title: The implementation effectiveness of the 'Strengthen your ankle' smartphone application for the prevention of ankle sprains: design of a randomized controlled trial.
abstract: BACKGROUND
  Ankle sprains continue to pose a significant burden to the individual athlete, as well as to society as a whole. However, despite ankle sprains being the single most common sports injury and despite an active approach by various Dutch organisations in implementing preventive measures, large-scale community uptake of these preventive measures, and thus actual prevention of ankle sprains, is lagging well behind. In an attempt to bridge this implementation gap, the Dutch Consumer Safety Institute VeiligheidNL developed a freely available interactive App ('Strenghten your ankle' translated in Dutch as: 'Versterk je enkel; available for iOS and Android) that contains - next to general advice on bracing and taping - a proven cost-effective neuromuscular program. The 'Strengthen your ankle' App has not been evaluated against the 'regular' prevention approach in which the neuromuscular program is advocated through written material. The aim of the current project is to evaluate the implementation value of the 'Strengthen your ankle' App as compared to the usual practice of providing injured athletes with written materials. In addition, as a secondary outcome measure, the cost-effectiveness will be assessed against usual practice.
  
  
  METHODS
  The proposed study will be a randomised controlled trial. After stratification for medical caregiver, athletes will be randomised to two study groups. One group will receive a standardized eight-week proprioceptive training program that has proven to be cost-effective to prevent recurrent ankle injuries, consisting of a balance board (machU/ MSG Europe BVBA), and a traditional instructional booklet. The other group will receive the same exercise program and balance board. However, for this group the instructional booklet is exchanged by the interactive 'Strengthen your ankle' App.
  
  
  CONCLUSIONS
  This trial is the first randomized controlled trial to study the implementation effectiveness of an App for proprioceptive balance board training program in comparison to a traditional printed instruction booklet, with the recurrence of ankle sprains among athletes as study outcome. Results of this study could possibly lead to changes in practical guidelines on the treatment of ankle sprains and in the use of mobile applications for injury prevention. Results will become available in 2014.
  
  
  BACKGROUND
  The Netherlands National Trial Register NTR4027. The NTR is part of the WHO Primary Registries.
authors.forename: Miriam
authors.initials: M
authors.lastname: Van Reijen
authors.forename: Ingrid I
authors.initials: II
authors.lastname: Vriend
authors.forename: Victor
authors.initials: V
authors.lastname: Zuidema
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
authors.affiliation: Department of Public & Occupational Health, EMGO + Institute for Health and Care Research and VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. e.verhagen@vumc.nl.
authors.forename: Evert A
authors.initials: EA
authors.lastname: Verhagen
mesh_terms: D016512:Ankle Injuries / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000517:prevention & control*; D000843:Ankle Joint / Q000503:physiopathology*; D001265:Athletic Injuries / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000517:prevention & control*; D001696:Biomechanical Phenomena; D040421:Cell Phone / Q000191:economics; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics / Q000379:methods*; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D063731:Mobile Applications / Q000191:economics; D053580:Muscle Strength; D010174:Pamphlets; D010353:Patient Education as Topic; D004856:Postural Balance; D012107:Research Design; D013180:Sprains and Strains / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome