Ellen Kemler

A Systematic Review on the Treatment of Acute Ankle Sprain: Brace versus Other Functional Treatment Types

Ankle injuries, especially ankle sprains, are a common problem in sports and medical care. Ankle sprains result in pain and absenteeism from work and/or sports participation, and can lead to physical restrictions such as ankle instability. Nowadays, treatment of ankle injury basically consists of taping the ankle. The purpose of this review is to evaluate the effectiveness of ankle braces as a treatment for acute ankle sprains compared with other types of functional treatments such as ankle tape and elastic bandages.A computerized literature search was conducted using PubMed, EMBASE, CINAHL and the Cochrane Clinical Trial Register. This review includes randomized controlled trials in English, German and Dutch, published between 1990 and April 2009 that compared ankle braces as a treatment for lateral ankle sprains with other functional treatments. The inclusion criteria for this systematic review were (i) individuals (sports participants as well as non-sports participants) with an acute injury of the ankle (acute ankle sprains); (ii) use of an ankle brace as primary treatment for acute ankle sprains; (iii) control interventions including any other type of functional treatment (e.g. Tubigrip®, elastic wrap or ankle tape); and (iv) one of the following reported outcome measures: re-injuries, symptoms (pain, swelling, instability), functional outcomes and/or time to resumption of sports, daily activities and/or work. Eight studies met all inclusion criteria. Differences in outcome measures, intervention types and patient characteristics precluded pooling of the results, so best evidence syntheses were conducted. A few individual studies reported positive outcomes after treatment with an ankle brace compared with other functional methods, but our best evidence syntheses only demonstrated a better treatment result in terms of functional outcome. Other studies have suggested that ankle brace treatment is a more cost-effective method, so the use of braces after acute ankle sprains should be considered. Further research should focus on economic evaluation and on different types of ankle brace, to examine the strengths and weaknesses of ankle braces for the treatment of acute ankle sprains.

Ankle injuries in the Netherlands: Trends over 10–25 years

Ankle injuries are a common health problem; data on ankle injury rates and time trends in the population at large are scarce. Our aim was to investigate the incidence of and time trends in population‐based and emergency department‐treated ankle injuries related to sports activities and other activities related to daily living. Data were obtained from one national survey on accidents and injuries (2000–2010) and one based on emergency department data (1986–2010). Linear regression was used to determine linear trends in ankle injuries per 1000 person‐years. The number of ankle injuries related to sports activities and other activities of daily living increased from 19.0 to 26.6 per 1000 person‐years (P = 0.002). The number of sports‐related ankle injuries treated in emergency departments decreased from 4.2 to 1.5 per 1000 person‐years (P < 0.001), and from 3.2 to 2.1 per 1000 person‐years (P < 0.001) for other activities of daily living. According to our data, the incidence rates of all ankle injuries are around 5.5 times higher than those registered at emergency departments. The high incidence rates of ankle injuries highlight the need for proper ankle injury treatment and prevention.

The relationship between the use of running applications and running-related injuries

ABSTRACT Objectives: Training errors are suggested to be an important cause of running-related injuries (RRIs). As most runners train individually, digital coaching using running applications is becoming increasingly popular. However, the quality of these applications is unknown. The aim of the present cross-sectional study was to evaluate the relationship between the use of running applications and RRIs. Methods: An online questionnaire was used to collect data on running activities of 1,029 runners, their injuries, and the association between the use of running applications and RRIs. Parametric and non-parametric tests for independent samples were used to analyze the baseline characteristics of the participants. Univariate logistic regression analyses and multiple logistic regression analysis (Enter procedure) were used to determine the association between the use of running applications and RRIs, while adjusting for confounding effects. Results: Of all the 1,029 runners included in this study, 31% (n = 319) got injured and 44% (n = 453) used an application in the previous 12 months. Multiple logistic regression analysis showed no statistically significant association between the use of running applications and RRIs. Conclusions: Based on this study, the use of running applications was not associated with an increased or decreased risk of RRIs. Running applications can be used by runners without any further implications to guide their training activities. However, runners should be aware that the use of predefined running schemes is associated with RRI risk. It is important that following a previous RRI, athletes should be fully recovered before resuming their training sessions as hindrance from a previous RRI is highly associated with the occurrence of a new RRI.

Economic Evaluation of a Soft Ankle Brace Compared to Tape in Acute Lateral Ankle Ligamentous Sprains

Background: Ankle sprains are common injuries, associated with high healthcare and societal costs. After sustaining an acute ankle sprain, ankle taping is the standard treatment in the Netherlands. Ankle braces are sometimes used as an alternative. The aim of the present study was to assess the costs-effectiveness of soft ankle bracing compared to ankle tape treatment in patients with an acute lateral ankle ligamentous sprain (ALALS). Methods: We conducted an economic evaluation from a societal perspective alongside a controlled trial. In order of presentation, patients were alternately allocated to four week treatment with a soft ankle brace or four week treatment with ankle tape. Costs and clinical outcomes with respect to re-injuries were derived from online patient questionnaires at 5, 9, 13, 26, 39, and 52 weeks after inclusion. Univariate and probabilistic sensitivity analyses were performed. Cost-effectiveness was assessed using bootstrapping with 5000 replications. Results: In total 157 patients with an ALALS were included, of which 151 (tape n=76, brace n=75) were analyzed. After one-year of follow-up, no significant clinical differences were found between both treatments groups. Mean total costs were €1,634 (SD 261) per patient in the brace group and €1,846 (SD 296) per patient in the tape group; mean difference -€212 (95%CI -854 to 436). The use of an ankle brace was less expensive in 71% of the bootstrap replications. Conclusions: In patients with ALALS, soft ankle bracing compared to ankle taping had similar clinical effect. The costs of soft bracing were lower. However, this difference was not statistically significant.

Response: letter to the editor: competitive influences of running applications on training habits

We would like to thank the authors of ‘Competitive influences of running applications on training habits’ for their valuable comments on our paper ‘The relationship between the use of running applications and running-related injuries’ [1]. We found no relationship between theuse of running applications (RAs) and the risk of running-related injuries (RRIs). Shei noted that the influences of virtual competition or challenges are not accounted for in our study [2].We largely agreewith these comments, since these factors may indeed affect the risk of RRIs. Especially given the fact that we found a positive relationship between running with a training scheme and the risk of RRIs. Both virtual competition and challengesmay lead to a tight, predefined schedule, since the participants want to achieve the desired result and get rewarded. Although our data did not consider the possible influence of a running-related competition or challenge, we did found some significant associations: (1) runnerswhoused an RA in the previous 12months used training schemesmore often and (2) the group of RA users were more goal-orientated runners. Goal-orientated runners were defined as runners who trained to accomplish a certain distance, to participate in a running event, or did both. The virtual competition or challenges could be one of these running goals and consequently may be more present in RA users. We are aware of the potential risk that running with particular goals, such as virtual competitions and challenges as integrated in different RAs, may contribute to risk of RRIs. For example, runners with extrinsic motivated goals expect to ignore warnings or signals indicating possible overload, continue running despite such signals [3], and consequently may be more prone to RRIs. However, in our opinion, the abovementioned virtual competitions and challenges are not the only running-related goals, which can contribute to the risk of RRIs. Other running goals such as training for a specific running event, setting a specific time for running a certain distance, or losing weight may also influence the risk of RRIs. Therefore, we indeed suggest further research on the relationship between runningrelated goals and the risk of RRIs. At present, we are studying the association between goal-orientated running and the risk of an RRI in the population as presented in our previous article [1] and in a prospective cohort study including half and full marathon runners. Any running-related goal, whether it concerns virtual competitions or otherwise, may increase the risk of RRI. And if this is the case, runners, trainers, and health-care professionals should be aware of this in order to tune training activities and programs to the physical capacity of runners.

Differences in injury risk and characteristics of injuries between novice and experienced runners over a 4-year period

ABSTRACT Objectives: Running is increasingly popular, but also carries a high injury risk, especially in novice runners. This study investigates differences in incidence and characteristics of running-related injuries (RRIs) between novice and experienced runners in the open population, in order to adapt to more specific needs for future prevention programs. Methods: Data were obtained from Injuries and Physical Activity in the Netherlands (IPAN), a Dutch questionnaire on injuries, physical activity, and sports. A representative sample of runners (n = 4621) from IPAN, including 1405 novice runners, was used to assess injury incidence rates, anatomical site, onset and need for medical attention of RRIs. Participants who started running during the past 12 months were defined as ‘novice’ runners. ‘Experienced’ runners are participants who had been running for more than 1 year. Results: Of the 4621 runners, 41,8% were female. The average age was 34.2 years. From 2010 to 2013, a total of 416 injuries were reported. The incidence of RRIs was significantly higher in novice runners compared with experienced runners: 8.78 (8.59–8.96) vs. 4.24 (4.11–4.37) per 1000 h running. In both novice and experienced runners, most RRIs were located at the knee (30.5%) and lower leg (17.8%), with the Achilles’ tendon less frequently injured in novice runners (2.3% vs. 8.4%, p = 0.031). Novice runners sustained more medical attention injuries (36.8%) than experienced runners (29.2%) (p > 0.132). Conclusions: In total, over 30% of all (novice and experienced) runners, suffered from RRI within 1 year. Novice runners reported more injuries per 1000 h of running in comparison to experienced runners. A tendency toward receiving medical attention more frequently was found in novice runners compared to experienced runners. In view of this higher injury incidence of RRIs and healthcare consumption in novice runners, more studies are needed to develop effective injury prevention programs for novice runners.

Effectiveness of a nationwide intervention to increase helmet use in Dutch skiers and snowboarders: an observational cohort study

Objective Helmet use in Dutch recreational skiers and snowboarders (DRSS) remains low. This study evaluated the effects of exposure to a nationwide intervention on relevant determinants of helmet use and helmet use in DRSS. Methods The intervention mapping protocol was used to develop an in-season intervention programme targeted at adult DRSS. A prospective single-cohort study was conducted to evaluate the impact of intervention exposure on determinants of helmet use (ie, knowledge about head injury risk and preventive measures, risk perception, attitudes to head injury risk and helmet use and intention to helmet use) and self-reported helmet use. A random sample of 363 DRSS from an existing panel participated in this study. Data were collected using online questionnaires before and immediately after the 2010/2011 intervention season. In a separate sample of 363 DRSS, intervention reach was assessed after the 2010/2011 season. Results Overall, no significant associations were found between intervention exposure and the determinants of helmet use. However, subgroup analyses revealed intervention effects on risk perception and knowledge in specific subpopulations. Intervention exposure had a significant, positive effect on helmet use in DRSS (β=0.23; 95% CI 0.017 to 0.44). Subgroup analyses revealed that this effect was found in: (1) skiers, (2) female DRSS, (3) young skiers and (4) intermediate skiers. Overall, intervention reach was 28.1%, with differences found between skiers and snowboarders. Conclusions Exposure to a nationwide intervention programme was associated with increased self-reported helmet use in DRSS. Differences were found in intervention effectiveness and reach between subpopulations. These differences must be taken into account when developing and evaluating future interventions.