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 People who suffer a bad sprain should have the injury assessed by an
appropriate healthcare professional like a doctor or physical
therapist to determine the severity of the injury and to get, at a
minimum, advice and instruction on how to manage the injury, said
co-lead author Brenda Brouwer of Queens University in Kingston,
Ontario, Canada.
The researchers recruited 503 people aged 16 years and older who
suffered an acute ankle sprain without other injuries or
mobility-limiting conditions. Half of the patients received standard
emergency department care, medical assessment and a page of
instructions for at-home management, including wearing a brace,
rest, ice, compression, elevation, pain medication and gradual
return to weight-bearing activities.
The remaining half of patients received the same information in
addition to supervised physiotherapy, including up to seven
30-minute clinic visits for exercise sessions designed to decrease
pain and swelling, increase range of motion, strength and exercise
tolerance.
“The therapy involves an initial assessment of the injury to
determine the structures involved, the associated symptoms such as
pain, swelling, bruising, and the development of a treatment plan to
get the individual back to pre-injury function,” Brouwer told
Reuters Health by email. “Home exercises and strategies to promote
normal joint mobility are prescribed.”
In the usual care group, 37 percent of people had achieved
“excellent recovery” by the three-month point, compared to 43
percent of people in the physiotherapy group. That difference is not
large enough to rule out the possibility it was due to chance,
according to the report published in BMJ.
There was little important difference between the groups at six
months post-injury.
“As such, it may give pause to individuals who have experienced a
simple ankle sprain in terms of deciding whether or not to access
physiotherapy, it’s a choice that our findings suggest will not
impact recovery providing they have had their injury assessed and
received general instruction on how to manage it,” Brouwer said.
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Many participants in both groups failed to achieve excellent
recovery, which is worrisome, and will need to be explored through
further study, she said.
There was little information on the nature of the rehabilitation
exercises in this study, said Chris Bleakley of Ulster University in
Newtownabbey, U.K., who wrote an accompanying editorial.
“I feel that (physiotherapy) is an essential part of recovery post
sprain,” Bleakley told Reuters Health by email. “However, this study
highlights clearly that not all physio treatments are equally
effective – in our recent review, we have already shown that studies
employ a wide range of exercises, treatment durations and
intensities – but the optimal combination is not yet clear.”
Quantity and dose of physiotherapy may determine effectiveness, he
said.
“Indeed, it is analogous to a drug treatment – if it’s under dosed,
the treatment effect will be blunted – and overdosing can cause
harmful side effects,” he said.
SOURCE: http://bit.ly/2eMpWzt and http://bit.ly/2gdtbfu BMJ, online
November 16, 2016.
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