• ankle injuries
• biopsy, fine-needle
• fascia
• randomized controlled trial

• Humans
• Male
• Female
• Ankle Injuries/therapy
• Acupuncture Therapy/methods
• Adult
• Treatment Outcome
• Sprains and Strains/therapy
• Middle Aged
• Pain Measurement
• Acupuncture Points
• Needles

• Chronic ankle instability
• Diagnostic
• Lateral ankle sprain
• Prevention
• Therapy

• Combat soldiers
• ankle sprain
• cait
• injuries
• postural balance
• proprioceptive ability

• ankle injuries
• exercise
• exercise therapy
• musculoskeletal manipulation

Even though ankle sprains are among the most frequent musculoskeletal injuries seen in emergency departments, management of these injuries continues to lack standardization. Our objective was to carry out an umbrella review of systematic reviews to collect the most effective evidence-based treatments and to point out the state-of-the-art management for this injury. PubMed, Scopus, Web of Science, and the Cochrane library were searched from January 2000 to September 2020. After removing duplicates and applying the eligibility criteria, based on titles and abstracts, 32 studies were screened. At the end of the process, 24 articles were included in this umbrella review with a mean score of 7.7/11 on the AMSTAR quality assessment tool. We found evidence supporting the effectiveness of non-surgical treatment in managing acute ankle sprain; moreover, functional treatment seems to be preferable to immobilization. We also found evidence supporting the use of paracetamol or opioids as effective alternatives to non-steroidal anti-inflammatory drugs to reduce pain. Furthermore, we found evidence supporting the effectiveness of manipulative and supervised exercise therapy to prevent re-injury and restore ankle dorsiflexion.

• Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca

Ankle sprains are one of the most prevalent soft-tissue injuries worldwide. Physical therapy, especially progressive exercise, has proven effective in improving function, while preventing recurrence.

We aim to present the results of a fully remote and digitally guided rehabilitation program for acute ankle sprains.

We performed a prospective longitudinal cohort study of individuals eligible for workers’ compensation, who were referred for digital rehabilitation therapy for a sprained ankle. Therapeutic exercise sessions were to be performed independently by the patient at home using the biofeedback device provided by SWORD Health. Primary endpoints were the change in self-reported Numerical Pain Rating Scale (NPRS) and Foot and Ankle Ability Measure–activities of daily living (FAAM–ADL) and FAAM–Sports scores. Participants were assessed at baseline, end of the program, and 6 months after program completion. Secondary outcomes included digital therapy dosage, pain and fatigue during sessions, and satisfaction.

In total, 93 (89.4%) patients completed the program and 79 (76.0%) were available for follow-up. Changes in the primary outcomes between baseline and the 6-month follow-up were both significant (P<.001) and clinically meaningful: mean difference of –2.72 points (95% CI –3.31 to –2.13) on the NPRS (49.8% reduction), 21.7 points (95% CI 17.13-26.27) on the FAAM–ADL (41.1% increase), and 37.8 points (95% CI 30.45-45.15) on the FAAM-Sports (151.8% increase). Longer waiting periods between the accident date and treatment initiation were found to negatively impact functional status at baseline and at the end of the program, triggering an extension in the program duration. The total training volume (12.5 hours, SD 10.5 hours) was similar to that of other interventions for ankle sprains, but the dosage per week was much higher (2.4 hours per week, SD 0.87 hours per week). The mean patient satisfaction score was 8.8 (SD 1.57) out of 10. Among program completers, 83.9% attained full recovery and were discharged with no residual disability.

Being far less demanding in terms of human resources, the digital program presented constituted a viable, clinically effective, and convenient solution for ankle sprain rehabilitation, particularly during the pandemic. This is the first study presenting a fully remote home-based rehabilitation program for acute ankle sprains, with patients achieving sustained long-term results. This was a prospective cohort study and, as such, did not include a control group, but the results appear comparable to those published for face-to-face interventions.

ClinicalTrials.gov NCT04819022; https://clinicaltrials.gov/ct2/show/NCT04819022

• acute ankle sprains
• ankle
• cohort
• digital health
• digital therapy
• fatigue
• home-based digital rehabilitation
• longitudinal
• outcome
• pain
• physical rehabilitation
• physical therapy
• prospective
• rehabilitation
• soft tissue
• sprain
• therapy

• Ankle sprain
• Athlete
• Exercise therapy
• Rehabilitation
• Return to play
• Sport injury

• Adult
• Ankle Injuries/radiotherapy
• Cohort Studies
• Female
• Humans
• Low-Level Light Therapy
• Male
• Middle Aged
• Recovery of Function
• Sprains and Strains/radiotherapy
• Treatment Outcome
• Young Adult

• Ankle sprain
• dynamic balance
• function
• pain
• proprioceptive training
• range of motion

• Adolescent
• Adult
• Ankle Injuries/physiopathology
• Ankle Injuries/rehabilitation
• Ankle Joint/physiopathology
• Arthralgia/physiopathology
• Arthralgia/rehabilitation
• Exercise Therapy/methods
• Female
• Humans
• Male
• Postural Balance/physiology
• Proprioception/physiology
• Range of Motion, Articular/physiology
• Sprains and Strains/physiopathology
• Sprains and Strains/rehabilitation
• Treatment Outcome
• Young Adult

• ankle sprain
• cost-effectiveness
• guideline
• inversion trauma
• sprain prevention

• Dose
• Exercise prescription
• Exercise therapy
• Physical therapy
• Therapeutic exercise

• Achilles Tendon/injuries
• Ankle Injuries/therapy
• Exercise Therapy/methods
• Fasciitis, Plantar/therapy
• Humans
• Tendinopathy/therapy

• ankle injuries
• emergency medicine
• evidence-based practice
• foot injuries
• review

• Adolescent
• Adult
• Aged
• Ankle Injuries/rehabilitation
• Female
• Humans
• Male
• Middle Aged
• Physical Therapy Modalities
• Quality of Life
• Recovery of Function
• Sprains and Strains/rehabilitation
• Surveys and Questionnaires
• Treatment Outcome

• Ankle
• Chronic
• Injury
• Injury prevention
• Sprain

• abnormalities
• ankle
• general practice
• imaging
• sprain

• Virtual reality
• pain
• physical function
• physiotherapy
• self-reported

• ankle injury
• instability
• training program

Although a delayed decrease in heart rate during the first minute after graded exercise has been identified as a powerful predictor of overall mortality in cardiac patients, the potential to influence this risk factor by aerobic training remains to be proven.

The aim was to study the relationship between aerobic training and Heart Rate Recovery (HRR) in patients with established heart disease.

(Quasi) randomized clinical trials on aerobic exercise training in adults with established heart disease were identified through electronic database and reference screening. Two reviewers extracted data and assessed the risk of bias and therapeutic validity. Methodological validity was evaluated using an adapted version of the Cochrane Collaboration’s tool for assessing risk of bias and the therapeutic validity of the interventions was assessed with a nine-itemed, expert-based rating scale (CONTENT). Scores range from 0 to 9 (score ≥ 6 reflecting therapeutic validity).

Of the 384 articles retrieved, 8 studies (449 patients) were included. Three of the included studies demonstrated adequate therapeutic validity and five demonstrated low risk of bias. Two studies showed both adequate therapeutic validity and a low risk of bias. For cardiac patients aerobic exercise training was associated with more improvement in HRR compared to usual care.

The present systematic review shows a level 1A evidence that aerobic training increases HRR in patients with established heart disease.

• Exercise Therapy/methods
• Heart Diseases/physiopathology
• Heart Diseases/therapy
• Heart Rate/physiology
• Humans

• Adult
• Ankle Joint/physiopathology
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Prognosis
• Randomized Controlled Trials as Topic
• Recovery of Function/physiology
• Recurrence
• Sprains and Strains/physiopathology
• Sprains and Strains/rehabilitation

• Arthroplasty, Replacement/rehabilitation
• Exercise
• Hospitalization
• Humans
• Preoperative Period
• Publication Bias
• Recovery of Function
• Reproducibility of Results
• Surveys and Questionnaires
• Time Factors

To summarise the available evidence for the efficacy of neuromuscular training in enhancing sensorimotor and functional deficits in subjects with chronic ankle instability (CAI).

Systematic review with best evidence synthesis.

An electronic search was conducted through December 2009, limited to studies published in the English language, using the Pubmed, CINAHL, Embase, and SPORTDiscus databases. Reference screening of all included articles was also undertaken.

Studies were selected if the design was a RCT, quasi RCT, or a CCT; the patients were adolescents or adults with confirmed CAI; and one of the treatment options consisted of a neuromuscular training programme. The primary investigator independently assessed the risk of study bias and extracted relevant data. Due to clinical heterogeneity, data was analysed using a best-evidence synthesis.

Fourteen studies were included in the review. Meta-analysis with statistical pooling of data was not possible, as the studies were considered too heterogeneous. Instead a best evidence synthesis was undertaken. There is limited to moderate evidence to support improvements in dynamic postural stability, and patient perceived functional stability through neuromuscular training in subjects with CAI. There is limited evidence of effectiveness for neuromuscular training for improving static postural stability, active and passive joint position sense (JPS), isometric strength, muscle onset latencies, shank/rearfoot coupling, and a reduction in injury recurrence rates. There is limited evidence of no effectiveness for improvements in muscle fatigue following neuromuscular intervention.

There is limited to moderate evidence of effectiveness in favour of neuromuscular training for various measures of static and dynamic postural stability, active and passive JPS, isometric strength, muscle onset latencies, shank/rearfoot coupling and injury recurrence rates. Strong evidence of effectiveness was lacking for all outcome measures. All but one of the studies included in the review were deemed to have a high risk of bias, and most studies were lacking sufficient power. Therefore, in future we recommend conducting higher quality RCTs using appropriate outcomes to assess for the effectiveness of neuromuscular training in overcoming sensorimotor deficits in subjects with CAI.