outcome and satisfaction in ankle sprains: a prospective randomized controlled
Theunissen E, Cleffken B, Brink PRG, de Bie RA, and Poeze M. BMC
Musculoskeletal Disorders. 2012 May 28.
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).
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.
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