title: Systematic review of the parachute ankle brace: injury risk reduction and cost effectiveness.
abstract: BACKGROUND
  Military parachuting has been shown to result in injuries. This investigation systematically reviewed studies examining the influence of the parachute ankle brace (PAB) on injuries during military parachuting and performed a cost-effectiveness analysis.
  
  
  METHODS
  Parachute ankle brace studies were obtained from seven databases, personal contacts, and other sources. Investigations were reviewed if they contained original, quantitative information on PAB use and injuries during parachuting. Meta-analysis was performed using a general variance-based meta-analysis method that calculated summary risk ratios (SRR) and 95% CIs.
  
  
  RESULTS
  Five studies met the review criteria. Compared with PAB users, PAB non-users had a higher risk of ankle injuries (SRR=2.1, 95% CI=1.8-2.5); ankle sprains (SRR=2.1, 95% CI=1.4-3.1); ankle fractures (SRR=1.8, 95% CI=1.1-2.9); and all parachuting injuries combined (SRR=1.2, 95% CI=1.1-1.4). The PAB had little effect on lower body injuries exclusive of the ankle (SRR [no PAB/PAB]=0.9, 95% CI=0.7-1.2). Cost-effectiveness analysis estimated that, for every dollar expended on the PAB, a savings of about $7 to $9 could be achieved in medical and personnel costs.
  
  
  CONCLUSIONS
  The PAB reduces ankle injuries by about half and is a cost effective device that should be worn during military airborne operations to reduce injury risk.
authors.affiliation: U.S. Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, Maryland 21010, USA. joseph.knapik@apg.amedd.army.mil
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Knapik
authors.forename: Anita
authors.initials: A
authors.lastname: Spiess
authors.forename: David I
authors.initials: DI
authors.lastname: Swedler
authors.forename: Tyson L
authors.initials: TL
authors.lastname: Grier
authors.forename: Salima S
authors.initials: SS
authors.lastname: Darakjy
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Jones
mesh_terms: D000062:Accidents, Occupational / Q000191:economics / Q000517:prevention & control* / Q000706:statistics & numerical data; D016512:Ankle Injuries / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D001359:Aviation / Q000191:economics / Q000706:statistics & numerical data*; D001915:Braces; D003362:Cost-Benefit Analysis; D006801:Humans; D008889:Military Personnel / Q000706:statistics & numerical data*; D011482:Protective Devices; D014481:United States / Q000453:epidemiology