Recovering, with a twist
November 22, 2016
A new study, published by researchers at Queen’s University, has found that there is no significant difference in recovery rates and degree of recovery between ankle sprain patients who received a simple medical assessment and instructions on home management of the injury to those who, in addition, received physiotherapy for their injuries.
“The findings indicate that there’s no added value of physical therapy for everyday ankle sprains,” says Brenda Brouwer (Rehabilitation Therapy/Dean (Graduate Studies)), the co-principal investigator on the study. "Proper assessment and instruction about PRICE (protection, rest, ice, compression and limb elevation) may, however, be important to the recovery process."
Ankle sprains are one of the most common musculoskeletal injuries, accounting for nearly 10 per cent of injury-related hospital visits in Kingston. Despite their prevalence, there remains a great deal of debate regarding the best methods of treatment for these injuries.
The study recruited 503 patients from two Kingston-based acute care hospitals, presenting with mild or moderate ankle sprains. The participants were randomly assigned to one of two groups – one group was instructed to treat the sprains using the PRICE method (consisting of protecting the ankle, rest, icing the joint to reduce inflammation, the application of compressive bandages and elevating the joint), the other received up to seven supervised physiotherapy sessions in addition to instructions on self-management.
Dr. Brouwer and her colleagues examined the patients’ ankle function at one, three and six months after their injury. Their findings showed that both groups recovered at similar rates – calling into question the utility of physiotherapy in general populations for simple ankle sprains. The study notes that a significant portion of both groups – 43 per cent of patients in the physiotherapy group and 38 per cent in the control arm – did not return to an “excellent” level of recovery indicating that residual loss of function six months post-injury is a significant problem.
“The lack of benefit of physiotherapy paired with the high number of people reporting functional deficits attributable to an ankle sprain incurred half a year earlier suggests the need for alternative interventions to promote better outcomes,” she explains.
In addition to Dr. Brouwer, the study was co-authored by Robert Brison (Emergency Medicine/KGH), Andrew Day (Public Health Sciences/KGH), Lucie Pelland (Rehabilitation Therapy), William Pickett (Emergency Medicine/Public Health Sciences), Ana Johnson (Public Health Sciences), Alice Aiken (Now of Dalhousie University) and David Pichora (Orthopaedics).
The full study, titled Effect of early supervised physiotherapy on recovery from acute ankle sprain: randomised controlled trial, was published in The BMJ (formerly the British Medical Journal) and is available online.