorderen en recidieven beter te voorkomen. Fysische interventies, operatie of immobilisatie zijn niet meer aan de orde, ongeacht de ernst van het letsel. Snijders EM, Thomas S, Verhagen AP. Assessment of the effectiveness of conservative treatment of acute ankle sprain. A review of the literature. Huisarts Wet 2008:51(1):17-23. Introduction In this literature review our aim was to assess the effectiveness of conservative treatments of acute ankle sprain. Methods We searched Medline and the Cochrane Library for systematic reviews and randomised studies of conservative treatment of acute ankle sprains. Included were articles scoring the following outcome measures: pain, return to work or sport or recurrence of injury. Reasons for exclusion were recurrent injuries or fractures. Results Except for medication, there is little or no evidence for the added value of any treatment versus placebo or no treatment. There is, however, strong evidence that as regards the group of functional treatments (a form of external support), a brace is more effective than a bandage. Furthermore, there is strong evidence that a functional treatment is more effective than immobilisation, and that physiotherapy is more effective than simply instructions or an elastic bandage. There is limited evidence that combining the use of an elastic bandage and a brace is more effective than merely using a brace. The thesis that additional physiotherapy is more effective than only functional treatment is also supported by limited evidence. Compared to placebo, there is limited evidence for the use of piroxicam and Wobenzym. Conclusion For the treatment of pain, medication is the preferred intervention. It is not known whether any intervention is better than no treatment for return to work or sport. If a functional treatment is chosen, it seems to be: ’the more support, the better’. Additional physiotherapy shortens the time to return to sport. To prevent re-injury, physiotherapy is the best intervention. There is no place for physical interventions, operation or immobilisation, no matter how severe the sprain is. behandeling-enkel-literatuuronderzoek-onderzoekHuisarts en wetenschap 01/2008; 51(1):17-23. DOI:10.1007/BF03086630
Article: Acuut inversieletsel enkel[Show abstract] [Hide abstract]
ABSTRACT: Een acuut inversieletsel van de enkel kan leiden tot een ruptuur van het laterale ligamentencomplex van de enkel, een veelvoorkomend probleem in de medische praktijk. Een optimale functionele behandeling met een brace, eventueel aangevuld met oefentherapie, leidt in de normale populatie tot een vlot herstel en significant minder restklachten dan niet behandelen. De juiste preventieve maatregelen, zoals het gebruik van een brace en het volgen van oefentherapie, leiden tot significant minder recidiefletsels.12/2010; 18(6). DOI:10.1007/s12506-010-0851-9
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ABSTRACT: The Cumberland Ankle Instability Tool (CAIT) is a valid instrument to determine the presence of chronic ankle instability (CAI) and to assess its severity. Self-report test is very useful for researchers and clinical practice, and CAI is a widespread tool. Nevertheless, there is lack of measurement instruments validated into Spanish, which represents a major difficulty for research dealing with a Spanish-speaking population. The questionnaire was cross-culturally adapted into Spanish. The psychometric properties tested in the Spanish version of the CAIT were measured for internal consistency, test-retest reliability, construct validity, criterion validity, and responsiveness in 108 participants who were recruited from several fitness centers. The Spanish version of the CAIT had high internal consistency (Cronbach's α = 0.766) and reliability (intraclass correlation coefficient = 0.979, 95 % confidence interval (CI) = 0.958-0.990). Correlation with the 36-item Short-Form Health Survey (SF-36) physical component summary score (rho = 0.241, p = 0.012) was greater than the SF-36 mental component summary score (rho = -0.162, p = 0.094). The construct validity shows three different factors in the questionnaire and good responsiveness with a mean change of -2.43 (95 % CI = -3.12 to 1.73, p < 0.0001) and a size effect of Cohen's d = 1.07. The Spanish version of the CAIT has been shown to be a valid and reliable instrument for measuring chronic ankle instability and constitutes a useful instrument for the measurement of CAI in the clinical setting in Spain.Clinical Rheumatology 10/2012; 32(1). DOI:10.1007/s10067-012-2095-0 · 1.77 Impact Factor