English

Title:
The effectiveness and cost-effectiveness of a proprioceptive balance board training programme for the prevention of recurrent acute lateral ankle sprains; a multicenter emergency room clinical trial 

Summary:
There is strong evidence that athletes have a twofold risk for re-injury after a previous ankle sprain, especially during the first year post-injury. These ankle sprain recurrences can result in disability and can lead to chronic pain or instability in 20 to 50% of these cases. When looking at the high rate of ankle sprain recurrences prolonged rehabilitation is needed in all athletes with ankle sprains in order to prevent ankle sprain recurrences. This prolonged rehabilitation does not need to be supervised by a sports physician or (sports) physical therapist and might also suffice if the injured athletes are encouraged to follow a preventive programme for a certain period of time after their ‘usual care’. Such an unsupervised preventive programme would keep the medical costs associated with a prolonged rehabilitation to a minimum, would have no additional demand on medical practitioners, and would have large potential positive effects in terms of health and direct medical costs due to ankle sprain recurrences.
The proposed study evaluates the effect of a proprioceptive balance board training programme on ankle sprain recurrences that is applied to individual athletes after rehabilitation and treatment by usual care. Injured athletes will be recruited through emergency rooms, and will be randomised to an intervention group and a control group. The primary outcome measure will be incidence of ankle sprain recurrences. Secondary outcome measures will include recurrence severity, pain, feeling of instability, direct and indirect injury costs, and intermediary factors such as knowledge and attitude regarding the prevention of ankle sprain recurrences.
The three main research questions that will be addressed in the proposed study are:
1. what is the effectiveness of an unsupervised proprioceptive balance board training programme given in addition to ‘usual care’ on the incidence of ankle sprain recurrences?
2. what is the cost-effectiveness of an unsupervised proprioceptive balance board training programme given in addition to ‘usual care’ and aimed at the prevention of ankle sprain recurrences?
3. what is the compliance with an unsupervised proprioceptive balance board training programme given in addition to ‘usual care’ and aimed at the prevention of ankle sprain recurrences?
Next to these questions, the link between balance training and the prevention of ankle sprain recurrences will be established from a mechanical and functional point of view. 

Additonal information?
Maarten Hupperets
EMGO Institute
Amsterdam, The Netherlands
m.hupperets(at)vumc.nl