Patients help to advance medical insight into treating ankle sprains
Thanks to patient volunteers at Kingston General and Hotel Dieu hospitals, clinicians now have new insight into the best way to treat simple ankle sprains.
A recently published study, led by Kingston General Hospital clinician-researcher Dr. Rob Brison and Dr. Brenda Brouwer from the School of Rehabilitation Therapy, have found that there is no significant benefit to recovery in providing a program of outpatient physical therapy.
While ankle sprains account for nearly 10 percent of injury-related visits to the Kingston hospitals, there’s not a lot of evidence showing how to best treat these injuries, Dr. Brison says. “Our study, which was the largest randomised controlled trial to date on this topic, showed that adding physiotherapy follow up to the usual self-managed care didn’t help people recover more quickly. This is important because of the economic costs and time commitment for patients associated with physiotherapy.”
The study recruited 503 patients from Kingston General and Hotel Dieu hospitals, presenting with mild or moderate ankle sprains. The participants were randomly assigned to one of two groups – one group was given a page of advice for treating their sprain at home that included the PRICE method (consisting of protecting the ankle, rest, icing the joint to reduce inflammation, the application of compressive bandages and elevating the joint). The other received up to seven supervised physiotherapy sessions in addition to the instructions on self-management.
Dr. Brison and his colleagues examined the patients’ ankle function at one, three and six months after their injury. Their findings showed that both groups recovered at similar rates – calling into question the utility of physiotherapy in general populations for simple ankle sprains. The study notes that a significant portion of both groups – 43 per cent of patients in the physiotherapy group and 38 per cent in the control arm – did not return to an “excellent” level of recovery indicating that residual loss of function six months post-injury is a significant problem.
“The lack of benefit of physiotherapy paired with the high number of people reporting functional deficits attributable to an ankle sprain incurred half a year earlier suggests the need for alternative interventions to promote better outcomes,” says Brenda Brouwer (Rehabilitation Therapy, Queen’s University) the co-principal investigator on the study.
In addition to Drs. Brison and Brouwer, the study was co-authored by Andrew Day (KGH Research Institute), Lucie Pelland (Rehabilitation Therapy), William Pickett (Emergency Medicine/Public Health Sciences), Ana Johnson (Public Health Sciences), Alice Aiken (now of Dalhousie University) and David Pichora (Orthopedics).
The full study, Effect of early supervised physiotherapy on recovery from acute ankle sprain: randomised controlled trial, was published in The BMJ (formerly the British Medical Journal) and is available online.