Impairment-based assessments for patients with lateral ankle sprain: A systematic review of measurement properties

Physiotherapists Approach in Lateral Ankle Sprain Rehabilitation: A Survey Study

BACKGROUND

To investigate how physiotherapists approach lateral ankle sprain (LAS) rehabilitation and their rationale for exercise progression. We also sought to determine typical exercise dosage prescribed and the extent to which they rely on objective outcomes for guiding rehabilitation progression and return-to-sports decisions.

METHODS

We distributed an online survey using Qualtrics. The survey comprised a combination of 23 open and 8 closed questions to capture data on: participant demographics and clinical experience, typical caseload, LAS rehabilitation dosage, with clinical vignettes used to determine the time taken to reach key rehabilitation milestones, use of objective markers to inform rehabilitation progress, and progression to each milestone. Data were analyzed descriptively; open questions were inventoried and categorized. Proportions were then calculated per category.

RESULTS

Ninety-six physiotherapists from Belgium, the Netherlands, and the United Kingdom responded to the survey, of which 23 completed all sections. On average, less than half (46%) of the responding therapists use objective measurements to guide rehabilitation progress. The estimated time to reach key clinical milestones is equivocal among participating physiotherapists. Most physiotherapists use pain and ankle impairments (eg, range of motion and muscle strength) to guide rehabilitation progress.

CONCLUSION

This study indicates that progress in LAS rehabilitation is determined subjectively and that not the entire spectrum of impairments is assessed. Physiotherapists should implement more objective measures throughout LAS rehabilitation.

Low Ankle-GO Score While Returning to Sport After Lateral Ankle Sprain Leads to a 9-fold Increased Risk of Recurrence: A Two-year Prospective Cohort Study

BACKGROUND

Lateral ankle sprain (LAS) is the most common sports injury, leading to a high rate of recurrence and the development of chronic ankle instability. One possible explanation is the lack of objective, evidence-based criteria to inform return to sport decisions following LAS. The aim of this study was therefore to assess the efficacy of a new functional score to distinguish patients at risk of recurrent LAS within two years after the initial injury.

METHODS

The Ankle-GO score was used in 64 active patients two months after LAS. This composite score includes 2 self-reported questionnaires and 4 functional tests, for a maximum score of 25 points. The rate of reinjury was prospectively recorded 2 years after inclusion. Potential predictive variables for reinjury were tested using the Chi-square and independent t-tests. The area under the receiver operating characteristics curve (AUC) with the optimal cut-off score was determined to assess the predictive value of the Ankle-GO score for the risk of reinjury. Multivariate logistic regression was then used to determine the influence of risk factors of reinjury.

RESULTS

Fifty-four (85%) patients were included (23 men and 31 women, 34.7 ± 13 years old) including 18 (33.3%) with a reinjury. The two-month Ankle-GO score was lower in patients with a recurrent LAS (5.4 ± 2.8 points vs. 9.1 ± 4.5, p = 0.002) and predicted the risk of reinjury (AUC = 0.75). Patients with < 8 points were found to have a significantly higher risk of reinjury (OR = 8.6; 95%CI: 2-37.2, p = 0.001). Women also tend to have a higher risk of recurrence (OR = 3.8; 95%CI: 0.9-15.5, p = 0.065).

CONCLUSION

The Ankle-GO score is a new objective criterion for RTS after LAS. Patients with a low score at two months have a 9-fold greater risk of recurrence within two years.