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Sarah E Lamb - One of the best experts on this subject based on the ideXlab platform.
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48 The Effects Of Different Types Of Ankle Support On Gait: A Randomised Cross-over Study
British Journal of Sports Medicine, 2014Co-Authors: David J Keene, Keith Willett, Sarah E LambAbstract:Introduction Ankle Supports are routinely issued to patients following Ankle injury and surgery [Lin et al. 2010]. Patients may be advised to use Tubigrip (elasticated tubular bandage), a stirrup brace or a type of removable walker boot (Figure 1). The primary differences in Support design are the extent and direction of mechanical limitation to Ankle joint motion. One of the main aims of the initial phase of rehabilitation after injury or surgery is to optimise the recovery of a normalised walking gait pattern. Aim To determine the effects of Ankle Supports on gait symmetry in healthy adults. Methods Participants were 18 healthy adult volunteers. This study was a randomised three-treatment, three-period, cross-over design. The order of Ankle Supports tested was balanced using Latin squares. Outcomes: 1) step length and single limb Support time symmetry indices (SI). SI are an expression of the relationship between the injured and uninjured limb [Hodt-Billington et al. 2011]. The SI have a minimum of 0 (perfect symmetry) and 0.1 is equivalent to 10% asymmetry, 0.5 is 50% asymmetry and so on. 2) step width (cm). These temporo-spatial gait parameters were measured on the GAITRite® electronic walkway system (CIR Symptoms, Havertown, PA, USA). The concurrent validity of GAITRite® has been established against the VICON® system [Webster et al. 2005]. Participants walked across the electronic walkway six times in each Support (twice at slow, preferred and fast walking speeds). Gait outcomes were normalised for walking velocity by use of multilevel modelling. Results Participants were on average 42 (SD 13) years old and 88% were female. The walker boot resulted in gait abnormalities compared with Tubigrip. There was greater asymmetry in step length in the walker boot when compared to Tubigrip by a 10% margin (95% CI 9 to 12%, p Discussion Walker boots induce step length and single limb Support time asymmetry and widen step width compared with Tubigrip in non-pathological gait. There are no important differences in gait in an Ankle stirrup brace compared with Tubigrip. Further research is required to directly compare the effects of these Ankle Supports in clinical populations to further inform clinical decision making. References Alfredson, H. et al., Am J Sport Med. 1998;26(3):360–366 Jarvinen, T. A. et al., Foot Ankle Clin. 2005;10(2):255–266 Malliaras, P. et al., Sports Medicine (Auckland, N. Z.), 43(4):267–286
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treatment of severe Ankle sprain a pragmatic randomised controlled trial comparing the clinical effectiveness and cost effectiveness of three types of mechanical Ankle Support with tubular bandage the cast trial
Health Technology Assessment, 2009Co-Authors: Matthew Cooke, Jennifer Marsh, Jane L Hutton, Rachel A Nakash, R M Jarvis, Michael Clark, Susan R. Wilson, Ala Szczepura, Sarah E LambAbstract:To estimate (1) The clinical effectiveness of three different methods of Ankle Support (below knee plaster cast, Kendall Ankle Support, Bledsoe boot) in comparison to Tubigrip in the recovery of mobility and function after Grade II and III sprains of the Ankle joint. (2) The cost-effectiveness of the three different methods of Ankle Support in comparison to Tubigrip only. The economic analysis will be conducted from a societal perspective. Tubigrip has been chosen as the reference (status quo) treatment; it is the cheapest, but is likely to be least effective (ref 1). The Bledsoe boot is a factor of 30 times more expensive (US$50 usual,assuming no re-use), and its clinical effectiveness is yet to be proven. The below knee plaster cast will be Scotch Cast (cost £5). There are a range of Ankle Supports available. We have selected the Kendall Gel Brace (£19 per brace), which is the cheapest and. in our experience is as clinically effective as other brands. All treatments will be provided in the NHS, in a manner consistent with current national practice.
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treatment of severe Ankle sprain a pragmatic randomised controlled trial comparing the clinical effectiveness and cost effectiveness of three types of mechanical Ankle Support with tubular bandage the cast trial
Health Technology Assessment, 2009Co-Authors: Matthew Cooke, Jennifer Marsh, Jane L Hutton, Rachel A Nakash, R M Jarvis, Michael Clark, Susan R. Wilson, Ala Szczepura, Sarah E LambAbstract:OBJECTIVE To estimate the clinical effectiveness and cost-effectiveness of three methods of Ankle Support compared with double layer tubular compression bandage. DESIGN A randomised controlled trial, designed to reflect practice in UK hospital emergency departments. SETTING Eight emergency departments in England. PARTICIPANTS Aged 16 or over with acute severe Ankle sprain, unable to weight bear, no fracture. INTERVENTIONS 584 participants were randomised to one of four treatment arms: tubular bandage, below knee cast, Aircast Ankle brace or Bledsoe boot, all applied 2-3 days after presentation to allow swelling to resolve. MAIN OUTCOME MEASURES Response to treatment was assessed using the Foot and Ankle Outcome Score and generic measures (Functional Limitations Profile, SF-12 and EQ-5D). RESULTS When adjusted for age, sex and baseline scores, the below knee cast offered a small but statistically significant benefit at 4 weeks in terms of pain (FAOS pain difference 5.1; 95% CI 0.4-9.8), foot- and Ankle-related quality of life (QoL) (FAOS QoL difference 5.9; 95% CI 0.1-11.8) and the physical component of the SF-12 (SF-12 score difference 2.2; 95% CI 0.0-4.4). Neither the Aircast brace nor the Bledsoe boot was statistically or clinically better. At 12 weeks the below knee cast was significantly better than tubular bandage in terms of pain (FAOS pain difference 5.1; 95% CI 0.3-10.0), activities of daily living (FAOS ADL difference 3.5; 95% CI 0.4-6.6), sports (FAOS sports difference 8.7; 95% CI 1.6-15.7) and QoL (FAOS QoL difference 8.7; 95% CI 2.4-15.0), and the Aircast brace was better only in terms of Ankle-related QoL and mental health. The Bledsoe boot conferred no significant advantage over tubular bandage. By 9 months there were no significant differences. Based on mean direct health-care costs per participant, the Bledsoe boot was the most expensive (215 pounds) and tubular bandage the least so (1 pound 44 pence). Inclusion of indirect costs (sick leave) raised overall costs substantially and removed any significant differences between the therapies. Cost-utility analysis demonstrated that the Aircast brace [301 pounds per quality-adjusted life-year (QALY)] and below knee cast (339 pounds per QALY) were more cost-effective than the Bledsoe boot (2116 pounds per QALY). However, inclusion of indirect costs produced different rank orders, depending on the assumptions made, and results should be treated with caution. CONCLUSIONS The below knee cast and the Aircast brace offered cost-effective alternatives to tubular bandage for acute severe Ankle sprain, the former having the advantage in terms of overall recovery at 3 months. As there were no differences in long-term outcome, practitioners should consider likely compliance and acceptability to patients when choosing a brace.
Mitchell L Cordova - One of the best experts on this subject based on the ideXlab platform.
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influence of external Ankle Support on lower extremity joint mechanics during drop landings
Journal of Sport Rehabilitation, 2010Co-Authors: Mitchell L Cordova, Yosuke Takahashi, Gregory M Kress, Jody B Brucker, Alfred E FinchAbstract:Objective: To investigate the effects of external Ankle Support (EAS) on lower extremity joint mechanics and vertical ground-reaction forces (VGRF) during drop landings. Design: A 1 × 3 repeated-measures, crossover design. Setting: Biomechanics research laboratory. Patients: 13 male recreationally active basketball players (age 22.3 ± 2.2 y, height 177.5 ± 7.5 cm, mass 72.2 ± 11.4 kg) free from lower extremity pathology for the 12 mo before the study. Interventions: Subjects performed a 1-legged drop landing from a standardized height under 3 different Ankle-Support conditions. Main Outcome Measures: Hip, knee, and Ankle angular displacement along with specific temporal (TGRFz1, TGRFz2; s) and spatial (GRFz1, GRFz2; body-weight units [BW]) characteristics of the VGRF vector were measured during a drop landing. Results: The tape condition (1.08 ± 0.09 BW) demonstrated less GRFz1 than the control (1.28 ± 0.16 BW) and semirigid conditions (1.28 ± 0.21 BW; P < .0001), and GRFz2 was unaffected. For TGRFz1, no-...
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effects of Ankle Support on lower extremity functional performance a meta analysis
Medicine and Science in Sports and Exercise, 2005Co-Authors: Mitchell L Cordova, Christopher D Ingersoll, Brady D Scott, Michael J LeblancAbstract:UNLABELLED Clinicians surmise that the application of external Ankle Support reduces the ability to perform functional skills and movements, but the outcomes from some of these studies have been inconclusive. PURPOSE To meta-analyze studies regarding the effects of external Ankle Support on lower-extremity functional performance measures. METHODS A total of 93 effects from 17 randomized controlled trials utilizing predominantly crossover designs with recreationally active participants and competitive athletes were subjected to a random-effects meta-analysis. The treatment variable was external Ankle Support with three levels: adhesive tape, lace-up style, and semirigid style. Differences between mean changes in treatment and control groups were computed as standardized effect sizes for sprint, agility, and vertical jump performance with their 90% confidence intervals (CI). Effect sizes >0.20 were considered substantial. RESULTS The greatest effect of Ankle Support on performance was a negative effect of lace-up style brace on sprint speed (effect size -0.22, 90% CI -0.47 to 0.03), equivalent to approximately 1% impairment of speed. The other effects of external Ankle Support on performance were insubstantial, though most were negative, and their lower confidence limits allowed for realistic chances of impaired performance. Substantial true variation between studies, although poorly defined, was also present for some effects, further increasing the likelihood of performance impairment in some settings. CONCLUSIONS More research is needed to reduce the uncertainty in the effects of external Ankle Support on performance. In the meantime, it is our opinion that the benefit in preventing injury outweighs the possibility of substantial but small impairment of performance when athletes use external Ankle Support.
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peroneus longus stretch reflex amplitude increases after Ankle brace application
British Journal of Sports Medicine, 2003Co-Authors: Mitchell L Cordova, Christopher D IngersollAbstract:Background: The use of external Ankle Support is widespread throughout sports medicine. However, the application of Ankle bracing to a healthy Ankle over a long period has been scrutinised because of possible neuromuscular adaptations resulting in diminished dynamic Support offered by the peroneus longus. Objective: To investigate the immediate and chronic effects of Ankle brace application on the amplitude of peroneus longus stretch reflex. Methods: Twenty physically active college students (mean (SD) age 23.6 (1.7) years, height 168.7 (8.4) cm, and mass 69.9 (12.0) kg) who had been free from lower extremity pathology for the 12 months preceding the study served as subjects. None had been involved in a strength training or conditioning programme in the six months preceding the study. A 3 x 3 x 2 (test condition x treatment condition x time) design with repeated measures on the first and third factor was used. The peroneus longus stretch reflex (% of maximum amplitude) during sudden foot inversion was evaluated under three Ankle brace conditions (control, lace up, and semi-rigid) before and after eight weeks of Ankle brace use. Results: A 3 x 3 x 2 repeated measures analysis of variance showed that peroneus longus stretch reflex amplitude increased immediately after application of a lace up brace (67.1 (4.4)) compared with the semi-rigid (57.9 (4.3)) and control (59.0 (5.2)) conditions (p<0.05). Peroneus longus stretch reflex also increased after eight weeks of use of the semi-rigid brace compared with the lace up and control conditions (p<0.05). Conclusions: Initial application of a lace up style Ankle brace and chronic use of a semi-rigid brace facilitates the amplitude of the peroneus longus stretch reflex. It appears that initial and long term Ankle brace use does not diminish the magnitude of this stretch reflex in the healthy Ankle.
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efficacy of prophylactic Ankle Support an experimental perspective
Journal of Athletic Training, 2002Co-Authors: Mitchell L Cordova, Christopher D Ingersoll, Riann M PalmieriAbstract:OBJECTIVE: To provide a comprehensive review of the literature regarding the role of external Ankle Support on joint kinematics, joint kinetics, sensorimotor function, and functional performance. DATA SOURCES: We searched MEDLINE and SPORT Discus databases from 1960-2001 for the key words Ankle bracing, Ankle Support, Ankle taping, and Ankle prophylaxes. We also used personal libraries based on our own research to complement the existing literature. DATA SYNTHESIS: The effects of external Ankle Support have been studied on a plethora of dependent measures. Here, we specifically discuss the role of external Ankle Support on joint kinematics, joint kinetics, sensorimotor function, and functional performance and present a general consensus regarding the overall effects of these prophylactic devices. CONCLUSIONS/RECOMMENDATIONS: The effects of Ankle Support on joint kinematics during static joint assessment and on traditional functional-performance measures (ie, agility, sprint speed, vertical jump height) are well understood. However, the potential effects of Ankle Support on joint kinetics, joint kinematics during dynamic activity (eg, a cutting maneuver), and various sensorimotor measures are not well known. Future research investigating the role of external Ankle bracing needs to focus on these areas.
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long term Ankle brace use does not affect peroneus longus muscle latency during sudden inversion in normal subjects
Journal of Athletic Training, 2000Co-Authors: Mitchell L Cordova, Christopher D Ingersoll, C V Cardona, Michelle A SandreyAbstract:Objective External Ankle Supports are widely used in sports medicine. However, Ankle bracing in a healthy Ankle over a sustained period has been scrutinized due to possible neuromuscular adaptations resulting in diminished dynamic Support offered by the peroneus longus muscle. Although this claim is anecdotal in nature, we sought to investigate the effects of long-term Ankle bracing using 2 commonly available appliances on peroneus longus latency in normal subjects. Our second purpose was to evaluate the effects of Ankle bracing on peroneus longus latency before a period of extended use. Design and setting A 3 x 3 x 2 design with repeated measures on the first and third factors was used in this study. All data were collected in the Sports Injury Research Laboratory. Subjects Twenty (12 men and 8 women) physically active college students (age = 23.6 +/- 1.7 years; height = 168.7 +/- 8.4 cm; weight = 69.9 +/- 12.0 kg) free of Ankle or lower extremity injury in the 12 months before the study and not involved in a strength-training or conditioning program in the 6 months before the study. Measurements We evaluated peroneus longus latency by studying the electromyogram of the muscle after sudden foot inversion. Results Application of a lace-up or semirigid brace did not affect peroneus longus latency. Additionally, 8 weeks of longterm Ankle appliance use had no effect on peroneus longus latency. Conclusions The duration of the peroneus longus stretch reflex (latency) is neither facilitated nor inhibited with extended use of an external Ankle Support. Proprioceptive input provided by the muscle spindles within the peroneus longus does not appear to be compromised with the long-term use of Ankle braces.
Matthew Cooke - One of the best experts on this subject based on the ideXlab platform.
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treatment of severe Ankle sprain a pragmatic randomised controlled trial comparing the clinical effectiveness and cost effectiveness of three types of mechanical Ankle Support with tubular bandage the cast trial
Health Technology Assessment, 2009Co-Authors: Matthew Cooke, Jennifer Marsh, Jane L Hutton, Rachel A Nakash, R M Jarvis, Michael Clark, Susan R. Wilson, Ala Szczepura, Sarah E LambAbstract:To estimate (1) The clinical effectiveness of three different methods of Ankle Support (below knee plaster cast, Kendall Ankle Support, Bledsoe boot) in comparison to Tubigrip in the recovery of mobility and function after Grade II and III sprains of the Ankle joint. (2) The cost-effectiveness of the three different methods of Ankle Support in comparison to Tubigrip only. The economic analysis will be conducted from a societal perspective. Tubigrip has been chosen as the reference (status quo) treatment; it is the cheapest, but is likely to be least effective (ref 1). The Bledsoe boot is a factor of 30 times more expensive (US$50 usual,assuming no re-use), and its clinical effectiveness is yet to be proven. The below knee plaster cast will be Scotch Cast (cost £5). There are a range of Ankle Supports available. We have selected the Kendall Gel Brace (£19 per brace), which is the cheapest and. in our experience is as clinically effective as other brands. All treatments will be provided in the NHS, in a manner consistent with current national practice.
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treatment of severe Ankle sprain a pragmatic randomised controlled trial comparing the clinical effectiveness and cost effectiveness of three types of mechanical Ankle Support with tubular bandage the cast trial
Health Technology Assessment, 2009Co-Authors: Matthew Cooke, Jennifer Marsh, Jane L Hutton, Rachel A Nakash, R M Jarvis, Michael Clark, Susan R. Wilson, Ala Szczepura, Sarah E LambAbstract:OBJECTIVE To estimate the clinical effectiveness and cost-effectiveness of three methods of Ankle Support compared with double layer tubular compression bandage. DESIGN A randomised controlled trial, designed to reflect practice in UK hospital emergency departments. SETTING Eight emergency departments in England. PARTICIPANTS Aged 16 or over with acute severe Ankle sprain, unable to weight bear, no fracture. INTERVENTIONS 584 participants were randomised to one of four treatment arms: tubular bandage, below knee cast, Aircast Ankle brace or Bledsoe boot, all applied 2-3 days after presentation to allow swelling to resolve. MAIN OUTCOME MEASURES Response to treatment was assessed using the Foot and Ankle Outcome Score and generic measures (Functional Limitations Profile, SF-12 and EQ-5D). RESULTS When adjusted for age, sex and baseline scores, the below knee cast offered a small but statistically significant benefit at 4 weeks in terms of pain (FAOS pain difference 5.1; 95% CI 0.4-9.8), foot- and Ankle-related quality of life (QoL) (FAOS QoL difference 5.9; 95% CI 0.1-11.8) and the physical component of the SF-12 (SF-12 score difference 2.2; 95% CI 0.0-4.4). Neither the Aircast brace nor the Bledsoe boot was statistically or clinically better. At 12 weeks the below knee cast was significantly better than tubular bandage in terms of pain (FAOS pain difference 5.1; 95% CI 0.3-10.0), activities of daily living (FAOS ADL difference 3.5; 95% CI 0.4-6.6), sports (FAOS sports difference 8.7; 95% CI 1.6-15.7) and QoL (FAOS QoL difference 8.7; 95% CI 2.4-15.0), and the Aircast brace was better only in terms of Ankle-related QoL and mental health. The Bledsoe boot conferred no significant advantage over tubular bandage. By 9 months there were no significant differences. Based on mean direct health-care costs per participant, the Bledsoe boot was the most expensive (215 pounds) and tubular bandage the least so (1 pound 44 pence). Inclusion of indirect costs (sick leave) raised overall costs substantially and removed any significant differences between the therapies. Cost-utility analysis demonstrated that the Aircast brace [301 pounds per quality-adjusted life-year (QALY)] and below knee cast (339 pounds per QALY) were more cost-effective than the Bledsoe boot (2116 pounds per QALY). However, inclusion of indirect costs produced different rank orders, depending on the assumptions made, and results should be treated with caution. CONCLUSIONS The below knee cast and the Aircast brace offered cost-effective alternatives to tubular bandage for acute severe Ankle sprain, the former having the advantage in terms of overall recovery at 3 months. As there were no differences in long-term outcome, practitioners should consider likely compliance and acceptability to patients when choosing a brace.
Christopher D Ingersoll - One of the best experts on this subject based on the ideXlab platform.
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effects of Ankle Support on lower extremity functional performance a meta analysis
Medicine and Science in Sports and Exercise, 2005Co-Authors: Mitchell L Cordova, Christopher D Ingersoll, Brady D Scott, Michael J LeblancAbstract:UNLABELLED Clinicians surmise that the application of external Ankle Support reduces the ability to perform functional skills and movements, but the outcomes from some of these studies have been inconclusive. PURPOSE To meta-analyze studies regarding the effects of external Ankle Support on lower-extremity functional performance measures. METHODS A total of 93 effects from 17 randomized controlled trials utilizing predominantly crossover designs with recreationally active participants and competitive athletes were subjected to a random-effects meta-analysis. The treatment variable was external Ankle Support with three levels: adhesive tape, lace-up style, and semirigid style. Differences between mean changes in treatment and control groups were computed as standardized effect sizes for sprint, agility, and vertical jump performance with their 90% confidence intervals (CI). Effect sizes >0.20 were considered substantial. RESULTS The greatest effect of Ankle Support on performance was a negative effect of lace-up style brace on sprint speed (effect size -0.22, 90% CI -0.47 to 0.03), equivalent to approximately 1% impairment of speed. The other effects of external Ankle Support on performance were insubstantial, though most were negative, and their lower confidence limits allowed for realistic chances of impaired performance. Substantial true variation between studies, although poorly defined, was also present for some effects, further increasing the likelihood of performance impairment in some settings. CONCLUSIONS More research is needed to reduce the uncertainty in the effects of external Ankle Support on performance. In the meantime, it is our opinion that the benefit in preventing injury outweighs the possibility of substantial but small impairment of performance when athletes use external Ankle Support.
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peroneus longus stretch reflex amplitude increases after Ankle brace application
British Journal of Sports Medicine, 2003Co-Authors: Mitchell L Cordova, Christopher D IngersollAbstract:Background: The use of external Ankle Support is widespread throughout sports medicine. However, the application of Ankle bracing to a healthy Ankle over a long period has been scrutinised because of possible neuromuscular adaptations resulting in diminished dynamic Support offered by the peroneus longus. Objective: To investigate the immediate and chronic effects of Ankle brace application on the amplitude of peroneus longus stretch reflex. Methods: Twenty physically active college students (mean (SD) age 23.6 (1.7) years, height 168.7 (8.4) cm, and mass 69.9 (12.0) kg) who had been free from lower extremity pathology for the 12 months preceding the study served as subjects. None had been involved in a strength training or conditioning programme in the six months preceding the study. A 3 x 3 x 2 (test condition x treatment condition x time) design with repeated measures on the first and third factor was used. The peroneus longus stretch reflex (% of maximum amplitude) during sudden foot inversion was evaluated under three Ankle brace conditions (control, lace up, and semi-rigid) before and after eight weeks of Ankle brace use. Results: A 3 x 3 x 2 repeated measures analysis of variance showed that peroneus longus stretch reflex amplitude increased immediately after application of a lace up brace (67.1 (4.4)) compared with the semi-rigid (57.9 (4.3)) and control (59.0 (5.2)) conditions (p<0.05). Peroneus longus stretch reflex also increased after eight weeks of use of the semi-rigid brace compared with the lace up and control conditions (p<0.05). Conclusions: Initial application of a lace up style Ankle brace and chronic use of a semi-rigid brace facilitates the amplitude of the peroneus longus stretch reflex. It appears that initial and long term Ankle brace use does not diminish the magnitude of this stretch reflex in the healthy Ankle.
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efficacy of prophylactic Ankle Support an experimental perspective
Journal of Athletic Training, 2002Co-Authors: Mitchell L Cordova, Christopher D Ingersoll, Riann M PalmieriAbstract:OBJECTIVE: To provide a comprehensive review of the literature regarding the role of external Ankle Support on joint kinematics, joint kinetics, sensorimotor function, and functional performance. DATA SOURCES: We searched MEDLINE and SPORT Discus databases from 1960-2001 for the key words Ankle bracing, Ankle Support, Ankle taping, and Ankle prophylaxes. We also used personal libraries based on our own research to complement the existing literature. DATA SYNTHESIS: The effects of external Ankle Support have been studied on a plethora of dependent measures. Here, we specifically discuss the role of external Ankle Support on joint kinematics, joint kinetics, sensorimotor function, and functional performance and present a general consensus regarding the overall effects of these prophylactic devices. CONCLUSIONS/RECOMMENDATIONS: The effects of Ankle Support on joint kinematics during static joint assessment and on traditional functional-performance measures (ie, agility, sprint speed, vertical jump height) are well understood. However, the potential effects of Ankle Support on joint kinetics, joint kinematics during dynamic activity (eg, a cutting maneuver), and various sensorimotor measures are not well known. Future research investigating the role of external Ankle bracing needs to focus on these areas.
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long term Ankle brace use does not affect peroneus longus muscle latency during sudden inversion in normal subjects
Journal of Athletic Training, 2000Co-Authors: Mitchell L Cordova, Christopher D Ingersoll, C V Cardona, Michelle A SandreyAbstract:Objective External Ankle Supports are widely used in sports medicine. However, Ankle bracing in a healthy Ankle over a sustained period has been scrutinized due to possible neuromuscular adaptations resulting in diminished dynamic Support offered by the peroneus longus muscle. Although this claim is anecdotal in nature, we sought to investigate the effects of long-term Ankle bracing using 2 commonly available appliances on peroneus longus latency in normal subjects. Our second purpose was to evaluate the effects of Ankle bracing on peroneus longus latency before a period of extended use. Design and setting A 3 x 3 x 2 design with repeated measures on the first and third factors was used in this study. All data were collected in the Sports Injury Research Laboratory. Subjects Twenty (12 men and 8 women) physically active college students (age = 23.6 +/- 1.7 years; height = 168.7 +/- 8.4 cm; weight = 69.9 +/- 12.0 kg) free of Ankle or lower extremity injury in the 12 months before the study and not involved in a strength-training or conditioning program in the 6 months before the study. Measurements We evaluated peroneus longus latency by studying the electromyogram of the muscle after sudden foot inversion. Results Application of a lace-up or semirigid brace did not affect peroneus longus latency. Additionally, 8 weeks of longterm Ankle appliance use had no effect on peroneus longus latency. Conclusions The duration of the peroneus longus stretch reflex (latency) is neither facilitated nor inhibited with extended use of an external Ankle Support. Proprioceptive input provided by the muscle spindles within the peroneus longus does not appear to be compromised with the long-term use of Ankle braces.
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influence of Ankle Support on joint range of motion before and after exercise a meta analysis
Journal of Orthopaedic & Sports Physical Therapy, 2000Co-Authors: Mitchell L Cordova, Christopher D Ingersoll, Michael J LeblancAbstract:Study Design Meta-analysis. Objective To evaluate the effects of different types of Ankle Support on Ankle and foot joint range of motion before and after activity using meta-analysis procedures. Background The effects of Ankle Support on joint range of motion before and after exercise has been extensively studied, but the results among studies are not consistent. Obtaining knowledge from synthesizing the available literature with a meta-analysis can provide a greater understanding of these effects. Methods and Measures A total of 253 cases from 19 studies were examined and included in this analysis. The treatment variables were Ankle Support with 3 levels (tape, lace-up, and semirigid) and time with 2 levels (before exercise and after exercise). Standardized effect sizes were computed for inversion, eversion, dorsiflexion, and plantar flexion range of motion to measure the difference between control and treatment groups at each point in time. Effect sizes were analyzed using a mixed-model factorial analy...
Ala Szczepura - One of the best experts on this subject based on the ideXlab platform.
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treatment of severe Ankle sprain a pragmatic randomised controlled trial comparing the clinical effectiveness and cost effectiveness of three types of mechanical Ankle Support with tubular bandage the cast trial
Health Technology Assessment, 2009Co-Authors: Matthew Cooke, Jennifer Marsh, Jane L Hutton, Rachel A Nakash, R M Jarvis, Michael Clark, Susan R. Wilson, Ala Szczepura, Sarah E LambAbstract:To estimate (1) The clinical effectiveness of three different methods of Ankle Support (below knee plaster cast, Kendall Ankle Support, Bledsoe boot) in comparison to Tubigrip in the recovery of mobility and function after Grade II and III sprains of the Ankle joint. (2) The cost-effectiveness of the three different methods of Ankle Support in comparison to Tubigrip only. The economic analysis will be conducted from a societal perspective. Tubigrip has been chosen as the reference (status quo) treatment; it is the cheapest, but is likely to be least effective (ref 1). The Bledsoe boot is a factor of 30 times more expensive (US$50 usual,assuming no re-use), and its clinical effectiveness is yet to be proven. The below knee plaster cast will be Scotch Cast (cost £5). There are a range of Ankle Supports available. We have selected the Kendall Gel Brace (£19 per brace), which is the cheapest and. in our experience is as clinically effective as other brands. All treatments will be provided in the NHS, in a manner consistent with current national practice.
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treatment of severe Ankle sprain a pragmatic randomised controlled trial comparing the clinical effectiveness and cost effectiveness of three types of mechanical Ankle Support with tubular bandage the cast trial
Health Technology Assessment, 2009Co-Authors: Matthew Cooke, Jennifer Marsh, Jane L Hutton, Rachel A Nakash, R M Jarvis, Michael Clark, Susan R. Wilson, Ala Szczepura, Sarah E LambAbstract:OBJECTIVE To estimate the clinical effectiveness and cost-effectiveness of three methods of Ankle Support compared with double layer tubular compression bandage. DESIGN A randomised controlled trial, designed to reflect practice in UK hospital emergency departments. SETTING Eight emergency departments in England. PARTICIPANTS Aged 16 or over with acute severe Ankle sprain, unable to weight bear, no fracture. INTERVENTIONS 584 participants were randomised to one of four treatment arms: tubular bandage, below knee cast, Aircast Ankle brace or Bledsoe boot, all applied 2-3 days after presentation to allow swelling to resolve. MAIN OUTCOME MEASURES Response to treatment was assessed using the Foot and Ankle Outcome Score and generic measures (Functional Limitations Profile, SF-12 and EQ-5D). RESULTS When adjusted for age, sex and baseline scores, the below knee cast offered a small but statistically significant benefit at 4 weeks in terms of pain (FAOS pain difference 5.1; 95% CI 0.4-9.8), foot- and Ankle-related quality of life (QoL) (FAOS QoL difference 5.9; 95% CI 0.1-11.8) and the physical component of the SF-12 (SF-12 score difference 2.2; 95% CI 0.0-4.4). Neither the Aircast brace nor the Bledsoe boot was statistically or clinically better. At 12 weeks the below knee cast was significantly better than tubular bandage in terms of pain (FAOS pain difference 5.1; 95% CI 0.3-10.0), activities of daily living (FAOS ADL difference 3.5; 95% CI 0.4-6.6), sports (FAOS sports difference 8.7; 95% CI 1.6-15.7) and QoL (FAOS QoL difference 8.7; 95% CI 2.4-15.0), and the Aircast brace was better only in terms of Ankle-related QoL and mental health. The Bledsoe boot conferred no significant advantage over tubular bandage. By 9 months there were no significant differences. Based on mean direct health-care costs per participant, the Bledsoe boot was the most expensive (215 pounds) and tubular bandage the least so (1 pound 44 pence). Inclusion of indirect costs (sick leave) raised overall costs substantially and removed any significant differences between the therapies. Cost-utility analysis demonstrated that the Aircast brace [301 pounds per quality-adjusted life-year (QALY)] and below knee cast (339 pounds per QALY) were more cost-effective than the Bledsoe boot (2116 pounds per QALY). However, inclusion of indirect costs produced different rank orders, depending on the assumptions made, and results should be treated with caution. CONCLUSIONS The below knee cast and the Aircast brace offered cost-effective alternatives to tubular bandage for acute severe Ankle sprain, the former having the advantage in terms of overall recovery at 3 months. As there were no differences in long-term outcome, practitioners should consider likely compliance and acceptability to patients when choosing a brace.