Author Names
Lin, C. W., Hiller, C. E., & de Bie, R. A.
Reviewer Name
Mason Dukes, SPT
Reviewer Affiliation(s)
Duke DPT Division
Paper Abstract
The most common ankle injuries are ankle sprain and ankle fracture. This review discusses treatments for ankle sprain (including the management of the acute sprain and chronic instability) and ankle fracture, using evidence from recent systematic reviews and randomized controlled trials. After ankle sprain, there is evidence for the use of functional support and non-steroidal anti-inflammatory drugs. There is weak evidence suggesting that the use of manual therapy may lead to positive short-term effects. Electro-physical agents do not appear to enhance outcomes and are not recommended. Exercise may reduce the occurrence of recurrent ankle sprains and may be effective in managing chronic ankle instability. After surgical fixation for ankle fracture, an early introduction of activity, administered via early weight-bearing or exercise during the immobilization period, may lead to better outcomes. However, the use of a brace or orthosis to enable exercise during the immobilization period may also lead to a higher rate of adverse events, suggesting that this treatment regimen needs to be applied judiciously. After the immobilization period, the focus of treatment for ankle fracture should be on a progressive exercise program. Keywords: Ankle injuries, Evidence-based practice, Rehabilitation, Systematic review, Therapy
- Is the review based on a focused question that is adequately formulated and described?
- Cannot Determine, Not Reported, Not Applicable
- Were eligibility criteria for included and excluded studies predefined and specified?
- Cannot Determine, Not Reported, Not Applicable
- Did the literature search strategy use a comprehensive, systematic approach?
- Yes
- Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
- Cannot Determine, Not Reported, Not Applicable
- Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
- Cannot Determine, Not Reported, Not Applicable
- Were the included studies listed along with important characteristics and results of each study?
- Yes
- Was publication bias assessed?
- Yes
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- No
Key Finding #1
Manual therapy was shown to have a limited (weak) effect on ankle sprains, however, strengthening and balance are still better ways to prevent ankle sprains from occurring again. Further, in chronic ankle instability, strengthening and balance are better ways to prevent the ankle from ankle injuries. All the evidence regarding this topic needs to have stronger evidence.
Key Finding #2
The use of manual therapy in people who have ankle fractures did not provide better results. Instead, when an ankle fracture occurs the focus should remain on progressing an exercise program with the surrounding structures.
Please provide your summary of the paper
Ankle sprains and fractures are 2 of the most common ankle injuries. This systematic review discusses the articles on whether manual therapy or exercise is more beneficial for the rehabilitation of these injuries. The use of RCTs used QOl assessments, ROM measures, the Pain Numerical Rating Scale, and disability indexes to determine if manual therapy techniques were effective. It was concluded that manual therapy could be effective when in the acute stages of rehabilitation. Chronic ankle instability does not have conclusive evidence regarding the effectiveness of manual therapy. Further, ankle fractures did not reflect the effectiveness of manual therapy techniques. Ankle sprains and fracture rehabilitation should focus on exercise programs for strengthening, balance, and weight-bearing.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This paper provided good information about the rehabilitation of ankle injuries. I imagined manual therapy would not be the best choice of treatment for acute injury due to pain and swelling. However, I was open to reading about it because I was curious about how these techniques were interpreted by the patients in the articles. There are parts of this article that talk about the ‘deemed improvement’ of the patient’s ankle after these techniques, but their scores did not reflect this same response. This was interesting to me, but I think it has more to do with the healing process as they will begin to feel better over time. I feel more informed and confident about the rehab techniques for this population, and I will focus my treatment on strengthening, balance, and weight-bearing.
