Comparison of conventional treatment and supervised rehabilitation for treatment of acute lateral ankle sprains: a systematic review of the literature.
METHODS
Systematic literature review.


OBJECTIVE
To compare the effectiveness of conventional treatment complemented by supervised rehabilitation training (supervised exercises) with conventional treatment alone for the rehabilitation of acute lateral ankle sprains.


BACKGROUND
Conventional treatment is advocated as a preferable treatment strategy. Whether supervised exercises should complement conventional treatment is unclear.


METHODS
We searched 5 computerized databases from 1966 to March 2004, checked the reference lists of all studies that fulfilled our eligibility criteria, and searched for nonindexed journals available on the Internet. Three reviewers independently selected randomized controlled trials (RCTs), and controlled clinical trials (CCTs), comparing conventional treatment alone with conventional treatment combined with supervised exercises for treating patients with an acute lateral ankle sprain. Two reviewers independently assessed the methodological quality of each included study. Two reviewers extracted data regarding outcomes, interventions, and results. Follow-up measurements were grouped as (a) immediate term, (b) short term, (c) intermediate term, and (d) long term. A best-evidence synthesis was conducted, weighting the studies with respect to their internal validity and statistical significance of the outcomes.


RESULTS
Seven RCTs were included. The quality assessment resulted in 1 high-quality and 6 low-quality studies. There is limited evidence that the addition of supervised exercises to a conventional treatment approach results in greater reduction in swelling and faster return to work. Studies reporting a lack of difference between treatment approach did not report statistical power, making interpretation of those results difficult.


CONCLUSIONS
The retrieved data failed to demonstrate a clearly superior treatment approach, although preliminary support exists for supervised exercises. Additional high-quality RCTs are needed that are appropriately designed and reported.
van Os
Anton G
AG
Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands. a.vanos@erasmusmc.nl
Bierma-Zeinstra
Sita M A
SM
Verhagen
Arrianne P
AP
de Bie
Rob A
RA
Luijsterburg
Pim A J
PA
Koes
Bart W
BW
D016512:Ankle Injuries / Q000534:rehabilitation*; D005081:Exercise Therapy; D006801:Humans; D026741:Physical Therapy Modalities; D011369:Professional-Patient Relations; D011787:Quality of Health Care; D013180:Sprains and Strains / Q000534:rehabilitation*; D016896:Treatment Outcome