title: Effect of early supervised physiotherapy on recovery from acute ankle sprain: randomised controlled trial.
abstract: OBJECTIVE
  To assess the efficacy of a programme of supervised physiotherapy on the recovery of simple grade 1 and 2 ankle sprains.
  
  
  METHODS
  A randomised controlled trial of 503 participants followed for six months.
  
  
  METHODS
  Participants were recruited from two tertiary acute care settings in Kingston, ON, Canada.
  
  
  METHODS
  The broad inclusion criteria were patients aged ≥16 presenting for acute medical assessment and treatment of a simple grade 1 or 2 ankle sprain. Exclusions were patients with multiple injuries, other conditions limiting mobility, and ankle injuries that required immobilisation and those unable to accommodate the time intensive study protocol.
  
  
  METHODS
  Participants received either usual care, consisting of written instructions regarding protection, rest, cryotherapy, compression, elevation, and graduated weight bearing activities, or usual care enhanced with a supervised programme of physiotherapy.
  
  
  METHODS
  The primary outcome of efficacy was the proportion of participants reporting excellent recovery assessed with the foot and ankle outcome score (FAOS). Excellent recovery was defined as a score ≥450/500 at three months. A difference of at least 15% increase in the absolute proportion of participants with excellent recovery was deemed clinically important. Secondary analyses included the assessment of excellent recovery at one and six months; change from baseline using continuous scores at one, three, and six months; and clinical and biomechanical measures of ankle function, assessed at one, three, and six months.
  
  
  RESULTS
  The absolute proportion of patients achieving excellent recovery at three months was not significantly different between the physiotherapy (98/229, 43%) and usual care (79/214, 37%) arms (absolute difference 6%, 95% confidence interval -3% to 15%). The observed trend towards benefit with physiotherapy did not increase in the per protocol analysis and was in the opposite direction by six months. These trends remained similar and were never statistically or clinically important when the FAOS was analysed as a continuous change score.
  
  
  CONCLUSIONS
  In a general population of patients seeking hospital based acute care for simple ankle sprains, there is no evidence to support a clinically important improvement in outcome with the addition of supervised physiotherapy to usual care, as provided in this protocol.Trial registration ISRCTN 74033088 (www.isrctn.com/ISRCTN74033088).
authors.affiliation: Queen's University Department of Emergency Medicine, Kingston, ON, Canada.|Kingston General Hospital Research Institute, Kingston, ON, Canada.|Queen's University Department of Public Health Sciences, Kingston, ON, Canada.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Brison
authors.affiliation: Kingston General Hospital Research Institute, Kingston, ON, Canada.|Queen's University Department of Public Health Sciences, Kingston, ON, Canada.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Day
authors.affiliation: Queen's University School of Rehabilitation Therapy, Kingston, ON, Canada.|The Human Mobility Research Centre, Kingston General Hospital and Queen's University, Kingston, ON, Canada.
authors.forename: Lucie
authors.initials: L
authors.lastname: Pelland
authors.affiliation: Queen's University Department of Emergency Medicine, Kingston, ON, Canada.|Queen's University Department of Public Health Sciences, Kingston, ON, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Pickett
authors.affiliation: Queen's University Department of Public Health Sciences, Kingston, ON, Canada.
authors.forename: Ana P
authors.initials: AP
authors.lastname: Johnson
authors.affiliation: Queen's University School of Rehabilitation Therapy, Kingston, ON, Canada.
authors.forename: Alice
authors.initials: A
authors.lastname: Aiken
authors.affiliation: The Human Mobility Research Centre, Kingston General Hospital and Queen's University, Kingston, ON, Canada.|Queen's University Division of Orthopaedics, Kingston, ON, Canada.
authors.forename: David R
authors.initials: DR
authors.lastname: Pichora
authors.affiliation: Queen's University School of Rehabilitation Therapy, Kingston, ON, Canada.|The Human Mobility Research Centre, Kingston General Hospital and Queen's University, Kingston, ON, Canada.
authors.forename: Brenda
authors.initials: B
authors.lastname: Brouwer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011788:Quality of Life; D020127:Recovery of Function; D013180:Sprains and Strains / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome