title: The "Strengthen your ankle" program to prevent recurrent injuries: A randomized controlled trial aimed at long-term effectiveness.
abstract: OBJECTIVE
  Recurrent ankle sprains can be reduced by a neuromuscular training program (NMT). The way NMT is delivered may influence the incidence of long term recurrent injuries, residual pain and disability.
  
  
  METHODS
  This RCT with a follow-up of twelve months, evaluated whether the implementation method of a proven effective NMT program delivered by a mobile application or a written instruction booklet, resulted in differences in injury incidence rates, functional ankle disability/pain in the long term, assuming equal compliance - as is shown in previous research - with the 8-week intervention.
  
  
  METHODS
  220 athletes with a history of ankle sprain were recruited for this RCT. 110 athletes were offered the freely available "Strengthen your ankle App" and the other 110 received a printed Booklet. Primary outcome measure was incidence density of ankle sprains. Secondary outcome measures were residual pain/disability and the individual cumulative number of ankle sprains during follow-up.
  
  
  RESULTS
  The incidence densities of self-reported ankle sprain recurrences were not significantly different between both groups (HR 1.06; 95% CI 0.76-1.49). Median FADI (Functional Ankle and Disability Index) scores increased equally over time in both groups, indicating a lower rate of limitation and pain in both groups at follow-up. Neither FADI scores nor cumulative recurrent injuries were significantly different between groups.
  
  
  CONCLUSIONS
  This study showed that the implementation method of a NMT program by using an App or a Booklet did neither lead to different injury incidence rates in the long term nor did it influence residual functional disability/pain. Assuming equal compliance during the 8-week intervention, both methods show similar effectiveness in twelve-month follow-up.
authors.affiliation: Amsterdam Collaboration on Health and Safety in Sports, IOC Research Center, VUmc/AMC, The Netherlands; Department of Public & Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Van Reijen
authors.affiliation: Amsterdam Collaboration on Health and Safety in Sports, IOC Research Center, VUmc/AMC, The Netherlands; Department of Public & Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, The Netherlands; Consumer Safety Institute VeiligheidNL, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Vriend
authors.affiliation: Consumer Safety Institute VeiligheidNL, The Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: Zuidema
authors.affiliation: Amsterdam Collaboration on Health and Safety in Sports, IOC Research Center, VUmc/AMC, The Netherlands; Department of Public & Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, The Netherlands; School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Ireland; School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Australia; UCT/MRC Research Unit for Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa.
authors.forename: W
authors.initials: W
authors.lastname: van Mechelen
authors.affiliation: Amsterdam Collaboration on Health and Safety in Sports, IOC Research Center, VUmc/AMC, The Netherlands; Department of Public & Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, The Netherlands; UCT/MRC Research Unit for Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa; Australian Centre for Research into Injury in Sport and its Prevention, Federation University Australia, Australia. Electronic address: e.verhagen@vumc.nl.
authors.forename: E A
authors.initials: EA
authors.lastname: Verhagen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D012008:Recurrence; D055502:Secondary Prevention / Q000379:methods*; D057566:Self Report; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Ankle injury; E-health; Injury prevention