Author Names
Gogate, N., Satpute, K., Hall, T.
Reviewer Name
Cameron Clark, SPT
Reviewer Affiliation(s)
Duke University Doctor of Physical Therapy Division
Paper Abstract
Objectives: To determine the effect of mobilization with movement (MWM) on pain, ankle mobility and function in patients with acute and sub-acute grade I and II inversion ankle sprain. Study design: Randomized placebo controlled trial. Setting: A general hospital. Subjects: 32 adults with inversion ankle sprain. Main outcome measures: The primary outcome was pain intensity on an 11 point Numeric Rating Scale (NRS) with higher score indicating greater pain intensity. Ankle disability identified by the Foot and Ankle Disability index (FADI) with higher score indicating lower disability, functional ankle dorsiflexion range, pressure pain threshold, and dynamic balance measured with the Y balance test were secondary outcomes. Results: Thirty participants completed the study. At each follow-up point, significant differences were found between groups favouring those receiving MWM for all variables. Pain intensity showed a mean difference of 1.7 points (95% confidence interval, 1.4 to 2.1) and 0.9 points (95% confidence interval, 0.5 to 1.3) at one and six-months follow-up respectively. Benefits were also shown for FADI, ankle mobility, pressure pain threshold and balance. Conclusion: This study provides preliminary data for the benefits of MWM for acute and sub-acute ankle sprain in terms of pain, ankle mobility, disability and balance.
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?
- Cannot Determine, Not Reported, or Not Applicable
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- Yes
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Yes
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
Patients who received the mobilizations with movement, taping, and an exercise program experienced greater and long term improvements in ankle pain and functional dorsiflexion ROM than patients with the sham mobilizations with movement treatment, sham taping and exercise program only.
Key Finding #2
Significant improvements were noted within both the experimental and the control groups.
Key Finding #3
Pain as tolerated can be permitted with care during exercise.
Key Finding #4
Please provide your summary of the paper
This paper describes the benefits of movement with mobilization in exercises with patients who were diagnosed with acute and sub-acute grade I and II ankle sprains. The participants in this study were randomized into the experimental and control groups. The experimental group included participants who would receive the mobilization with movement, taping, and an exercise program. The control group received sham mobilizations with movement, sham taping, and an exercise program. The participants in both groups were treated for 6 sessions spread over 2 weeks. The study concluded that patients who received the mobilizations with movement, taping, and an exercise program experienced greater and long term improvements in ankle pain, functional dorsiflexion ROM, disability, pressure pain threshold, and balance than patients with the sham mobilizations with movement treatment, sham taping and exercise program only.
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 provides evidence of a greater improvement in ankle pain, functional dorsiflexion range of motion, disability, pressure pain threshold, and balance in patients who receive mobilizations with movement, taping, and an exercise program compared to those who received only the exercise program. These improved outcomes indicate an opportunity to use this treatment with patients with acute and subacute inversion ankle sprains. The patients who received the sham treatment with an exercise program also portrayed improvements in these areas over time. Therefore, if the opportunity to implement this treatment approach presents itself, it would be worth using for the best possible outcomes. However, if the ideal patient is present to use this treatment but the tools to implement or ideal conditions are not present, the therapist should not fret as there is still evidence of improved outcomes in these areas with an exercise program.
