Physical therapy referral and medication for ankle sprain visits to physician offices: an analysis of the national ambulatory medical care survey
Bowers LC, Gribble PA, Hoch MC, Villasante Tezanos AG, Kosik KB. Phys Sportsmed. 2020 Aug 6:1-6. doi: 10.1080/00913847.2020.1800369.
Despite clinical practice guidelines for treating ankle sprains, physicians are providing pain medications more frequently than referring patients to physical therapy during office-based visits.
Several clinical practice guidelines outline the best sequence of treatments for an ankle sprain injury. Current recommendations suggest that clinicians advise patients to use non-steroidal anti-inflammatory drugs (NSAIDs) for pain management as needed, and to refer patients to supervised physical therapy. It remains unclear if physicians seeing a patient with an ankle sprain in office settings follow this treatment plan. Therefore, the authors assessed how many people with an ankle sprain were referred to physical therapy or given medication during an office-based physician visit in the United States from 2007-2016. The authors used data from the National Ambulatory Medical Care Survey, which collected data from a representative sample of physician office visits in the United States. Physicians reported medical data on about 30 patients during a random 1-week period. This data can be used to estimate the injury and treatment trends throughout the country. The researchers assessed International Classification of Disease, Ninth Revision (ICD-9) codes from this database to assess the number of ankle sprain cases in which physicians administered, supplied, or ordered pain medications for their patient and the number of cases where physicians referred a patient to physical therapy. The authors found that of an estimated 14.9 million ankle sprains across 10 years, only 17%, or 2.5 million patients, received a referral for physical therapy. However, physicians administered, supplied, or ordered pain medications for ~35% of cases, or 5.2 million patients. Although NSAIDs were the most common medication (72%; 3.7 million), physicians frequently used opioids (21%; 1.1 million) as a pain medication for people with an ankle sprain.
Despite recommendations for ankle sprain patient care, the authors found that physicians might rely too heavily on pain medication for a patient with an ankle sprain to reduce a patient’s pain immediately. Furthermore, physicians underutilize physical therapy. Given that about 40% of people with an ankle sprain go on to have repeated ankle sprains and long-term pain and disability, known as chronic ankle instability, it is imperative that clinicians more frequently recommend patients seek physical therapy as a primary treatment option. It is also important to note that opioids were the second most frequently prescribed pain medication for ankle sprains, which is a point of concern given the opioid epidemic in the United States. Sports medicine clinicians should educate local physicians about current clinical practice guidelines for treating ankle sprains. This education could decrease the use of pain medications for short-term injury management and encourage exercise as medicine, which offers viable long-term interventions.
Questions for Discussion
Do you educate your patients on the importance of physical therapy options for long-term management of ankle sprain injuries? What are some ways that we can encourage ankle sprain patient referrals for physical therapy?
Written by: Alexandra F. DeJong
Reviewed by: Jeffrey Driban