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Anterior to posterior talocrural joint mobilizations provides no benefit for ankle sprains
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March 2014
Anterior to posterior talocrural joint mobilizations provides no benefit for ankle sprains
Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A
Immediate effects of anterior to posterior talocrural joint mobilizations following acute lateral ankle sprain
J Man Manip Ther. 2011 May;19(2):76-83. doi: 10.1179/2042618610Y.0000000005Did you know you're eligible to earn 0.5 CME credits for reading this report? Click Here
Synopsis
17 patients were randomized to investigate the effects of a single bout of anterior to posterior (AP) talocrural joint mobilization for acute lateral ankle sprains. Patients received either a single 30-second bout of grade III AP talocrural joint mobilization or no intervention and were assessed after the first 24 hours. A single bout of AP talocrural joint mobilizations was revealed to have no immediate effect on ankle dorsiflexion range of motion (ROM), posterior talar translation, or self-reported function; however, an immediate effect on pain perception was observed.
Publication Funding Details
+
Funding:
Not Reported
Conflicts:
None disclosed
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
4/4
Randomization
3/4
Outcome Measurements
3/4
Inclusion / Exclusion
3/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
Following a lateral ankle sprain, it has been reported that individuals may experience decreased dorsiflexion ROM and posterior talar glide. While these individuals may benefit from joint mobilization, there has been no previous study evaluating the use of anterior to posterior (AP) talocrural joint mobilizations in patients with acute lateral ankle sprains. Thus, this study aimed to investigate the immediate effects of a single bout of grade III AP talocrural joint mobilization on ankle dorsiflexion ROM, posterior talar translation, and self-reported pain and function in these patients.
What was the principal research question?
Did a single bout of AP talocrural joint mobilization lead to better ankle dorsiflexion ROM, posterior talar translation, and self-reported pain and function, compared to no intervention, in acute lateral ankle sprains when assessed after the first 24 hours?
Study Characteristics
-
Population:
17 individuals with an acute lateral ankle sprain (grade I/II), who had previously been immobilized in a walking boot. Mean age = 19.76 +/- 1.35 years
Intervention:
Treatment group: Patients received a 30-second bout of grade III anterior to posterior (AP) talocrural joint mobilizations performed at a rate of ~1 mobilization per second (n = 9).
Comparison:
Control group: Patients did not receive any treatment or physical contact from the treating clinician (n = 8).
Outcomes:
The main outcome measures involved ankle dorsiflexion ROM (taken with the patient seated), posterior talar translation (through a portable ankle arthrometer), and self-reported pain and function (through the foot and ankle disability index (FADI) and foot and ankle disability index-sport (FADI-sport)).
Methods:
RCT: Single-blind (assessor)
Time:
24 hours (measurements at baseline, post-treatment and at 24 hours)
What were the important findings?
- In regard to dorsiflexion ROM, there was not a significant group by time interaction (F2,30 = 0.17, P = 0.85, 1-beta = 0.07) or group main effect (F2, 30 = 0.21, P = 0.66, 1-beta = 0.07); however, there was a significant main effect for time (F2,30 = 3.67, P = 0.04, 1-beta = 0.63).
- While there was a significant improvement in dorsiflexion ROM from baseline to 24 hour follow-up (P=0•037), there was no significant difference between the treatment (6.49 (SD 6.43) to 8.82 (SD 7.29)) and control (7.36 (SD 6.38) to 9.94 (SD 4.02)) groups (P > 0.05).
- There was no significant difference (P > 0.05) regarding posterior talar translation measures between the treatment (7.09 (SD 3.54) to 7.06 (SD 2.99)) and control (5.86 (SD 2.81) to 6.95 (SD 3.64)) groups from baseline to the 24 hour follow-up. No significant group by time interaction (F2,30= 0.58, P = 0.57, 1-beta = 0.14), group main effect (F2,30 = 0.45, P = 0.51, 1-beta = 0.10), or time main effect (F2,30 = 0.86, P = 0.43, 1-beta = 0.18) were seen.
- In respect to the FADI-ADL and FADI-sport, there were no significant group by time interactions (F1,15 = 0.43, P = 0.52, 1-beta = 0.09; F1,15 = 0.04, P = 0.84, 1-beta = 0.05, respectively) or group main effects (F1,15 = 1.51, P = 0.24, 1-beta = 0.21; F1,15 = 0.00, P = 0.99, 1-beta = 0.05).
- The treatment group demonstrated a 20% reduction in pain (t8 = -3.74, P = 0.006) at the 24 hour follow-up when compared to the control group (t7 = 0.00, P = 1.0).
What should I remember most?
A single bout of AP talocrural joint mobilization for acute ankle sprains displayed no effect in increasing ankle dorsiflexion ROM, decreasing posterior talar glide, or improving self-reported function. However, individuals receiving joint mobilization demonstrated decreased pain compared to those who did not receive the intervention.
How will this affect the care of my patients?
This study suggests that joint mobilization provides no apparent benefit in ankle dorsiflexion ROM, posterior talar translation, or self-reported function when treating acute lateral ankle sprains. However, there may be a positive benefit in terms of pain perception immediately following treatment. Future research is required to investigate the long-term effects of multiple applications of joint mobilizations.
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