Low Ankle-GO Score While Returning to Sport After Lateral Ankle Sprain Leads to a 9-fold Increased Risk of Recurrence: A Two-year Prospective Cohort Study.

BACKGROUND: Lateral ankle sprain (LAS) is the most common sports injury, leading to a high rate of recurrence and the development of chronic ankle instability. One possible explanation is the lack of objective, evidence-based criteria to inform return to sport decisions following LAS. The aim of this study was therefore to assess the efficacy of a new functional score to distinguish patients at risk of recurrent LAS within two years after the initial injury. METHODS: The Ankle-GO score was used in 64 active patients two months after LAS. This composite score includes 2 self-reported questionnaires and 4 functional tests, for a maximum score of 25 points. The rate of reinjury was prospectively recorded 2 years after inclusion. Potential predictive variables for reinjury were tested using the Chi-square and independent t-tests. The area under the receiver operating characteristics curve (AUC) with the optimal cut-off score was determined to assess the predictive value of the Ankle-GO score for the risk of reinjury. Multivariate logistic regression was then used to determine the influence of risk factors of reinjury. RESULTS: Fifty-four (85%) patients were included (23 men and 31 women, 34.7 ± 13 years old) including 18 (33.3%) with a reinjury. The two-month Ankle-GO score was lower in patients with a recurrent LAS (5.4 ± 2.8 points vs. 9.1 ± 4.5, p = 0.002) and predicted the risk of reinjury (AUC = 0.75). Patients with < 8 points were found to have a significantly higher risk of reinjury (OR = 8.6; 95%CI: 2-37.2, p = 0.001). Women also tend to have a higher risk of recurrence (OR = 3.8; 95%CI: 0.9-15.5, p = 0.065). CONCLUSION: The Ankle-GO score is a new objective criterion for RTS after LAS. Patients with a low score at two months have a 9-fold greater risk of recurrence within two years.

Development and Validation of the Ankle-GO Score for Discriminating and Predicting Return-to-Sport Outcomes After Lateral Ankle Sprain.

BACKGROUND: Lateral ankle sprain (LAS) is the most common sports-related injury. However, there are currently no published evidence-based criteria to guide the patient's return to sport (RTS) and this decision is generally time-based. The aim of this study was to assess the psychometric properties of a new score (Ankle-GO) and its predictive ability for RTS at the same level of play after LAS. HYPOTHESIS: The Ankle-GO is robust for discriminating and predicting RTS outcomes. STUDY DESIGN: Prospective diagnostic study. LEVEL OF EVIDENCE: Level 2. METHODS: The Ankle-GO was administered to 30 healthy participants and 64 patients at 2 and 4 months after LAS. The score was calculated as the sum of 6 tests for a maximum of 25 points. Construct validity, internal consistency, discriminant validity, and test-retest reliability were used to validate the score. The predictive value for the RTS was also validated based on the receiver operating characteristic (ROC) curve. RESULTS: The internal consistency of the score was good (Cronbach's alpha coefficient of 0.79) with no ceiling or floor effect. Test-retest reliability was excellent (intraclass coefficient correlation = 0.99) with a minimum detectable change of 1.2 points. The 2-month scores were significantly lower than 4-month and control group scores (7.7 ± 4, 13.9 ± 4.6, and 19.6 ± 3.4 points, respectively, P < 0.01). Ankle-GO values were also significantly higher in patients who returned to their preinjury level at 4 months compared with those who did not (P < 0.01). The predictive value of the 2-month Ankle-GO score was fair for a RTS at the same or higher than preinjury level at 4 months (area under ROC curve, 0.77; 95% CI, 0.65-0.89; P < 0.01). CONCLUSION: The Ankle-GO appears to be a valid and robust score for clinicians to predict and discriminate RTS in patients after LAS. CLINICAL RELEVANCE: Ankle-GO is the first objective score to help in the decision-making of the RTS after LAS. At 2 months, patients with an Ankle-GO score <8 points are unlikely to RTS at the same preinjury level.

[Validated care programs for patients with functional neurological disorders]. / Modèles de soins validés pour les patients souffrant de troubles neurologiques fonctionnels.

Functional neurological disorder (FND) is a common cause of persistent and disabling neurological symptoms. Diagnostic delay may lead to no treatment, inappropriate treatment or even iatrogenic symptoms. Yet, several treatments significantly reduce physical symptoms and improve functioning in FND patients even though not all patients respond to the currently available treatments. This review aims to describe the range of evidence-based rehabilitative and/or psychological therapeutic approaches available for FND patients. The most effective treatments are multidisciplinary and coordinated; using an outpatient or inpatient setting. Building a network of FND-trained healthcare professionals around the patient is an essential aspect of optimal patient management. Indeed, a supportive environment coupled with a collaborative therapeutic relationship improves understanding of FND and appears to help patients engage in appropriate treatments. Patients need to be invested in their own care and have to understand that recovery may depend on their commitment. The conventional treatment combines psychoeducation, physical rehabilitation and psychotherapy (cognitive and behavioral therapy, hypnosis, psychodynamic interpersonal therapy). Early referral of patients to physical therapy is recommended; however, the optimal parameters of treatment, duration and intensity are unknown and seem to vary with the severity and chronicity of symptoms. The goal is to minimize self-awareness by diverting attention or by stimulating automatically generated movements with non-specific and gradual exercises. The use of compensatory technical aids should be avoided as much as possible. Psychotherapeutic management should encourage self-evaluation of cognitive distortions, emotional reactions and maladaptive behaviors while empowering the patient in managing symptoms. Symptom management can use anchoring strategies to fight against dissociation. The aim is to connect to the immediate environment and to enrich one's sensoriality. The psychological interventions should then be adapted to the individual psychopathology, cognitive style and personality functioning of each patient. There is currently no known curative pharmacological treatment for FND. The pharmacological approach rather consists of progressively discontinuing medication that was introduced by default and that could lead to undesirable side effects. Finally, neurostimulation (transcranial magnetic stimulation, transcranial direct current stimulation) can be effective on motor FND.