FOOT & ANKLE
Immediate effects of anterior to posterior talocrural joint mobilizations following acute lateral ankle sprain
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(5):9 J Man Manip Ther. 2011 May;19(2):76-83. doi: 10.1179/2042618610Y.000000000517 patients were randomized to investigate the effects of a single bout of anterior to posterior (AP) talocrural joint mobilization for acute lateral ankle sprains. Patients received either a single 30-second bout of grade III AP talocrural joint mobilization or no intervention and were assessed after the first 24 hours. A single bout of AP talocrural joint mobilizations was revealed to have no immediate effect on ankle dorsiflexion range of motion (ROM), posterior talar translation, or self-reported function; however, an immediate effect on pain perception was observed.
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
Randomização
3/4
Medições dos resultados
3/4
Inclusão / Exclusão
3/4
Descrição da terapia
3/4
Estatística
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?
Following a lateral ankle sprain, it has been reported that individuals may experience decreased dorsiflexion ROM and posterior talar glide. While these individuals may benefit from joint mobilization, there has been no previous study evaluating the use of anterior to posterior (AP) talocrural joint mobilizations in patients with acute lateral ankle sprains. Thus, this study aimed to investigate the immediate effects of a single bout of grade III AP talocrural joint mobilization on ankle dorsiflexion ROM, posterior talar translation, and self-reported pain and function in these patients.
Qual era a principal questão de investigação?
Did a single bout of AP talocrural joint mobilization lead to better ankle dorsiflexion ROM, posterior talar translation, and self-reported pain and function, compared to no intervention, in acute lateral ankle sprains when assessed after the first 24 hours?
Quais foram os resultados importantes?
- In regard to dorsiflexion ROM, there was not a significant group by time interaction (F2,30 = 0.17, P = 0.85, 1-beta = 0.07) or group main effect (F2, 30 = 0.21, P = 0.66, 1-beta = 0.07); however, there was a significant main effect for time (F2,30 = 3.67, P = 0.04, 1-beta = 0.63).
- While there was a significant improvement in dorsiflexion ROM from baseline to 24 hour follow-up (P=0•037), there was no significant difference between the treatment (6.49 (SD 6.43) to 8.82 (SD 7.29)) and control (7.36 (SD 6.38) to 9.94 (SD 4.02)) groups (P > 0.05).
- There was no significant difference (P > 0.05) regarding posterior talar translation measures between the treatment (7.09 (SD 3.54) to 7.06 (SD 2.99)) and control (5.86 (SD 2.81) to 6.95 (SD 3.64)) groups from baseline to the 24 hour follow-up. No significant group by time interaction (F2,30= 0.58, P = 0.57, 1-beta = 0.14), group main effect (F2,30 = 0.45, P = 0.51, 1-beta = 0.10), or time main effect (F2,30 = 0.86, P = 0.43, 1-beta = 0.18) were seen.
- In respect to the FADI-ADL and FADI-sport, there were no significant group by time interactions (F1,15 = 0.43, P = 0.52, 1-beta = 0.09; F1,15 = 0.04, P = 0.84, 1-beta = 0.05, respectively) or group main effects (F1,15 = 1.51, P = 0.24, 1-beta = 0.21; F1,15 = 0.00, P = 0.99, 1-beta = 0.05).
- The treatment group demonstrated a 20% reduction in pain (t8 = -3.74, P = 0.006) at the 24 hour follow-up when compared to the control group (t7 = 0.00, P = 1.0).
De que é que me devo lembrar mais?
A single bout of AP talocrural joint mobilization for acute ankle sprains displayed no effect in increasing ankle dorsiflexion ROM, decreasing posterior talar glide, or improving self-reported function. However, individuals receiving joint mobilization demonstrated decreased pain compared to those who did not receive the intervention.
Como é que isto afectará o tratamento dos meus doentes?
This study suggests that joint mobilization provides no apparent benefit in ankle dorsiflexion ROM, posterior talar translation, or self-reported function when treating acute lateral ankle sprains. However, there may be a positive benefit in terms of pain perception immediately following treatment. Future research is required to investigate the long-term effects of multiple applications of joint mobilizations.
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