Adherence and effectiveness of rehabilitation in acute ankle sprain

Abstract

Objective: To estimate adherence to and effectiveness of rehabilitation after acute ankle sprain.

Method: Patients with acute ankle sprain attending four emergency departments were recruited between February and July 2009. After the initial examination (classification of the severity of the sprain), each patient received an Aircast(®) ankle brace and the same, standardized rehabilitation program. Between two and three months later; the patient was contacted by phone (always by the same investigator) in order to find out whether he/she had performed the prescribed rehabilitation, establish whether the physiotherapist had complied with the prescribed rehabilitation programme and assess subjective recovery. If a patient failed to respond to three phone calls, he/she was excluded from the study.

Results: Of the 245 patients initially included, 111 (67 men and 44 women; 17 mild sprains, 67 moderate sprains and 27 severe sprains) answered the "phone questionnaire". In terms of treatment adherence by the patient, 92 patients (82.9%) performed their rehabilitation (beginning an average of 13.8 days after the injury). In terms of prescription compliance by the physiotherapist, 88 patients (95.6%) received massage, 71 (77.2%) underwent physiotherapy, 83 (90.2%) performed weight training and 87 (94.5%) received proprioceptive training. Eighty-two patients said that they had received manipulative therapy that was not part of the prescribed programme. Impact on recovery: 61 patients (55%) considered that their injury had healed (10 mild, 42 medium and nine severe sprains), whereas 50 had not healed (seven mild, 25 medium and 18 severe sprains). There was no statistically significant association between recovery and compliance with rehabilitation. However, the application of massage (p=0.004) and proprioceptive training (p=0.017) were significantly associated with recovery, while physiotherapy, weight training and manipulative therapy were not.

Conclusion: In acute ankle sprain, adherence with rehabilitation is good and the treating physiotherapists comply with the prescription. However, there was no statistically significant link between rehabilitation compliance and subjective recovery at 3 months. Revaluation of these patients at one year may be necessary for estimating the impact of rehabilitation on ankle function and the rate of injury recurrence.