Author Names
Nambi, G. & Shah, B.
Reviewer Name
Kathryn O’Reilly, SPT
Reviewer Affiliation(s)
Duke University School of Medicine – Doctor of Physical Therapy Division
Paper Abstract
Background: The effectiveness of taping and bracing in the treatment of ankle injuries in hockey has not been investigated, although it has been shown effective in reducing the incidence of Sub-acute ankle injuries in other sports (basketball and US football). The effectiveness of application Mulligan‟s Mobilization with movement technique for talocrural dorsiflexion to sub acute lateral ankle sprains produces an initial dorsiflexion gain, and simultaneously produces a mechanical but not thermal hypoalgesia, so need to be proved the effectiveness in sub-acute lateral ankle sprain in secondary Hockey players. Methods: Thirty Subjects who have fulfilled inclusion and exclusion criteria have been selected from the population and divided into two Groups (A=Kinesiotaping technique & B=Mulligan‟s Mobilization with movement technique.). Ultrasound was given to both groups. Groups were evaluated with Qualitative outcome: Numerical pain Rating Scale and Quantitative outcome: Dorsiflexion range of motion (Knee-to- wall principal). Results: Both the Kinesiotaping and Mulligan‟s Mobilization with movement technique are effective in sub-acute lateral ankle sprain to reduce pain and improve the dorsiflexion range of motion. In Numerical pain rating scale Group B show 74.90% (p=0.01) of reduction as compare to Group A there is 55.69% (p=0.01) of reduction. In Dorsiflexion range of motion Group B there is 71.07% (p=0.000) of improvement as compare to Group A there is 27.64% (p=0.000) of improvement. Conclusions: This study demonstrated an effect of Mulligan‟s Mobilization with movement technique on sub-acute lateral ankle sprain in secoundary hockey players. These results suggest that this technique should be considered in rehabilitation program following subacute lateral ankle sprain. This study provides justification for follow-up research of the longterm effect of Mulligan‟s Mobilization with movement on sub-acute lateral ankle sprain and proposes further work be conducted on the weight-bearing posteroanterior tibial glide Mobilization with movement
NIH Risk of Bias Tool
Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group
- Was the study question or objective clearly stated?
Yes
- Were eligibility/selection criteria for the study population prespecified and clearly described?
Yes
- Were the participants in the study representative of those who would be eligible for the test/service/intervention in the general or clinical population of interest?
Yes
- Were all eligible participants that met the prespecified entry criteria enrolled?
Yes
- Was the sample size sufficiently large to provide confidence in the findings?
No
- Was the test/service/intervention clearly described and delivered consistently across the study population?
Yes
- Were the outcome measures prespecified, clearly defined, valid, reliable, and assessed consistently across all study participants?
Yes
- Were the people assessing the outcomes blinded to the participants’ exposures/interventions?
No
- Was the loss to follow-up after baseline 20% or less? Were those lost to follow-up accounted for in the analysis?
Cannot Determine, Not Reported, Not Applicable
- Did the statistical methods examine changes in outcome measures from before to after the intervention? Were statistical tests done that provided p values for the pre-to-post changes?
Yes
- Were outcome measures of interest taken multiple times before the intervention and multiple times after the intervention (i.e., did they use an interrupted time-series design)?
No
- If the intervention was conducted at a group level (e.g., a whole hospital, a community, etc.) did the statistical analysis take into account the use of individual-level data to determine effects at the group level?
Cannot Determine, Not Reported, Not Applicable
Key Finding #1
The study found both Kinesiotaping and Mulligan’s Mobilizations to be successful in improving talocrural dorsiflexion range of motion in secondary-school hockey players with sub-acute lateral ankle sprains.
Key Finding #2
Group B (Mulligan’s Mobilizations with movement) showed a 74.90% reduction in Numerical Pain Rating compared to Group A (Kinesiotaping), who showed a 55.69% reduction.
Key Finding #3
Statistical analysis shows a 71.07% improvement in dorsiflexion range of motion in Group B (Mulligan’s Mobilizations with movement), compared to a 27.64% improvement in Group A (Kinesiotaping).
Please provide your summary of the paper
The purpose of this study was to compare the effectiveness of Kinesiotaping and Mulligan’s Mobilization with movement technique in the treatment of sub-acute lateral ankle sprains to reduce pain and improve dorsiflexion range of motion in secondary-school hockey players. Thirty subjects who fulfilled previously determined inclusion and exclusion criteria were selected from the population and placed into two groups. Subjects were between the ages of 13-17 and had suffered the injury at any point from 10 days to 7 weeks prior to the study’s start. Group A received Kinesiotaping for 3 sessions per week and Group B received Mulligan’s Mobilization with movement technique for 3 sessions per week. Both groups additionally received ultrasound treatment and were evaluated with the Numerical Pain Rating Scale and Dorsiflexion range of motion measurements (knee to wall principal). The results of this study show that Mulligan’s Mobilizations improve both subjective reports of pain as well as quantitative measures of dorsiflexion range of motion in hockey players with subacute lateral ankle sprains. While both Kinesiotaping and Mulligan’s Mobilizations showed improvements in each of these measures, Mulligan’s Mobilizations proved to be more successful. It is possible that the tension provided via the Kinesio-tape was not sufficient enough; as such, this may have altered results.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
It is highly worth noting that this is a comparative study done with a very small sample size and is not randomized. Limitations to the study include its limited sample size, a higher number of male participants compared to female participants, absence of a long-term follow up with patients in the study, and no control group. A strength of this study is its highly detailed descriptions regarding the specific treatment methods and goals of Kinesiotaping and Mulligan’s Mobilizations for this population. Detailed inclusion and exclusion criteria was established prior to choosing subjects. The study was able to reliably utilize the Numeric Pain Rating Scale and Dorsiflexion Range of Motion as outcome measures throughout its duration, which led to excellent inter- and intra-rater reliability. Furthermore, both interventions were described with great detail regarding intervention technique, frequency and duration of the intervention, and general procedure for application. The authors are able to utilize their own findings to compare to additional studies examining Mulligan’s mobilizations and manual therapy for ankle sprains. However, the conclusion is still that further research is vital to determine the long-term effects of this intervention. The results of this study may lead to therapists implementing Mulligan’s mobilizations with movement more frequently for athletes with sub-acute lateral ankle sprains. Additionally, with literature on Kinesiotaping being minimal as is, this further emphasizes the possibility of incorporating a manual technique such as Mulligan’s mobilizations for increasing range of motion and improving subjective pain reports.
