title: Increasing compliance with neuromuscular training to prevent ankle sprain in sport: does the 'Strengthen your ankle' mobile App make a difference? A randomised controlled trial.
abstract: BACKGROUND
  E-health has the potential to facilitate implementation of effective measures to prevent sports injuries.
  
  
  OBJECTIVE
  We evaluated whether an interactive mobile application containing a proven effective exercise programme to prevent recurrent ankle sprains resulted in higher compliance as compared with regular written exercise materials.
  
  
  METHODS
  220 athletes participated in this randomised controlled trial with a follow-up of 8 weeks; 110 athletes received a booklet explaining an 8-week neuromuscular training programme; 110 athletes participated in the same programme in an interactive mobile App (Strengthen your ankle). The primary outcome was compliance with the exercise programme. Secondary outcome measure was the incidence density of self-reported recurrent ankle sprains.
  
  
  RESULTS
  The mean compliance to the exercise scheme was 73.3% (95% CI 67.7% to 78.1%) in the App group, compared with 76.7% (95% CI 71.9% to 82.3%) in the Booklet group. No significant difference in compliance was found between groups. The incidence densities of self-reported time-loss recurrences were not significantly different between both groups (HR 3.07; 95% CI 0.62 to 15.20).
  
  
  CONCLUSIONS
  This study shows that the method of implementing the exercises by using an App or a Booklet does not lead to different compliance rates.
  
  
  RESULTS
  The use of a mobile App or a Booklet lead to similar compliance and injury rates in the short term.
  
  
  BACKGROUND
  The Netherlands National Trial Register NTR 4027. The NTR is part of the WHO Primary Registries.
authors.affiliation: Department of Public & Occupational Health, Amsterdam Collaboration on Health & Safety in Sports, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: M
authors.identifier: http://orcid.org/0000-0002-0858-857X
authors.initials: M
authors.lastname: Van Reijen
authors.affiliation: Department of Public & Occupational Health, Amsterdam Collaboration on Health & Safety in Sports, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Consumer Safety Institute VeiligheidNL, Amsterdam, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Vriend
authors.affiliation: Consumer Safety Institute VeiligheidNL, Amsterdam, The Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: Zuidema
authors.affiliation: Department of Public & Occupational Health, Amsterdam Collaboration on Health & Safety in Sports, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Physiotherapy and Population Sciences, School of Public Health, University College Dublin, Dublin, Ireland Faculty of Health and Behavioural Sciences, School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia.
authors.forename: W
authors.initials: W
authors.lastname: van Mechelen
authors.affiliation: Department of Public & Occupational Health, Amsterdam Collaboration on Health & Safety in Sports, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Faculty of Health Sciences, Department of Human Biology, UCT/MRC Research Unit for Exercise Science and Sports Medicine (ESSM), University of Cape Town, South Africa Australian Center for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, Victoria, Australia.
authors.forename: E A
authors.identifier: http://orcid.org/0000-0001-9227-8234
authors.initials: EA
authors.lastname: Verhagen
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000517:prevention & control*; D001265:Athletic Injuries / Q000517:prevention & control*; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D010174:Pamphlets; D010349:Patient Compliance / Q000706:statistics & numerical data*; D013180:Sprains and Strains / Q000517:prevention & control*
keywords: Ankle; Exercise rehabilitation; Injuries; Physical activity; Randomised controlled trial