Advances in Hand Therapy: Best Practice in Conservative Management of Proximal Phalangeal Fractures in Children.

BACKGROUND: Proximal phalangeal fractures are one of the most commonly treated hand injuries in children. Conservative management of these fractures is often to splint for 5 weeks post injury, despite children presenting as clinically healed at 3 weeks post injury. Therefore, we investigated the effect of splinting for only 3 weeks in children who present with clinically healed proximal phalangeal fractures at 3 weeks compared with usual care. METHODS: Participants (n=80, aged 10.3 ±2.5 years) presenting to the Hand Clinic of a tertiary Children's Hospital in Sydney, Australia, were randomly allocated into a Current Protocol and a New Protocol group. Following were the inclusion criteria: aged between 5 and 16 years; present with an non-displaced or minimally displaced and stable fracture; no surgical intervention; assessed as clinically healed at 3-week visit. The primary outcome measure was total active motion (TAM) of the injured digit compared with the contralateral digit (deg), at 5 weeks post injury. Secondary outcome measures were grip strength, and a parent-reported questionnaire. Statistical analysis used χ 2 test and the absolute difference described by a 90% CI. The New Protocol was considered noninferior if the 90% CI overlap was > 20% of the Current Protocol. Analysis was by intention to treat. RESULTS: There was a 10% loss to follow up at 5 weeks (Current Protocol =4, New Protocol =4). All CIs between groups overlapped by >10%. TAM 90% CI for Current Protocol was 17.7 to 5.4 degrees and for the New Protocol was 4.7 to 1.6 degrees. CONCLUSIONS: A change in practice is warranted to cease immobilization for children with conservatively managed proximal phalangeal fractures who present as clinically healed at 3 weeks. Therapist assessment of fracture healing is an appropriate indicator for intervention and can be utilized in a therapist-led model of care. LEVEL OF EVIDENCE: Level 1-noninferiority randomized control trial with 2 parallel arms.

Dance for Chronic Pain Conditions: A Systematic Review.

OBJECTIVES: Globally, 20-25% of people will experience chronic pain in their lifetimes. Dance is a physical activity with psychosocial benefits that might positively impact pain. This review aimed to investigate the effect of dance interventions on the experience of pain by quantitative measures and qualitative themes. METHODS: Seven major databases were searched from inception to January 2021. Two independent reviewers screened articles at each stage. Qualitative and quantitative studies were included if the dance interventions lasted more than 6 weeks, participants reported pain of duration longer than 3 months, and pain was an outcome of the study. All articles were critically appraised with appropriate Joanna Briggs Institute tools, and data were collated through the use of results-based convergent synthesis. RESULTS: From 23,628 articles, 34 full papers were included, with a total of 1,254 participants (75.2% female). Studies predominantly investigated individuals with fibromyalgia (26%) and generalized chronic pain (14%), with aerobic dance (20.7%) and Biodanza (20.7%) being the most common dance genres investigated. Overall, 74% of studies noted either reduced pain through quantitative pain measures or qualitative themes of improved pain experience (88% for chronic primary pain and 80% for chronic secondary musculoskeletal pain). DISCUSSION: There were positive effects of dance on chronic primary and secondary musculoskeletal pain across diverse populations. A variety of study designs and interventions noted improved pain measures and themes around pain coping and acceptance, with all dance therapies showing improvements, particularly when performed for 60-150 minutes' duration weekly. Dance should be considered as an effective adjunct in the management of chronic pain.

Promoting behavior-related low back health in nurses by in-person and social media interventions in the workplace.

BACKGROUND: Nurses are put at high risk of work-related low back pain due to the nature of their work. The aim of this study was to develop and evaluate intervention based on the PRECEDE-PROCEED Model on promoting behaviors of low back health via two educational approaches. METHODS: This study was a community randomized-controlled clinical trial. The educational content was developed with six modules: knowledge, attitude, self-efficacy, reinforcing factors, enabling factors, and behavior. Intervention was delivered by two modes: (1) in-person (n = 60) and (2) social media (n = 60). Data were evaluated by a self-designed questionnaire at baseline, 3, and 6 months. Baseline comparisons between groups were made with Mann-Whitney U Test and T-Test. Comparison of change scores between groups and two delivery types across the three time periods used the mixed between-within subject analysis of variance. RESULTS: A total of 120 nurses received the allocated intervention. All educational component scores increased at 3-months in both groups. At the 6-month follow-up scores increased for enabling factors and behavior in the intervention group, while in the control group all scores increased except for attitude. Based on Bonferroni Post hoc analysis social media was more effective in knowledge, self-efficacy, reinforcing factors, and behavior than the in-person intervention. CONCLUSION: An educational program for low back health based on the PRECEDE-PROCEED model proved effective at improving all components. However, social media was more successful than in-person in the maintenance of behavior over the long term. TRIAL REGISTRATION: IRCT20170313033054N2: 25-02-2018. https://www.irct.ir/trial/25598.

Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework-an international multidisciplinary consensus.

BACKGROUND: Despite being the most commonly incurred sports injury with a high recurrence rate, there are no guidelines to inform return to sport (RTS) decisions following acute lateral ankle sprain injuries. We aimed to develop a list of assessment items to address this gap. METHODS: We used a three-round Delphi survey approach to develop consensus of opinion among 155 globally diverse health professionals working in elite field or court sports. This involved surveys that were structured in question format with both closed-response and open-response options. We asked panellists to indicate their agreement about whether or not assessment items should support the RTS decision after an acute lateral ankle sprain injury. The second and third round surveys included quantitative and qualitative feedback from the previous round. We defined a priori consensus being reached at >70% agree or disagree responses. RESULTS: Sixteen assessment items reached consensus to be included in the RTS decision after an acute lateral ankle sprain injury. They were mapped to five domains with 98% panellist agreement-PAASS: Pain (during sport participation and over the last 24 hours), Ankle impairments (range of motion; muscle strength, endurance and power), Athlete perception (perceived ankle confidence/reassurance and stability; psychological readiness), Sensorimotor control (proprioception; dynamic postural control/balance), Sport/functional performance (hopping, jumping and agility; sport-specific drills; ability to complete a full training session). CONCLUSION: Expert opinion indicated that pain severity, ankle impairments, sensorimotor control, athlete perception/readiness and sport/functional performance should be assessed to inform the RTS decision following an acute lateral ankle sprain injury. TRIAL REGISTRATION NUMBER: ACTRN12619000522112.

Cross-cultural adaptation of the Cumberland Ankle Instability Tool - Youth Thai version.

BACKGROUND: This study aimed to translate the original version of the Cumberland Ankle Instability Tool (CAITY) into a Thai version by using cross-cultural adaptation, and to examine the psychometric properties and cut-off score of the CAITY - Thai version (CAITY-T). METHODS: Six cross-cultural adaptation steps were used to translate and validate the psychometric properties with 267 participants, 140 with chronic ankle instability (CAI) and 127 without CAI. Their mean age was 12.3 ± 2.42 years. Validation was carried out for internal consistency and concurrent validity against a visual analog scale for global perceived ankle instability, and for discriminant validity (receiver operating characteristic curve). The CAITY-T was completed twice by 133 volunteer children (49.62%) for test-retest reliability. The cut-off score was determined using Youden's index. RESULTS: The CAITY was successfully adapted for the Thai language. Validation showed good internal consistency (Cronbach's α = 0.767) and concurrent validity (Pearson correlation coefficient = 0.8 right ankle and 0.784 left ankle). The test-retest reliability was substantial with an intraclass correlation coefficient (2,1) of 0.865 (95% Confidence Interval = 0.809-0.904). The receiver operating characteristic curve and Youden's index showed the cut-off score that discriminated between children with and without CAI on the CAITY-T at ≤25. The CAITY-T obtained 95.2% sensitivity, 97% specificity, 0.05 negative, and 32 positive likelihood ratios. CONCLUSION: The CAITY-T was valid and available for Thai children aged 8-16 years. It displayed positive reliability, good validity, and an acceptable cut-off score. The cut-off score for children had high sensitivity, specificity, and positive and negative likelihood ratios.

Comparison of lower limb stiffness between male and female dancers and athletes during drop jump landings.

Repetition of jumps in dance and sport training poses a potential injury risk; however, non-contact landing injuries are more common in athletes than dancers. This study aimed to compare the lower limb stiffness characteristics of dancers and athletes during drop landings to investigate possible mechanisms of impact-related injuries. Kinematics and kinetics were recorded as 39 elite modern and ballet dancers (19 men and 20 women) and 40 college-level team sport athletes (20 men and 20 women) performed single-legged drop landings from a 30-cm platform. Vertical leg stiffness and joint stiffness of the hip, knee, and ankle were calculated using a spring-mass model. Stiffness data, joint kinematics, and moments were compared with a group-by-sex 2-way analysis of variance. Multiple linear regression was used to assess the relative contribution of hip and knee and ankle joint stiffness to variance in overall vertical leg stiffness for dancers and athletes. Dancers had lower leg (P < 0.001), knee joint (P = 0.034), and ankle joint stiffness (P = 0.043) than athletes. This was facilitated by lower knee joint moments (P = 0.012) and greater knee (P = 0.029) and ankle joint (P = 0.048) range of motion in dancers. Males had higher leg (P < 0.001) and ankle joint stiffness (P < 0.001) than females. This occurred through lower ankle range of motion (P < 0.001) and greater ankle moment (P = 0.022) compared to females. Male and female dancers demonstrated reduced lower limb stiffness compared to athletes, indicating a more pliable landing technique. Dance training techniques could potentially inform approaches to injury prevention in athletes.

Injury rates and characteristics in recreational, elite student and professional dancers: A systematic review.

The purpose of this study was to systematically review the literature and synthesise the evidence on injury rates and characteristics in recreational, elite student, and professional dancers. Five online databases were searched from inception to January 2018 and screened by two independent reviewers. Primary research studies were eligible for inclusion if they reported injury rates in recreational, elite student, and/or professional dancers of any genre and measured individual dance exposure at the hour, event, or day level. Sixteen studies were included, with only three studies incorporating recreational dancers. Reported injury incidence rates were less than 5 injuries per 1,000 dance hours, however substantially different definitions and methods for measuring injury and dance exposure were used. Based on the current evidence there is not an identifiable difference in injury rate or characteristics between recreational, elite student, and professional dancers. However, there remains a lack of high quality comprehensive data available across levels and genres of dance participation, and greater focus on consistency and completeness of reporting in dance injury research is still required.

Temporal trends in dancing among adults between 1994 and 2012: The Health Survey for England.

The benefits of physical activity are established, however, increasing population physical activity levels remains a challenge. Participating in activities that are enjoyable and multidimensional, such as dancing, are associated with better adherence. However, the extent to which the general population participates in dancing and its temporal trends has not been well studied. The aim of this study was to investigate temporal trends and patterns and correlates of dance participation in England from 1994 to 2012 using a series of large nationally representative surveys. We used data from the Health Survey for England 1994, 1997, 1998, 1999, 2003, 2004, 2006, 2008 and 2012 to examine dance temporal trends. Temporal trends data were age-standardized and correlates of dance participation were examined for males and females over each study year. Changes in population prevalence of dance participation were determined using multiple logistical regression with 1997 as the reference year. Of all survey participants (n=98,178) 7.8% (95%CI: 7.63-7.96) reported dance participation. There was a marked steady decrease over time, with the steepest decline from 2003 onwards. The multivariable-adjusted odds ratios for dance participation were 0.51 for males (95%CI 0.408-0.630, p<0.001) and 0.69 for females (95%CI: 0.598-0.973, p<0.001) in 2012 compared to 1997. Dance participation in adults in England has decreased markedly over time. This study suggests that dance is not being adequately utilized as a health enhancing physical activity, and therefore further research and resources should be dedicated to supporting dance in the community.

Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium.

Lateral ankle sprain injury is the most common musculoskeletal injury incurred by individuals who participate in sports and recreational physical activities. Following initial injury, a high proportion of individuals develop long-term injury-associated symptoms and chronic ankle instability. The development of chronic ankle instability is consequent on the interaction of mechanical and sensorimotor insufficiencies/impairments that manifest following acute lateral ankle sprain injury. To reduce the propensity for developing chronic ankle instability, clinical assessments should evaluate whether patients in the acute phase following lateral ankle sprain injury exhibit any mechanical and/or sensorimotor impairments. This modified Delphi study was undertaken under the auspices of the executive committee of the International Ankle Consortium. The primary aim was to develop recommendations, based on expert (n=14) consensus, for structured clinical assessment of acute lateral ankle sprain injuries. After two modified Delphi rounds, consensus was achieved on the clinical assessment of acute lateral ankle sprain injuries. Consensus was reached on a minimum standard clinical diagnostic assessment. Key components of this clinical diagnostic assessment include: establishing the mechanism of injury, as well as the assessment of ankle joint bones and ligaments. Through consensus, the expert panel also developed the International Ankle Consortium Rehabilitation-Oriented ASsessmenT (ROAST). The International Ankle Consortium ROAST will help clinicians identify mechanical and/or sensorimotor impairments that are associated with chronic ankle instability. This consensus statement from the International Ankle Consortium aims to be a key resource for clinicians who regularly assess individuals with acute lateral ankle sprain injuries.

Beighton scores and cut-offs across the lifespan: cross-sectional study of an Australian population.

Objectives: The primary aim of this study was to evaluate generalized joint hypermobility (GJH) according to the Beighton scoring system in an Australian population. Secondary aims were to identify whether the commonly used Beighton score cut-off of ⩾4 is appropriate, and to suggest age- and sex-specific Beighton score cut-offs across the lifespan. Methods: A thousand individuals aged 3-101 years were assessed for GJH with the Beighton scoring system. Differences between age, sex and ethnicity were investigated. The appropriateness of the ⩾4 cut-off was investigated with use of a binary logistic regression. Each Beighton score cut-off was established as the nearest Beighton score that delineated the uppermost 5% of the population. Results: Overall, females and non-Caucasians had higher Beighton scores across the lifespan (P < 0.001). Based on a binary logistic regression model, if a cut-off of ⩾4 was utilized, the Beighton scoring system demonstrated a sensitivity of 0.8% and a specificity of 99.3% (P < 0.001). A cut-off of ⩾4 was only found to be appropriate for females aged 40-59 years and males aged 8-39 years. Conclusion: Beighton scores varied across the lifespan and were significantly influenced by age, sex and ethnicity. Assessing GJH using the Beighton scoring system required age- and sex-specific cut-off scores based on the uppermost 5% values. This was confirmed by the low sensitivity, high specificity and 60% false-positive rate if a cut-off of ⩾4 was used for both sexes across the lifespan. To lower the risk of a false-positive diagnosis of GJH, further tests of hypermobility need to be utilized.

Correlates of Perceived Ankle Instability in Healthy Individuals Aged 8 to 101 Years.

OBJECTIVES: To provide reference data for the Cumberland Ankle Instability Tool (CAIT) and to investigate the prevalence and correlates of perceived ankle instability in a large healthy population. DESIGN: Cross-sectional observational study. SETTING: University laboratory. PARTICIPANTS: Self-reported healthy individuals (N=900; age range, 8-101y, stratified by age and sex) from the 1000 Norms Project. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants completed the CAIT (age range, 18-101y) or CAIT-Youth (age range, 8-17y). Sociodemographic factors, anthropometric measures, hypermobility, foot alignment, toes strength, lower limb alignment, and ankle strength and range of motion were analyzed. RESULTS: Of the 900 individuals aged 8 to 101 years, 203 (23%) had bilateral and 73 (8%) had unilateral perceived ankle instability. The odds of bilateral ankle instability were 2.6 (95% confidence interval [CI], 1.7-3.8; P<.001) times higher for female individuals, decreased by 2% (95% CI, 1%-3%; P=.001) for each year of increasing age, increased by 3% (95% CI, 0%-6%; P=.041) for each degree of ankle dorsiflexion tightness, and increased by 4% (95% CI, 2%-6%, P<.001) for each centimeter of increased waist circumference. CONCLUSIONS: Perceived ankle instability was common, with almost a quarter of the sample reporting bilateral instability. Female sex, younger age, increased abdominal adiposity, and decreased ankle dorsiflexion range of motion were independently associated with perceived ankle instability.

Chronic musculoskeletal ankle disorders in Sri Lanka.

BACKGROUND: Musculoskeletal disorders of the lower extremities are commonly affected by chronicity and disability. One of the most commonly affected areas is the ankle. Epidemiological information is limited for chronic musculoskeletal ankle disorders in the general community, particularly in the developing world. This study aimed to determine the prevalence and impact of chronic musculoskeletal ankle disorders in the Sri Lankan community. METHODS: A cross-sectional stratified random sample of people (n = 1000) aged 18 to 85 years in Sri Lanka was undertaken by questionnaire in the general community setting. Of those questionnaires, 827 participants provided data. Point prevalence for no history of ankle injury or ankle disorders, history of ankle injuries without chronic ankle disorders, and chronic ankle disorders were obtained. Point prevalence of chronic musculoskeletal disorders and causes for chronicity was evaluated. RESULTS: There were 448 (54.2%) participants with no ankle disorders, 164 (19.8%) with a history of ankle injury but no chronic disorders, and 215 (26.0%) with chronic ankle disorders. The major component of chronic ankle disorders was musculoskeletal disorders (n = 113, 13.7% of the total sample), most of which were due to ankle injury (n = 80, 9.7% of the total). Sprains were responsible for 17.7% of the total ankle injuries. Arthritis was the other main cause for chronicity of ankle disorders with 4% of total participants (n = 33). CONCLUSIONS: Almost 14% of the Sri Lankan community was affected by chronic musculoskeletal ankle disorders. The majority were due to a previous ankle injury, and arthritis. Most people had to limit or change their physical activity because of the chronic ankle disorder. A very low utility of physiotherapy services was observed.

2016 consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains.

The Executive Committee of the International Ankle Consortium presents this 2016 position paper with recommendations for information implementation and continued research based on the paradigm that lateral ankle sprain (LAS), and the development of chronic ankle instability (CAI), serve as a conduit to a significant global healthcare burden. We intend our recommendations to serve as a mechanism to promote efforts to improve prevention and early management of LAS. We believe this will reduce the prevalence of CAI and associated sequelae that have led to the broader public health burdens of decreased physical activity and early onset ankle joint post-traumatic osteoarthritis. Ultimately, this can contribute to healthier lifestyles and promotion of physical activity.

Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains.

Lateral ankle sprains (LASs) are the most prevalent musculoskeletal injury in physically active populations. They also have a high prevalence in the general population and pose a substantial healthcare burden. The recurrence rates of LASs are high, leading to a large percentage of patients with LAS developing chronic ankle instability. This chronicity is associated with decreased physical activity levels and quality of life and associates with increasing rates of post-traumatic ankle osteoarthritis, all of which generate financial costs that are larger than many have realised. The literature review that follows expands this paradigm and introduces emerging areas that should be prioritised for continued research, supporting a companion position statement paper that proposes recommendations for using this summary of information, and needs for specific future research.

Diagnostic accuracy of clinical tests for ankle syndesmosis injury.

OBJECTIVE: Our aim was to investigate the diagnostic accuracy of the clinical presentation of ankle syndesmosis injury and four common clinical diagnostic tests. DESIGN: Cross-sectional diagnostic accuracy study. SETTING: 9 clinics in two Australian cities. PARTICIPANTS: 87 participants (78% male) with an ankle sprain injury presenting to participating clinics within 2 weeks of injury were enrolled. METHODS: Clinical presentation, dorsiflexion-external rotation stress test, dorsiflexion lunge with compression test, squeeze test and ankle syndesmosis ligament palpation were compared with MRI results (read by a blinded radiologist) as a reference standard. Tests were evaluated using diagnostic accuracy, sensitivity, specificity and likelihood ratios (LRs). A backwards stepwise Cox regression model determined the combined value of the clinical tests. RESULTS: The clinical presentation of an inability to perform a single leg hop had the highest sensitivity (89%) with a negative LR of 0.37 (95% CI 0.13 to 1.03). Specificity was highest for pain out of proportion to the apparent injury (79%) with a positive LR of 3.05(95% CI 1.68 to 5.55). Of the clinical tests, the squeeze test had the highest specificity (88%) with a positive LR of 2.15 (95% CI 0.86 to 5.39). Syndesmosis ligament tenderness (92%) and the dorsiflexion-external rotation stress test (71%) had the highest sensitivity values and negative LR of 0.28 (95% CI 0.09 to 0.89) and 0.46 (95% CI 0.27 to 0.79), respectively. Syndesmosis injury was four times more likely to be present with positive syndesmosis ligament tenderness (OR 4.04, p=0.048) or a positive dorsiflexion/external rotation stress test (OR 3.9, p=0.004). CONCLUSIONS: Although no single test is sufficiently accurate for diagnosis, we recommend a combination of sensitive and specific signs, symptoms and tests to confirm ankle syndesmosis involvement. An inability to hop, syndesmosis ligament tenderness and the dorsiflexion-external rotation stress test (sensitive) may be combined with pain out of proportion to injury and the squeeze test (specific).

Mechanisms of lateral ankle ligament sprains in professional netball: A systematic video analysis.

OBJECTIVES: To undertake a systematic analysis of 17 medical attention and time-loss lateral ankle ligament sprain (LALS) events from televised Australian professional netball games during the 2020-2023 seasons. DESIGN: Case series. METHODS: Three analysts independently assessed the video footage and then convened to review and discuss each case until a consensus was reached. RESULTS: When in possession (7 cases) a player was commonly performing an agility-based manoeuvre to break free from an opponent and reposition themselves to be a passing option (5/7 cases). When out of possession (10 cases) a player was either attempting to intercept a pass (6 cases) or marking an opponent (4 cases). Players tended to land on the anterior one-third of the plantar surface of the foot - forefoot or shoe tip (7 cases). Players often landed on either the ground (7 cases) or the opponent's shoe then the ground (8 cases). In 9 cases the ankle-foot was considered to be in a neutral alignment in the frontal plane at landing. At the estimated index frame the players' weight tended to be all on the foot on the injured side (11 cases) or favouring the foot on the injured side (5 cases). Inversion and adduction was a common injury mechanism. Plantar-flexion was rarely involved. CONCLUSION: Landing on the anterior one-third of the plantar surface of the foot and subsequent weight transference onto the injured limb side was more important than ankle-foot inversion at initial ground contact. Exercises involving external perturbations that challenge the control of frontal and transverse plane ankle-foot motion and improve proprioception, neuromuscular control, and dynamic balance are warranted.

The Effectiveness of Dance Interventions on Psychological and Cognitive Health Outcomes Compared with Other Forms of Physical Activity: A Systematic Review with Meta-analysis.

BACKGROUND: Physical activity is known to improve psychological and cognitive outcomes. Learning dance sequences may challenge cognition, partnered or group dance may benefit social interactions, and the artistic aspect may improve psychological wellbeing. Dance is an equally effective form of physical activity compared with other structured physical activities to improve physical health, but it is unclear how effective dance could be for psychological and cognitive outcome measures. OBJECTIVE: To systematically review the literature on the effectiveness of structured dance interventions, compared with structured exercise programmes, on psychological and cognitive outcomes across the lifespan. METHODS: Eight databases were searched from earliest records to July 2022. Studies investigating a dance intervention lasting ≥ 4 weeks, including psychological and/or cognitive health outcomes, and having a structured exercise comparison group were included. Screening and data extraction were performed by two independent reviewers at all stages. All reviewer disagreements were resolved by the primary author. Where appropriate, meta-analysis was performed, or an effect size estimate generated. RESULTS: Of 21,737 records identified, 27 studies met the inclusion criteria. Total sample size of included studies was 1392 (944 females, 418 males, 30 unreported). Dance was equally as effective as other physical activity interventions in improving quality of life for people with Parkinson's disease [mean difference 3.09; 95% confidence interval (CI) - 2.13 to 8.30; p = 0.25], reducing anxiety (standardised mean difference 2.26; 95% CI - 2.37 to 6.90; p = 0.34), and improving depressive symptoms (standardised mean difference 0.78; 95% CI - 0.92 to 2.48; p = 0.37). Preliminary evidence found dance to be superior to other physical activity interventions to improve motivation, aspects of memory, and social cognition and to reduce distress. Preliminary evidence found dance to be inferior to other physical activity interventions to improve stress, self-efficacy and language fluency. CONCLUSION: Undertaking structured dance of any genre is generally equally and occasionally more effective than other types of structured exercise for improving a range of psychological and cognitive outcomes. TRIAL REGISTRATION: PROSPERO: CRD42018099637.

Diagnostic accuracy of clinical tests for diagnosis of ankle syndesmosis injury: a systematic review.

OBJECTIVES: To determine the value of clinical tests for accurate diagnosis of ankle syndesmosis injury. DESIGN: Systematic review. DATA SOURCES: An electronic database search was conducted (to 6 August 2012) of databases such as: MEDLINE, CINAHL, EMBASE, PubMed and Cochrane Databases. References from identified articles were examined and seven authors of eligible studies were contacted for additional information. STUDY SELECTION: Studies of any design, without language restriction, were included; however, systematic reviews were excluded. Eligible studies included participants with a suspected ankle syndesmosis injury but without fracture. Reliability studies compared one or more clinical tests and studies of test accuracy compared the clinical test with a reference standard. RESULTS: The database search resulted in 114 full text articles which were assessed for eligibility. Three studies were included in the review and raw data of these studies were retrieved after contacting the authors. Eight clinical diagnostic tests were investigated; palpation of the tibiofibular ligaments, external rotation stress test, squeeze, Cotton, fibula translation, dorsiflexion range of motion (ROM) and anterior drawer tests. Two studies investigated diagnostic accuracy and both investigated the squeeze test by with conflicting results. Likelihood ratios (LR) ranging from LR+1.50 to LR-1.50 were found for other tests. High intra-rater reliability was found for the squeeze, Cotton, dorsiflexion ROM and external rotation tests (83-100% close agreement). Inter-rater reliability was good for the external rotation test (ICC2,1>0.70). Fair-to-poor reliability was found for other tests. CONCLUSIONS: This is the first systematic review to investigate the reliability and accuracy of clinical tests for the diagnosis of ankle syndesmosis injury. Few studies were identified and our findings show that clinicians cannot rely on a single test to identify ankle syndesmosis injury with certainty. Additional diagnostic tests, such as MRI, should be considered before making a final diagnosis of syndesmosis injury.

Effect of Braces on Performance in the Context of Chronic Ankle Instability.

Ankle braces are commonly recommended for prevention of ankle sprains, especially secondary sprains, rehabilitation, and return to normal activity or sport after injury. One common resistance to use is the feeling that braces will impede functional performance. For people with chronic ankle instability, the limited research indicates that the use of semirigid, lace-up, or soft-shell braces will not affect, and in some cases, may enhance performance. Activities that could be enhanced are jumping, hopping, and dynamic balance.