Adherence and effectiveness of rehabilitation in acute ankle sprain




Abstract


Objective


To estimate adherence to and effectiveness of rehabilitation after acute ankle sprain.


Method


Patients with acute ankle sprain attending four emergency departments were recruited between February and July 2009. After the initial examination (classification of the severity of the sprain), each patient received an Aircast ® ankle brace and the same, standardized rehabilitation program. Between two and three months later; the patient was contacted by phone (always by the same investigator) in order to find out whether he/she had performed the prescribed rehabilitation, establish whether the physiotherapist had complied with the prescribed rehabilitation programme and assess subjective recovery. If a patient failed to respond to three phone calls, he/she was excluded from the study.


Results


Of the 245 patients initially included, 111 (67 men and 44 women; 17 mild sprains, 67 moderate sprains and 27 severe sprains) answered the “phone questionnaire”. In terms of treatment adherence by the patient, 92 patients (82.9%) performed their rehabilitation (beginning an average of 13.8 days after the injury). In terms of prescription compliance by the physiotherapist, 88 patients (95.6%) received massage, 71 (77.2%) underwent physiotherapy, 83 (90.2%) performed weight training and 87 (94.5%) received proprioceptive training. Eighty-two patients said that they had received manipulative therapy that was not part of the prescribed programme. Impact on recovery: 61 patients (55%) considered that their injury had healed (10 mild, 42 medium and nine severe sprains), whereas 50 had not healed (seven mild, 25 medium and 18 severe sprains). There was no statistically significant association between recovery and compliance with rehabilitation. However, the application of massage ( p = 0.004) and proprioceptive training ( p = 0.017) were significantly associated with recovery, while physiotherapy, weight training and manipulative therapy were not.


Conclusion


In acute ankle sprain, adherence with rehabilitation is good and the treating physiotherapists comply with the prescription. However, there was no statistically significant link between rehabilitation compliance and subjective recovery at 3 months. Revaluation of these patients at one year may be necessary for estimating the impact of rehabilitation on ankle function and the rate of injury recurrence.


Résumé


Objectif


Connaître l’observance du traitement par rééducation et son impact sur la guérison dans l’entorse de cheville.


Méthode


Quatre services d’accueil-urgences ont inclus, du 15/02 au 13/07/2009, les patients consultants pour entorse de cheville. Après l’examen initial (classification de l’entorse selon le degré de gravité), le patient recevait une orthèse semi-rigide et une ordonnance standardisée de rééducation. Puis le patient était contacté, par téléphone, au troisième mois, toujours par le même investigateur, pour savoir si la rééducation prescrite avait été faite, si le kinésithérapeute avait respecté le protocole de rééducation et enfin évaluer la guérison de l’entorse. Après trois appels téléphoniques sans réponse, le patient était exclu.


Résultats


Sur les 245 patients initialement inclus, 111 (67 hommes et 44 femmes) ont répondu au questionnaire téléphonique (17 entorses bénignes, 67 moyennes et 27 graves). Observance du traitement par le patient : 92 patients (82,9 %) ont fait leur rééducation qui a débuté 13,8 jours après l’accident. Respect de la prescription par le kinésithérapeute : 88 patients (95,6 %) ont eu des massages, 71 (77,2 %) de la physiothérapie, 83 (90,2 %) de la musculation et 87 (94,5 %) de la proprioception. Quatre-vingt-deux patients disent avoir eu des manipulations non prescrites dans le protocole donné. Impact sur la guérison : 61 patients (55 %) s’estiment guéris (dix entorses bénignes, 42 moyennes et neuf graves) et 50 non guéris (sept entorses bénignes, 25 moyennes et 18 graves). Il n’y a pas de lien significatif entre la guérison et la rééducation. Mais la pratique des massages ( p = 0,004) et de la proprioception ( p = 0,017) sont des liens significatifs avec la guérison alors que la physiothérapie, la musculation et les manipulations ne sont pas liées.


Conclusion


L’observance thérapeutique pour la rééducation de l’entorse de cheville est bonne et les kinésithérapeutes respectent bien la prescription médicale. Cependant, il n’existe pas de lien significatif entre la kinésithérapie et la guérison de cette entorse, à trois mois. Il semble indispensable de réévaluer ces patients dans un délai plus long, un an, pour juger l’impact de la rééducation sur le taux de récidive d’entorse.


1


English version


Ankle injuries account for 25% of all cases of locomotor system trauma . Lateral sprain of the talocrural joint is the most frequent instep injury, with a daily estimated incidence of one per 10,000 and an annual peak incidence (between the ages of 15 and 19) of 7.2 per 1000 . In addition to the frequency of ankle sprain, the cost of treatment makes this injury a public health problem. Although no estimates are available for France , the cost in the Netherlands has been estimated at €360 per sprain . Despite these data, many physicians still consider that ankle sprain is a trivial injury – which explains the sometimes perfectible initial management and treatment and the correspondingly invalidating sequelae in both sportspeople and the general population . In a recent literature review, Van Rijn et al. reported that only 36 to 85% of patients make a full recovery 3 years after injury. “Expert” orthopaedists and sports injury specialists are rarely the first physicians to examine ankle sprain victims, who often initially attend an accident and emergency (A&E) department . Hence, the initial treatment is generally prescribed by emergency physicians. Regardless of the degree of sprain severity, the latter often choose functional treatment that (after the acute phase and application of the RICE protocol ) includes immobilization in a brace and rehabilitation . This type of treatment is perfectly justified, given that the various literature reviews have shown that surgery does not give better results and functional treatment is better than immobilization in a plastic cast in terms of the rapid resumption of sporting or professional activities, as long as semi-rigid braces (which are preferable to the other compression devices) are prescribed .


However, many of the prescribed rehabilitation techniques have not been tested in comparative studies – even though neuromuscular reprogramming is important . We were unable to find any French comparative studies in this field . Moreover, rehabilitational treatment is not always monitored by the prescribing physician in terms of both patient adherence and the physiotherapist’s compliance with the prescription .


The present study had two objectives:



  • •

    to assess the patient’s adherence with the prescribed functional treatments;


  • •

    to evaluate the physiotherapist’s compliance with the prescription (notably in terms of neuromuscular reprogramming) and its impact on recovery.



1.1


Patients, material and methods


1.1.1


Patients


Between February 15th and July 13th, 2009, patients suffering from a sprained ankle were included in the study by emergency physicians in four A&E departments in the Brittany region of western France (Quimper Hospital, Brest Military Hospital, the Keraudren Clinic and Brest University Hospital).


The only non-inclusion criterion was repeat injury following ankle sprain in the previous 12 months.


1.1.2


Method


For each patient, the emergency physician filled out a case report form with the person’s contact details, the cause of the sprain (a sports injury, a workplace accident or an everyday accident) and the severity (mild, moderate or severe). The physician was free to prescribe additional examinations.


The physician then prescribed a RICE protocol and handed over a prescription for analgesics, a semirigid brace (the Aircast ® ) and a standardized rehabilitation programme ( Appendix 1 ). The same prescription was issued in all four A&E departments. Patients were free to attend the physiotherapy practice of their choice.


The study participants were informed orally (i.e. written consent was not obtained) that they would be contacted by phone three months later, in order to assess the sprain’s outcome.


1.1.2.1


The phone survey


All included patients were contacted between 60 and 90 days later by a physician who had not been involved in the inclusion procedure. The patients were asked to reply to a series of questions ( Appendix 2 ) concerning brace use, rehabilitation and the extent of their recovery. In the event of three missed phone calls, patients were excluded from the study.


The study was approved by the independent ethics committee at Brest University Hospital.


1.1.3


Statistical analysis


All data were entered and processed with SPSS software (version 17.0 from SPSS Inc. Chicago, IL, USA). Chi 2 or Fisher’s exact tests were used to analyze categorical variables and the Mann-Whitney test was applied to continuous variables. The threshold for statistical significance was set to p < 0.05.


1.2


Results


1.2.1


Population


A total of 245 patients were initially included by the four A&E departments; 134 were subsequently excluded because they failed to respond to three phone calls. Ultimately, 111 patients were included in the analysis (corresponding to a response rate of 45%): 67 men and 44 women; mean ± SD age: 31.5 ± 12.3 years (range: 15 to 55). The ankle sprain resulted from everyday accidents in 55 cases (50%) (11 severe sprains, 35 moderate sprains and nine mild sprains), a sports injury in 34 cases (30%) (12 severe sprains, 18 moderate sprains and four mild sprains) and a workplace accident in 22 cases (20%) (4 severe sprains, 14 moderate sprains and 4 mild sprains). The examining physicians classified 17 sprains as mild (15.3%), 67 as moderate (60.4%) and 27 as severe sprains (24.3%). At the time of the phone survey, 61 patients (55%) considered that they had made a full recovery and 50 patients (45%) considered that they had not.


1.2.2


Brace use


A brace had been worn in 96 cases (86%) and only 15 patients have never worn one at all (six moderate sprains and nine severe sprains). On average, the brace had actually been used for 18.5 ± 12 days (18 ± 11.5 days in the 61 patients who felt that they had made a full recovery and 19 ± 13 days for the 50 patients who felt that they had not). There was no statistically significant relationship between brace use and subjective recovery ( p = 0.911).


1.2.3


Rehabilitation


1.2.3.1


Patient adherence


Ninety-two patients (83.9%) performed rehabilitation and only 19 (17.1%) did not visit a physiotherapist. The reasons for non-attendance were lack of time ( n = 10), a presumed lack of usefulness ( n = 6) and stated lack of a prescription ( n = 3). None of the patients stated that financial constraints or the lack of an available physiotherapist had prevented him/her from performing the rehabilitation programme. On average, rehabilitation was initiated 13.9 ± 13 days after the injury.


1.2.3.2


Compliance with the prescription by the physiotherapist


Of the 92 patients having performed rehabilitation, 88 (95.6%) received massage, 71 (77.2%) underwent physiotherapy, 83 (90.2%) performed weight training and 87 (94.6%) received proprioceptive training. Eighty-two patients (89%) stated that they had also received manipulative therapy (local-regional joint mobilization and not spinal manipulation), despite the fact that the latter was not part of the prescribed rehabilitation programme.


1.2.3.3


Impact of rehabilitation on recovery


Of the 61 patients (55%) who felt that they had made a full recovery by the time of the phone survey (i.e. during the third month post-injury), 10 had suffered from a mild sprain, 42 had suffered from a moderate sprain and nine had suffered from a severe sprain. Of the 50 patients (45%) who considered that they had not recovered, seven had suffered from a mild sprain, 25 had suffered from a moderate sprain and 18 had suffered from a severe sprain.


Forty-seven of the non-recovered patients (94%) complained of residual pain (with an average pain score of 3.8 out of 10) and 28 (56%) felt unsafe walking or experienced ankle instability. Of the latter, 25 (50%) also experienced injury-related pain and three did not suffer from pain.


Although there was no statistically significant relationship between subjective recovery and overall compliance with rehabilitation ( p = 0.806), the use of massage ( p = 0.04) and proprioceptive training ( p = 0.017) were associated with recovery (in contrast to physiotherapy, weight training and manipulative therapy) ( Table 1 ).



Table 1

Comparison between patients who considered that they had recovered and those who did not.







































Recovered (%) Not recovered (%)
Rehabilitation 49/61 (80) 43/50 (86) 0.806 (NS)
Massage 49/61 (80) 39/50 (78) 0.04 (S)
Physiotherapy 41/61 (67) 30/50 (60) 0.319 (NS)
Manipulative therapy 45/61 (74) 37/50 (74) 0.503 (NS)
Weight training 46/61 (75) 37/50 (74) 0.727 (NS)
Proprioception 49/61 (80) 38/50 (76) 0.017 (S)


1.3


Discussion


1.3.1


Population


After the emergency physicians had “pre-included” 245 patients, we ultimately analyzed 111 cases. We were unaware of the outcomes for other 134 patients, which constitute a typical source of bias in this type of study. However, we note than the telephone survey response rate was quite high (45%) for a study population examined just once in the A&E department.


Although the majority of our 111 patients (mean age: 31.5 years) were male (57.6%), most ankle sprain studies have been performed in younger populations of sportspeople with a higher proportion of male subjects . However, a recent epidemiological study of ankle sprains in the general population consulting in an A&E department did not observe male predominance . In the latter study, sports accidents accounted for half of the injuries. In our study, everyday accidents were the most frequent cause of injury. It could be that sportspeople in our region preferred to consult in specialist sports injury clinics. Some studies have included this type of specialist centre (along with A&E departments) in their recruitment of ankle sprain patients, which may explain the high reported proportion of sports injuries in the literature (67%) .


1.3.2


Brace use


The Aircast brace provides better support than strapping and is relatively cost-effective . Here, adherence with brace use was high. The duration of brace use is subject to debate but a recent study showed that a short period of immobilisation (10 days) with a brace or plaster cast gave excellent functional results three months after severe ankle sprain . In our work and despite brace use for 18.5 days, there was no apparent correlation with recovery – even though only 15 patients (including nine with a severe sprain) did not use immobilisation.


1.3.3


Rehabilitation


1.3.3.1


Adherence by the patient


We observed very good adherence (95.6%) by the patients to rehabilitation, which was not the case in a similar study performed on muscle-related sports injuries . The cost and availability of care were never mentioned as reasons for not performing rehabilitation. In a study performed by physiotherapists in the Netherlands to evaluate their patients’ adhesion to therapeutic guidelines for ankle sprain, the adherence varied from 71 to 100%. Female patients, patients with a history of recurrent sprains and those with co-morbidities showed the best adherence .


1.3.3.2


Adherence by the physiotherapist


The physiotherapists’ compliance with the prescription was good, regardless of sprain severity. This excellent compliance contrasts with lower values in a Dutch study in which only 66% of the physiotherapists applied the recommendations to over half their patients . The second part of the phone questionnaire (with closed questions and an explanation of terms such as “physiotherapy” and “proprioception”) enabled us to determine adherence. In fact, in response to the first part of the questionnaire (open questions), the patients told us about their rehabilitation sessions in general and did not have to mention the sessions’ duration or composition. The physiotherapists in our region appeared to have complied with the basic principles of combating pain and oedema, restoring joint amplitudes, strengthening muscles and reinforcing proprioception. However, in a high proportion of cases (89%), we noted the almost addition of non-prescribed manipulative therapy (or acts described as such by the patients); this reflects the significant ongoing fashion for manual therapy .


1.3.3.3


Impact of rehabilitation on recovery


Ever since Freeman’s suggestions on preventing functional instability of the foot , rehabilitation has been considered to be essential in the treatment of ankle sprain. However, our study showed that there was no significant relationship between compliance with rehabilitation in general and subjective recovery between 60 and 90 days post-injury (which is in agreement with literature findings ). In fact, the only (moderate) benefit of rehabilitation other than brace use may be more rapid resumption of sport ; however, we did not explore this parameter in the present study. In contrast, massage and proprioceptive training were significantly related to the recovery. Proprioceptive training is gaining in importance in rehabilitation programmes , especially since this home-based technique effectively reduces the re-injury rate in sportspeople and decreases the cost of treating relapses .


When considering the benefits of rehabilitation, it is important to differentiate between the time lag to resumption of professional and sporting activities (i.e. the feeling of having “recovered” – the parameter we measured here) and sprain recurrence (which is significant in the 12 months following the initial injury ).


Some researchers consider that rapid resumption of activities is the most important treatment outcome . In most cases, patients resume their normal activities 4 weeks after the sprain . Between weeks 4 and 8 post-injury, the ligaments heal and the aim of rehabilitation is to enable the injured person to rapidly resume professional and sporting activities . Although the time needed to recover normal laxity appears to be greater than 8 weeks , the healing time for the anterior talofibular ligament (and thus the duration of immobilization and rehabilitation) has not been established . This is why our survey focussed on the notion of recovery (resumption of activities) after eight weeks.


Of course, other factors may also modulate the impact of rehabilitational treatment – notably the time interval between the injury and the start of rehabilitation (13.9 days in the present study). Recently, doubt has been cast on the conventional first-line emergency treatment (the RICE protocol) because immediate rehabilitation appeared to lead to faster relapse-free recovery of ankle function over a 16-week follow-up period . This finding clashes with Lamb’s work showing that 10 days of immobilisation in a plaster cast is (in contrast to general medical opinion) the best strategy for rapidly recovering from a sprain (as judged over a 9-month follow-up period). These contradictory results underline the persistent difficulties in the therapeutic management of ankle sprain and its short, medium and long follow-up – even for supposedly mild sprains, since there is no correlation between the initially defined sprain severity and the frequency of sequelae .


1.4


Conclusion


Our present study evidenced excellent adherence by ankle sprain patients to rehabilitation and a high degree of compliance by private-practice physiotherapists with the physician’s prescription. However, there was no significant correlation between rehabilitation in general and subjective recovery from ankle sprain in the 60 to 90 days following the injury. Nevertheless, the use of massage and proprioceptive training were significantly correlated with recovery; this finding should encourage the emergency physicians to maintain the systematic prescription of rehabilitation in their management of ankle injuries seen in the A&E department. It now appears necessary to perform a new survey of our population after a one-year follow-up period, in order to assess the impact of rehabilitation on the sprain relapse rate.




2


Version française


La traumatologie de cheville représente 25 % de l’ensemble de la traumatologie de l’appareil locomoteur . L’entorse latérale de l’articulation talocrurale est la plus fréquente des entorses du cou-de-pied avec une incidence quotidienne estimée à un pour 10 000 et avec un pic d’incidence annuelle, entre 15 et 19 ans, de 7,2 pour 1000 . Outre sa fréquence, cette entorse de cheville est un problème de santé publique par son coût. Même si en France, il n’existe pas de réelle évaluation , le coût est estimé à 360 Euros par entorse, en Hollande . Malgré cela, l’entorse de cheville reste, pour de nombreux médecins, un accident banal ce qui explique sa prise en charge initiale et son traitement parfois perfectibles et leur corollaire que sont les séquelles invalidantes chez les sportifs mais également dans la population générale . Dans une revue récente de la littérature, Van Rijn et al. , montrent que seuls 36 à 85 % des patients sont totalement guéri à trois ans. Ce sont rarement les « experts », orthopédistes et traumatologues du sport, qui examinent, en premier, le patient victime d’un traumatisme de cheville. Le patient blessé à la cheville se présente souvent dans un service accueil-urgence (SAU) . La prise en charge initiale et le traitement sont ordonnés par les médecins urgentistes. Ces derniers, pour tous les degrés de sévérité d’entorse, optent souvent pour un traitement fonctionnel qui, après la phase aiguë et l’application du protocole RICE , comprend une immobilisation par attelle et une rééducation . Ce traitement est parfaitement justifié au vue des différentes revues de la littérature qui montrent que la chirurgie n’a pas fait la preuve de sa supériorité et que ce traitement fonctionnel est également supérieure à l’immobilisation plâtrée pour le délai de reprise du sport et des activités professionnelles à condition de prescrire des attelles semi rigides, préférables aux autres contentions .


Cependant, parmi les techniques de rééducation proposées, beaucoup n’ont pas fait l’objet d’études comparatives même si la reprogrammation neuro musculaire est importante . Aucune étude comparative française n’a été identifiée . De plus, ce traitement rééducatif n’est pas toujours contrôlé par le médecin prescripteur aussi bien dans son observance par le patient que dans le respect de la prescription par le kinésithérapeute .


Le but de ce travail est double :



  • •

    connaître l’observance, par le patient, du traitement fonctionnel ;


  • •

    connaître le respect de la prescription par le kinésithérapeute, notamment sur la reprogrammation neuro musculaire, et son impact sur la guérison



2.1


Patients, matériel et méthode


2.1.1


Patients


Entre le 15/02/2009 et le 13/07/2009, les médecins urgentistes de quatre SAU (le centre hospitalier de Quimper, centre hospitalier inter armées de Brest, la clinique de Kéraudren de Brest, le centre hospitalier Cavale-Blanche de Brest) ont inclus les patients souffrant d’une entorse de cheville.


Le seul critère de non inclusion était le patient ayant eu une entorse, sur cette même cheville, dans les 12 derniers mois.


2.1.2


Méthode


Pour chaque patient, le médecin urgentiste remplissait une fiche d’inclusion avec les coordonnées du patient, la cause du traumatisme (accident de sport, accident du travail, accident de la vie quotidienne) et le degré de gravité de cette entorse (bénigne, moyenne, grave). Le médecin était libre de prescrire ou pas de examens complémentaires.


Puis le médecin prescrivait au patient le protocole RICE, remettait une ordonnance d’antalgique, une attelle semi rigide (Aircast ® ) et une ordonnance de rééducation standardisée ( Annexe 1 ). Cette prescription était la même pour les quatre SAU. Les patients étaient libres du choix du kinésithérapeute.


Les patients étaient informés oralement (pas de consentement écrit) qu’ils seraient contactés par téléphone, au troisième mois d’évolution, pour connaître les suites de cette entorse.


2.1.2.1


Enquête téléphonique


Tous les patients inclus étaient contactés par téléphone, entre j60 et j90, par un même médecin, qui n’avait pas participé aux inclusions, pour répondre à un questionnaire ( Annexe 2 ) sur le port de l’attelle, le traitement rééducatif et le niveau de guérison. Après trois appels téléphoniques, sans réponse, le patient était exclu de l’étude.


L’étude a reçu l’accord du comité d’éthique de CHU de Brest.


2.1.3


Analyses statistiques


Les données ont été saisies sur SPSS (17.0, Chicago, IL). Les tests statistiques utilisés ont été le Chi 2 (ou Fisher exact nécessaire) pour les variables discrètes et le Mann et Whitney pour les variables continues. Les valeurs de p < 0,05 ont été considérées significatives.


2.2


Résultats


2.2.1


Population


Deux cent quarante-cinq patients ont été initialement inclus dans les quatre SAU ; 134 ont été exclus par faute de réponse après trois appels téléphoniques. Au final, 111 patients ont été inclus, soit un taux de réponse de 45 % ; Soixante-sept hommes et 44 femmes, âgés de 31,5 ± 12,3 ans (extrêmes 15 à 55 ans). Les traumatismes de cheville entraient dans le cadre d’un accident de la vie quotidienne pour 55 cas (50 %) (11 entorses graves, 35 moyennes et neuf bénignes) d’un accident de sport pour 34 cas (30 %) (12 entorses graves, 18 moyennes et quatre bénignes), et d’un accident du travail pour 22 cas (20 %) (quatre entorses graves, 14 moyennes et quatre bénignes). Les médecins urgentistes ont donc déterminé, en conclusion de leur examen, 17 entorses bénignes (15,3 %), 67 entorses moyennes (60,4 %) et 27 entorses graves (24,3 %). 61 patients (soit 55 %) s’estimaient totalement guéris au moment du questionnaire et 50 patients (45 %) ne s’estimaient pas guéris.


2.2.2


Port de l’attelle


L’attelle a été portée dans 96 cas (86 %), seuls 15 patients n’ont jamais porté cette immobilisation (six entorses moyennes et neuf graves). Cette attelle a été effectivement portée pendant 18,5 ± 12 jours ; 18 ± 11,5 jours chez les 61 patients qui s’estimaient guéris et 19 ± 13 jours pour les 50 patients qui s’estimaient non guéris. Il n’existe pas de lien significatif entre le port de l’attelle et la guérison ( p = 0,911).


2.2.3


Rééducation


2.2.3.1


Observance par le patient


Quatre-vingt-douze patients (83,9 %) ont fait leur rééducation et seuls 19 (17,1 %) ne se sont pas rendus chez un kinésithérapeute. Les raisons invoqués par ces 19 patients étaient pour dix d’entre eux l’indisponibilité au niveau du temps, pour six qu’ils n’avaient pas jugé utile de faire cette rééducation et enfin trois ont dit ne pas avoir eu de prescription. Aucun patient n’a déclaré ne pas avoir fait de rééducation par manque de moyen financier ou manque de kinésithérapeute disponible. La rééducation a débuté en moyenne 13, 9 ± 13 jours après l’accident.


2.2.3.2


Observance de la prescription par le kinésithérapeute


Pour les 92 patients rééduqués, 88 (95,6 %) ont eu des massages, 71 (77,2 %) de la physiothérapie, 83 (90,2 %) de la musculation et 87 (94,6 %) de la proprioception. Quatre-vingt-deux patients (89 %) disent aussi avoir eu des manipulations (mobilisations articulaires locorégionales et non de la « vertébrothérapie ») alors qu’elles ne figuraient pas sur la prescription de rééducation.


2.2.3.3


Impact de la rééducation sur la guérison


Sur les 61 patients (55 %) qui s’estimaient totalement guéris au moment du questionnaire, soit dans le courant du troisième mois après le traumatisme, dix avaient initialement une entorse bénigne, 42 une entorse moyenne et neuf une entorse grave. Sur les 50 patients (45 %) qui ne s’estimaient pas guéris, sept avaient une entorse bénigne, 25 une entorse moyenne et 18 une entorse grave. Pour les patients non guéris, 47 (94 %) se plaignaient de douleur résiduelle évaluée à 3,8/10 et 28 (56 %) ressentaient une insécurité ou une instabilité de cheville dont 25 (50 %) avec une douleur associée et trois sans douleur associée.


Il n’y a pas de lien significatif entre la guérison et la rééducation ( p = 0,806) mais la pratique des massages ( p = 0,04) et de la proprioception ( p = 0,017) sont liés avec la guérison alors que la physiothérapie, la musculation et les manipulations ne le sont pas ( Tableau 1 ).


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Apr 23, 2017 | Posted by in PHYSICAL MEDICINE & REHABILITATION | Comments Off on Adherence and effectiveness of rehabilitation in acute ankle sprain

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