FOOT & ANKLE
Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(9):21 BMJ. 2010 May 10;340:c1964. doi: 10.1136/bmj.c1964101 patients with an acute grade 1 or 2 ankle sprain were randomized to be managed with an early therapeutic exercise program or a conventional PRICE (protection, rest, ice, compression and elevation) protocol. It was observed that after early incorporating therapeutic exercises during the first week after an ankle sprain brings about significant improvements in physical activity and improved functional status compared to the standard treatment at weeks 1 and 2. At 16-week follow-up, both groups had good and comparable ankle function.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
4/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Ankle sprains are very common musculoskeletal injuries with acute side affects, such as pain and loss of function. A passive treatment approach involves protection, rest, ice, compression and elevation. This approach is common for all soft tissue injuries, which raises the question as to whether a more accelerated protocol would be effective in improving recovery and long term outcomes from ankle sprains.
Qual era a principal questão de investigação?
Does an accelerated intervention involving exercise confer additional benefit compared to the standard treatment of protection, rest, ice, compression and elevation in patients with ankle sprains, 16 weeks after treatment?
Quais foram os resultados importantes?
- Overall treatment effect favoured the exercise group for improved physical activity at week 1 (baseline adjusted difference in treatment 5.28, 98.75% CI 0.31-10.26, p=0.008) and week 2 (baseline adjusted difference in treatment 4.92, 98.5%CI 0.27-9.57, p=0.0083)
- The exercise group was found to be significantly more active when analyzed through time spent walking (p=0.029), average number of steps taken daily (p=0.021), and numbers of steps taken daily (p=0.047).
- At weeks 3, 4, and 16, there were no significant differences in pain at rest, pain on activity, or swelling, and the re-injury rate was the same between groups (4%).
De que é que me devo lembrar mais?
At the first and second week, the group receiving the accelerated intervention reported increased amounts of physical activity, had improved ankle function, lesser swelling, and pain compared to the group receiving standard care. At 16-week follow-up, there was no significant difference in ankle function between the two groups, and the reinjury rate was the same between groups.
Como é que isto afectará o tratamento dos meus doentes?
Accelerated exercise rehabilitation received during the first week after an ankle sprain is an effective method to improve early ankle function. Patients who partake in the accelerated interventions are more physically active than those receiving standard treatment.
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