Table 2.
Characteristics of included studies
| Author | Study population | Conventional treatment | Supervised treatment |
|---|---|---|---|
| Basset et al22 | 47 (of 52 enrolled) patients with acute ankle sprain (first time or recurrent) recruited from 4 physical therapy clinics in middle to low socioeconomic suburbs: 60% male; mean (SD) age 30 (12.4); injury grade: 38% mild, 51% moderate, 11% severe; re-sprain 55% | Home based intervention programme. Small home programme of no more than 4 simple activities. Equipment such as strapping tape, Tubigrip for compression, Thera-band resistance bands, and wobble boards. Treatment booklet; information about structure of ankle, ankle sprains, diary grids, progress sheets, adherence enhancing, and 3 treatment phases: 1—acute (36-48 hours): RICE, and active ankle movements within limits of pain; 2—mobilising (10-14 days): mobilising and strengthening exercises, calf and heel stretches, ankle strapping/taping; 3—strengthening (10-14 days): Thera-band resistance, bodyweight resistance in standing, one leg standing, standing on wobble board, weight bearing activities, ankle strapping | Clinic based intervention programme. Small home programme of no more than 4 simple activities. Physical therapist treated symptoms, and supervised activities/exercises of 3 phase physical therapy programme: 1—acute (36-48 hours): RICE, and active ankle movements within limits of pain; mobilising (10-14 days): 2—mobilising and strengthening exercises, calf and heel stretches, ankle strapping/taping; 3—strengthening (10-14 days): Thera-band resistance, bodyweight resistance in standing, one leg standing, standing on wobble board, weight bearing activities, ankle strapping |
| Brooks et al23 | 102 (241) patients with inversion injury, with talar tilt <15°, who attended local emergency department, age 12-65 | Treatment groups: 1—no treatment, no support or only minimal bandage; 2—double Tubigrip support to wear during daytime and advised to remove in bed at night; 3—ankle completely immobilised in below knee plaster of Paris cast, but patients encouraged to bear weight as soon as possible | First day or within 48 hours of presentation: iced foot bath, mobilisation, instruction in normal gait. Second or third visit: wobble board exercises. Treatment considered complete when patient could tolerate 10 minutes on wobble board |
| Holme et al24 | 71 (92) patients, all recreational athletes, with ankle sprain sustained during sports who attended local emergency department: 62% male; mean age 26.5; injury grade: 30% mild, 53% moderate, 17% severe | Information regarding early ankle mobilisation, including strength, mobility, and balance exercises | Information regarding early ankle mobilisation, including strength, mobility, and balance exercises, combined with supervised group physical therapy rehabilitation (1 hour, twice weekly): comprehensive balance exercises on both legs, figure of eight running; standing on balance board and catching ball, standing on outside of feet, standing on inside of feet with open and closed eyes |
| Hultman et al30 | 65 (115) with ankle sprain who attended emergency department: 54% male; mean (range) age 35 (18-65) | Examination of ankle, initial weight unloading with crutches, elastic wrap, and verbal and/or written information from attending physician or nurse about mobilisation and early weight bearing, followed by two visits to physiotherapist (6 weeks, 3 months): early range of motion training, weight bearing on injured ankle, balance and strength training, instructions for home exercises | Examination of ankle, initial weight unloading with crutches, elastic wrap, and verbal and/or written information from attending physician or nurse about mobilisation and early weight bearing, followed by four visits to physiotherapist (baseline, 3 weeks, 6 weeks, 3 months): early range of motion training, weight bearing on injured ankle, balance and strength training, instructions for home exercises |
| Karlsson et al21 | 84 (86) consecutive patients, active in sports on recreational or competitive level, with ligament ruptures of ankle: 66% male; mean (range) age 22 (16-38); injury grade: 59% moderate, 41% severe | Elastic wrapping, partial weight bearing, and crutches until pain subsided | Functional treatment: compression pads, early weight-bearing. Range of motion training: dorsal and plantar flexion, supination, proprioceptive training, standing on one leg with eyes closed, walking along zig-zag lines. Strength training: rubber cords, weight boots |
| Nilsson25 | 118 (180) patients with injury to lateral ankle ligaments (classified as “rupture” or “no rupture”) within past 6 hours, who attended local emergency department: 59% male; mean (range) age 33.6 (15-66) | Elastic wrapping only (n=59) | Elastic wrapping and cryotherapy combined with physiotherapy starting on 5th day after injury: limbering exercises of ankle, ultrasound treatment to lateral side of ankle, coordination exercises, strengthening exercises of fibular muscles (n=59). Each session lasted 45 mins and was given daily until patient was symptom free or had received 10 treatments |
| Oostendorp26 | 24 (24) patients with inversion injury of ankle, sustained during volleyball, basketball, handball, or soccer, who attended physical therapy practices: 67% male; mean (range) age 22.1 (15-30) | Cryotherapy, compression bandage and minimal weight bearing followed by 6 week tape bandage | Cryotherapy, compression bandage, and minimal weight bearing followed by 6 week tape bandage combined with standardised progressive training program (3 physical therapy sessions/week, daily home exercises): stability exercises, disturbance in balance, variation in posture, visual control), isometric strengthening exercises, manual resistance |
| Reinhardt et al27 | 72 (80) patients, consisting of recruits and professional soldiers, with acute ankle sprain: mean age 22.6 | Early functional treatment: Aircast brace, non-weight bearing, cryotherapy, elevation for 3-5 days | Early functional treatment: Aircast-brace, non-weight bearing, cryotherapy, elevation for 3-5 days. Six physical therapy sessions: proprioceptive training (balance board, rough terrain), limbering exercises, strengthening exercises, home exercises (n=47) |
| Roycroft et al28 | 43 (98) patients with inversion injuries of ankle who attended local emergency department: injury grade: 47.5% mild, 52.5% moderate | Wool and elastoplasts bandage or plaster of Paris backslab, non-weight bearing (n=37) | Immediate active treatment (RICE) and full weight bearing, after 24 hours referred to physical therapy: ultrasonography, taping, Tubigrip support, mobilisation and rehabilitation (n=43) |
| van Rijn et al20 | 102 (107) patients with acute lateral ankle sprain, who attended GP or local emergency department: 58% male; mean age 37.0; injury grade 42% mild, 40% moderate, 4% severe, 14% unknown | Early ankle mobilisation, home exercises, early weight bearing, and tape, bandage, or brace (n=53) | Early ankle mobilisation, home exercises, early weight bearing, and tape, bandage, or brace. Progressive training programme supervised by physiotherapist (max 9 half hour sessions, within 3 months): balance exercises, walking, running, jumping (n=49) |
| Wester et al29 | 48 (61) patients, active in sports >2 hour/week, with primary ankle sprain who attended local emergency department: 60% male; mean (SD) age 25 (7.2); injury grade: moderate | Compression bandage for 1 week, leg elevation and immobilisation for 2 days, avoiding activities straining lateral ligaments, and return to sport activities not permitted until activities of daily living possible without pain. | Compression bandage for 1 week, leg elevation and immobilisation for 2 days, avoiding activities straining lateral ligaments, and return to sports activities not permitted until activities of daily living possible without pain, 12 week training programme (15 min/day), with wobble board |
RICE=rest, ice, compression, elevation.