Sports Medicine Research: In the Lab & In the Field: Taping versus Semi-rigid Bracing on Patient Outcome and Satisfaction in Ankle Sprains (Sports Med Res)
Thursday, July 5, 2012

Taping versus Semi-rigid Bracing on Patient Outcome and Satisfaction in Ankle Sprains

The effect of taping versus semi-rigid bracing on patient outcome and satisfaction in ankle sprains: a prospective randomized controlled trial

Lardenoye S, Theunissen E, Cleffken B, Brink PRG, de Bie RA, and Poeze M. BMC Musculoskeletal Disorders. 2012 May 28.

Among musculoskeletal injuries sustained during athletic activity one of the most common are inversion ankle sprains. While many effective treatments for ankle sprains exist, little research has examined patient satisfaction with regards to different treatment options. Therefore, Lardenoye and colleagues completed a prospective randomized controlled trial to assess patient satisfaction of two commonly used methods of functional treatment: semi-rigid bracing and taping. Patients included in this study had either a grade II or III ankle sprain (grade II = presence of a lateral hematoma or tenderness; grade III = hematoma, tenderness and anterior drawer instability) that was assessed by a physician in an outpatient clinic. Patients were excluded from this study if patients, a) were undergoing preventative treatment, b) were diagnosed with a fracture, c) had a previous ankle sprain for fracture, or d) had swelling which would impede proper taping. Initial treatments for all ankle sprains consisted of a compressive bandage, rest, ice, and elevation. Participants were instructed to return to the clinic in 5-7 days to be reassessed. At that point all grade II and III ankle sprains were randomized into two treatment groups (group 1 = tape, group 2 = semi-rigid ankle brace: AirLoc®). Taping was applied by experienced healthcare professionals and consisted of latex-free adhesive bandages then 2.5 cm non-elastic strapping tape for support then 6 cm elastoplast for fixation of the second layer. The tape was applied once a week (or when the patient felt stability was lost) for 4 weeks. Both groups also performed proprioceptive exercises (first supervised then given with verbal and written instructions). Follow-up occurred at weeks 2, 4, 8, and 12 after the start of the treatment. The authors assessed the outcomes with verbal rating scale (patient satisfaction), Karlsson score scale (joint function, 0-90 points), and ankle range of motion. Self-reported pain and hygiene were also recorded using a 5-point Likert scale. Overall 100 patients were included in the study of which 70 (71%) had all outcomes assessed (both groups had a similar loss to follow-up rate). During the 4-week period patient satisfaction was significantly higher in the bracing group at weeks 2 and 4 than the taping group. Conversely, patient satisfaction in the taping group significantly decreased from week 1 until week 5. Self-reported patient hygiene score were also significantly higher in the bracing group at all time points. While all subjective scores supported the use of bracing over taping, functional scores did not differ between the two groups with respect to range of motion or Karlsson score (assessing pain, swelling, instability, stiffness, stair climbing, running, work activities and support).

Overall this study seems to support that ankle sprain patients who are treated with semi-rigid ankle braces are more satisfied with their treatments than those who are treated using tape. These results must be interpreted cautiously however as little detail was provided for the exact method that the tape was applied in the taping group. Without this information it is difficult to determine how the method of taping used in this study compares to the various taping methods commonly deployed in the clinical setting. Clinically though, this data suggests that while bracing after an ankle sprain leads to better patient satisfaction, there is no functional differences between those receiving tape versus bracing. This has strong implications for all clinicians, but especially for those with whom budgetary restrictions are an issue. It would be interesting to see if the same results would be found if this study’s patient population was different (e.g., patients who endured an ankle sprain while wearing a preventative brace). What are your experiences with taping and bracing after an ankle injury? Do your patients seem to respond better to ankle bracing than taping when treating an ankle sprain?  Is treating ankle sprains with bracing an option in your day-to-day practice? Tell us why.

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

Related Posts:


Sacha Lardenoye, Ed Theunissen, Berry Cleffken, Peter RG Brink, Rob A de Bie and Martijn Poeze (2012). The effect of taping versus semi-rigid bracing on patient outcome and satisfaction in ankle sprains: a prospective, randomized controlled trial BMC Musculoskeletal Disorders, 13 DOI: 10.1186/1471-2474-13-81

17 comments:

Aaron said...

Kyle I agree with some of the issues you have brought up regarding the methods of this study. The major one that struck me first was their application of tape. I am aware that this study was conducted in The Netherlands so possibly the procedures are different, but I have never heard of anyone leaving tape on for up to 2 weeks clinically. I believe this would absolutely have a negative effect on patient self-reports of pain and hygiene.

Also as you have previously mentioned they do not go into detail regarding the application of the tape or the nature of the rehabilitation program; limiting the information only to the "three layers of the tape" and "proprioceptive exercises". They also fail to mention exactly how many qualified healthcare professionals were used to apply the tape. A more thorough description of the tape application and limiting the number of practitioners would have improved the study.

I agree any results from this study should be taken with caution. I believe both bracing and taping have their own pros and cons, and their application should be determined on an individual basis. I am interested what others think of this study.

Nate said...

I think this article adds to the information out there on taping vs bracing and with part of the practice of taping and bracing being psychological I think looking at patient satisfaction is key.

From my experience the decision to tape vs brace has been driven by the specific athlete, the sport, and setting. In the high school setting you can't expect every athlete to go out and buy an ankle brace if they sprain their ankle and you don't have time or budget to tape them everyday so you tend to use your best judgement if the injury is severe enough to be worth the athlete getting a brace or if you will be able to tape and return them to play. In the D1 setting the bigger budget allows you to still choose based on severity and based on what you think the specific athlete will experience better outcomes with but now sports comes more into play. Soccer players for example can't function the way they need to with a brace.

Overall I agree with the previous comments. I still think each ankle injury should be treated individually with regards to the brace or tape decision. While I don't think this will directly affect the way I practice clinically it is interesting to see data on patient satisfaction with these common interventions.

Jeffrey Driban said...

Hi Aaron: I was also struck by the long duration the tape stayed on. When I used tape in a similar capacity to this study I would normally change it daily. The authors noted they would change the tape as needed but never offered any ideas of how often that happened. I know I would not be thrilled about wearing the same taping for 2 weeks but I also realize with a brace I would also be prone to taking it off every once in a while (I'll admit it :). The ability to take off the brace would probably improve my satisfaction with the brace compared to tape.

I agree with Aaron and Nate that the final decision should be made with the athlete and that this study highlights that we need to consider patient satisfaction with the treatment option. So much of what we do requires the patient to be compliant and to buy into what we're doing with them.

Chip said...

I have to agree with all of the above comments regarding the taping procedure and application. Nobody leaves tape on for a week at a time, and I've read before that much of tape's tension is lost within a short amount of time after application. If that's true, by the time the subject reported feelings of instability, the tape would likely be useless. This study itself won't affect any of my practice, but a revised study might change my opinion. If taping were done every day as to mimic a more likely clinical experience, we might see opposite results in this study(functional assessments weren't different, only the hygiene and subjective assessments). A revised study has potential here.

Jeffrey Driban said...

Hi Chip: Just to play devil's advocate - It's apparent that some people probably are doing longer-duration tapings than what we are familiar (otherwise the authors probably wouldn't have come up with the protocol). I'm also not certain that the tape would be worthless just because the tension was lost. Unlike a brace, which the patient can take off and on without the clinician knowing, you can't hide the fact you took off the tape. So the tape could be a good reminder to a patient to slow down a bit; which could be pretty valuable for some patients.

Zahida M said...

I agree with you Jeffrey. Regardless of the tension of the tape, I think the tape even being on the individual probably had some sort of effect . I like the direction the researches were going with this article, however I just wish there was more information about the taping protocols and exercise protocols as Aaron stated earlier. There is not much clinically to take out of this study except for the fact that patient satisfaction is key. The article states that there was not functional differences between the groups, but the patient satisfaction was higher in the bracing group. That might just be the case because of the tape duration or because of the specific individuals used in this specific study. I have treated many athletes who prefer tape over bracing and vice versa. There are some who prefer both together. There may or may not be a difference between taping and bracing, but if the athlete feels like there is a difference and one makes and athlete more comfortable then the other, then I think that is valuable enough!

Kate said...

This research seems to have good clinical application in which bracing may be a more satisfactory as well as cost effective alternative to taping in regards to managing ankle pathologies. However, like Kyle stated the taping technique was not stated so it is hard to definitely state whether this study can be applied into clinical application just yet. I am a little weary when it states that tape was applied once a week. Tape often loosens within about 15-30 minutes so the premise of keeping tape on for a whole week does not seem to have much functional purpose to it.

It would be nice to see the objective implications of studies such as this, including EMG and force plate data in tape and brace groups. This would allow clinicians to better understand the objective values associated with "improved function" felt by these patients instead of subjective data. Patients in this study had just received severe ankle sprains and reported improved function over 4 weeks. Is that from the tape and brace or is that just due to the natural order of the healing process? Future research may wish to include a control group to determine if taping and bracing really does improve patient outcomes or if a standard rehabilitation program produces the same results.

However, while results may not be applicable to clinical practice yet, the study brings a valid question of what is more satisfactory to the patient. In regards to long rehabilitation and future treatment patient satisfaction must be considered if we want our patients to keep coming back to us.

Kirsten said...

I think the concept of wearing tape for an extended period of time is new and interesting. Although its a totally different type of tape I have used kinesiotape to help manage swelling after acute injuries and the patients will keep that tape on for several days. The athletes I saw didn't seem to mind the tape and since they could see noticable differences in the amount of swelling I think they were pleased with the treatment outcomes. Kinesiotape has many uses besides being used to help reduce swelling; I wonder if some of the different methods might be used in this situation to provide long-term tape support.
I agree that taping and bracing each have their place and while we try to make the patient happy it is also our job as clinicians to make our patients the most informed about the different treatment options so we can help them make the best decision. I was at a high school and had several lace-up braces in different sizes that I loaned to athletes after a sprain. I had an athlete who sprained her ankle I taped her for sports and eventually gave her a brace to wear for the season. Even though I explained that tape generally loses its tension and support fairly quickly she insisted that her ankle felt better when it was taped. I had the resources so I taped her each day.

As clinicians its important to keep in mind that no matter how trivial or severe the injury may seem to us the athlete may have a different perception and injuries are both physical and psychological in nature. I think if you are able to do what your athlete wants and no further harm will be caused, even if a brace might work better, then make the athlete feel comfortable. When they are comfortable they will be more confident during activity and will be better able to perform to a level they desire.

Kyle said...

Kate: I too would like to see a control group in this study. Apart from very few details regarding the actual taping process, not much was given regarding the details of the rehab program. This is something else I would have liked to see better described. In the end though I think your last two sentences hit the nail on the head. We should be looking at patient satisfaction wherever we can. I believe the happier a patient is the more likely they will come back to the clinician with a complaint before it becomes a major issue. I know that due to some bad experiences with the athletic trainer prior to myself, many of my athletes did not come forward and seek treatment until injuries had progressed and become complex issues. When I probed into why it took them so long to see me they expressed their displeasure in the past and saw withholding their symptoms as a way of bypassing "the aggregation." After some educating and time they began to see that they could be satisfied with their care and improve (sometimes faster than even they expected) if they were diligent with rehab. Great post. Thanks!

Kyle said...

Kirsten,

While I have not tried it myself, I have been interested in the usage of Kinesiotape in a long-term support/bracing type of capacity. While it is not the same, I do remember seeing something else to that effect using Leukotape. Have you run in to anything like that before?

Surrey chiropractic said...

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Kirsten said...

Kyle: I've used leukotape in conjunction with regular tape if I think the athlete needs the extra support. But I haven't looked into using it by itself or in a fashion similar to kinesiotape. If its possible to use less tape and get the same support and also have the option to keep the tape on for a longer period for stabilization that would have some real benefits especially for the ATC who's in a setting with a tight budget.

Kyle said...

Kirsten,

Thanks for the comment. I agree with you that the option of using less tape and for longer periods of time is an interesting idea that should get more attention. Like you, I am not aware of any instances of using leukotape in a similar way to kinesiotape but that was one thought I had when reading through this article. As I said in the post, I think knowing the method by which the tape was applied would really be helpful in addressing this. Either way I agree that in a time of shrinking school and athletic budgets, this in an enticing idea.

Jennifer Bokoski said...

I agree with the previous comments on this article and believe that it is difficult to say which method is better between taping and ankle braces because I think each ankle injury needs to be looked at individually. The research that was done though is helpful because it shows that functionally they both work the same just athletes prefer the brace. Knowing this is good because for schools on a budget and cannot afford to give the athlete a brace, taping the ankle will also do the job.

I also believe that it all depends on the tape job that was done and knowing more about those details would be helpful. There could be a better way of taping the ankle so it would be more comfortable for the athlete. I'm actually surprised that the athletes ankles were only taped once a week unless they felt like it had seemed lose. Just from experience, I would think that the ankle would need to be taped more than once a week for an ankle sprain. That could also have an effect on what the athletes think because the tape could have been bothering them, even though it was working correctly. Knowing the method of the tape job though would be very helpful to know.

Kyle said...

Jennifer,

Great comment, thank you. I agree with your point that each ankle sprain much be evaluated and treated differently. I also think that there the person who sustained the ankle sprain, and their personality play a role in my treatment decision. I think your point about having 2 different but effective treatment options in your pocket so-to-speak, is one that we should not lose sight of. While both treatments have been shown here to have similar outcomes we should still remain vigilant in trying to identify our gold standard. I think this mean more research looking at all the the variable that yourself and the other commentators have brought up in this thread. While we do that though it nice to have options to make our patients feel as comfortable and safe as possible.

Michael Burkeitt said...

I found this article interesting due to the main point of focus being the patient's comfort/satisfaction. Many times we as professionals fail to remember that our athlete's comfort should be our primary concern. When their comfort is compromised, they are unable to perform at their highest level and we see a decrease on the field. While I personally am a supporter of taping , but understand the drawbacks. We must understand that all athletic trainers tape with slight differences and that all the different tapes we use in clinical settings have a different feel. These minute differences can lead to inconsistencies overtime that make the athlete feel uncomfortable. Also the tape is subjected to weather conditions such as loosening over time due to becoming wet, or being ripped of. A brace on the other hand can be re adjusted as often as the athlete wants throughout their course of play. They can adjust the tightness at their own will, when with taping they would have to take all the tape off and then have to be re taped. Finally the main point that I found interesting was the financial aspect. In a cost efficient world, bracing does make sense. Although a much higher price at first, but can be reused multiple times. This article provided me with tremendous insight into a point of view to which I had not previously thought.

Jeffrey Driban said...

Hi Michael:
Thanks for the comment. You raise a good point about how a patient's comfort needs to be considered. Another aspect besides their performance may also be there compliance. If the patient doesn't like the feel of something they may be less compliant or if they modify the taping so that they are more comfortable, then this could also cause issues. Thanks for the comment and I'm glad the article provided you something to think about.

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