Author Names
Prabhakaradoss, D., Sreejesh, M.S., Hameed Pakkir Mohamed, S., Vijay Subbarayalu, A., Prabaharan, S.
Reviewer Name
Kiara Pryor, SPT
Reviewer Affiliation(s)
Duke University Doctor of Physical Therapy Division
Paper Abstract
Background: Lateral Ankle Sprain (LAS) is the most common musculoskeletal injury among highly active and non-active populations. Physiotherapy plays a significant role in reducing pain and improving range of motion (ROM) and functional outcomes in people with LAS. Aims and Objectives: The study’s main objective is to compare the effects of manual therapy (Mulligan’s MWM) conventional physiotherapy (PRICE and therapeutic exercises) and conventional physiotherapy alone on pain, ankle ROM, and function in subjects with LAS. Study Design: A randomized clinical trial was used, and 40 patients diagnosed with acute and sub-acute grade I or II LAS were randomly allotted to two experimental groups. Setting: The patients who met the selection criteria were recruited from the Team Physio Clinic, Pudukkottai, Tamilnadu, from January 2020 to June 2021. Materials and Methods: The experimental group I (n=20) received Mulligan’s MWM and conventional physiotherapy, whereas those assigned to the experimental group II (n=20) received conventional physiotherapy alone. The treatment duration for both groups was four weeks. Outcome measures such as pain intensity, ankle dorsiflexion ROM, and foot and ankle disability index (FADI) were used. Statistics: The Shapiro-Wilk test was applied to examine whether the data had a normal distribution. A paired ‘t-test’ was used to compare the pre-and post-intervention mean scores within a group. Further, an unpaired ‘t-test’ was used to compare the mean scores of both experimental groups at pre-and post-intervention stages. The data analysis was carried out using SPSS at a 5% level of significance. Results: Both experimental groups significantly reduced pain and improved ankle dorsiflexion ROM and function following the treatment duration. There is a significant difference between the two experimental groups in reducing pain and improving ankle dorsiflexion ROM and function at the post-intervention stage. Conclusion: MWM with conventional physiotherapy is significantly more effective than conventional physiotherapy alone in reducing pain and improving ankle dorsiflexion ROM and function in acute and subacute grade I or II LAS.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- No
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- No
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Yes
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Yes
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
Key Finding #1
When conventional physiotherapy is paired with manual therapy, there is a significant improvement in pain when compared to only utilizing conventional therapy alone.
Key Finding #2
When conventional physiotherapy is paired with manual therapy, there is a significant improvement in ankle dorsiflexion ROM when compared to only utilizing conventional therapy alone.
Key Finding #3
When conventional physiotherapy is paired with manual therapy, there is a significant improvement in overall ankle function, via a self-answered disability index, when compared to only utilizing conventional therapy alone.
Please provide your summary of the paper
This study assessed the outcome of lateral ankle sprains (LAS) when treated either with conventional therapy and manual therapy paired, or with conventional therapy alone. 40 participants were randomly assigned to one of the two intervention groups, 20 in one, and 20 in the other, where they would be compared to each other on the improvement of pain, ankle ROM, and overall function. Participants were aged 18-50 who had a unilateral LAS for the first time. Each patient received ankle immobilizing treatment for two to four weeks before treatment. Outcome measures assessed were a Numeric Pain Rating Scale (NRPS), ankle dorsiflexion (DF) ROM, the Foot and Ankle Disability Index, as well as The Shapiro-Wilk test to ensure normal statistical distribution. The treatment lasted four weeks, with two sessions per week. Group 1, the experimental group, received Mulligan’s MWM along with therapeutic exercise while Group 2, the controlled group, received only therapeutic exercise. At the end of the eight weeks, Group 1’s NRPS mean decreased from 6.20/10 to 1.85/10 while Group 2’s decreased from 6.35/10 to 3.30/10. Group 1’s ankle DF ROM increased from a mean of 25.10 degrees to 40.0 degrees while Group 2’s ankle DF ROM increased from 25.65 to 30.65. Lastly, Group 1’s disability index mean score increased from 64.70 to 85.20 and Group 2’s disability mean index increased from 64.25 to 79.60. In conclusion, it was proven that when conventional therapy is paired with manual therapy, there are better overall outcomes in pain, ROM, and overall function than if conventional therapy is provided alone.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
The article explained that lateral ankle sprains account for up to 30% of all athletic injuries. Ramifications of this injury include but are not limited to, treatment costs, time loss from sport, a decrease in physical activity, and a decrease in mental health if not treated correctly. This study showed that in order to provide the best recovery for this type of injury, physical therapists should consider adding manual therapy in combination with the traditional therapeutic exercises they prescribe. Not only will this be beneficial in reducing pain and increasing ROM, but overall ankle function improvement as well. Since lateral ankle sprains are such a prevalent injury, knowing best practice techniques is key to promoting the most positive outcome.
