WHAT’S NEW?: High-quality study supports self-guided training program
This is the first RCT to assess the effect of a nonsupervised home-based proprioceptive training program, in addition to usual care, on the recurrence of ankle sprain. Two earlier studies had evaluated balance board exercises to prevent initial ankle injuries in young athletes, and both found these exercises to be effective.8,11 But prior studies evaluating prevention of recurrent ankle sprain have had methodology weaknesses or small sample sizes.12-14
One other RCT had studied the effect of an exercise program that included balance boards on the risk of ankle sprain recurrence and found a significant difference in favor or the intervention group (absolute risk reduction=22%).15 But the exercise program in that study was supervised by professionals rather than self-guided by patients. The study was also marred by significant loss to follow-up (27%), and the information on reinjury was collected retrospectively a year after the acute ankle sprain.
By comparison, the study done by Hupperets et al had a large sample size, minimal loss to follow-up (14%), and monthly check-in with patients to assess reinjury. The results show an absolute reduction of 11% in the risk of recurrence of ankle sprain. The evidence brought forth by this high-quality RCT supports adding a home-based proprioceptive training program for every patient with an acute ankle sprain to reduce the incidence of sprain recurrence.
CAVEATS: Will patients do their exercises?
One concern highlighted by this study is compliance with the treatment regimen. Only 23% of those in the intervention group fully complied with the 8-week program, 29% were partially compliant, 35% were not compliant, and 13% were of unknown compliance.
We think these findings reflect the compliance seen in the real world, so it is encouraging to know that the intervention was nonetheless effective. Clearly, some proprioceptive training is better than none; the optimal amount is not known.
Generalizability is another concern, since this study focused on athletes. However, the investigators included a wide spectrum of patients (ages 12-70 years, male and female, and those engaged in all levels of sports activity). Furthermore, since the mechanism of injury for lateral ankle sprain is generally the same, we think it is reasonable to assume that ankle sprains not related to sports would benefit from a proprioceptive program, as well.
CHALLENGES TO IMPLEMENTATION: No significant barriers exist
The treatment does not have any significant adverse effects and should be easy to recommend. Balance boards can be obtained from a sporting goods supplier or online, at a cost of $13 to $35. Some busy physician practices may not have the time or staff to teach patients how to carry out these exercises. In that case, a 1-time referral to a physical therapist should be sufficient.
Acknowledgment
The PURLs Surveillance System is supported in part by Grant Number UL1RR024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.