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Try out PMC Labs and tell us what you think. Learn More. Ankle sprains are common problems in acute medical care, text compression phd thesis. The variation in treatment observed for the acutely injured text compression phd thesis ankle ligament complex in the first week after the injury suggests a lack of evidence-based management strategies for this problem. To analyze the effectiveness of applying rest, ice, compression, and elevation RICE therapy begun within 72 hours after trauma for patients in the initial period after ankle sprain.
Eligible studies were published original randomized or quasi-randomized controlled trials concerning at least 1 of the 4 subtreatments of RICE therapy in the treatment of acute ankle sprains in adults. MEDLINE, Cochrane Clinical Trial Register, CINAHL, and EMBASE. The lists of references of retrieved publications also were checked manually. We extracted relevant data on treatment outcome pain, swelling, ankle mobility or range of motion, return to sports, return to work, complications, and patient satisfaction and assessed the quality of included studies.
If feasible, text compression phd thesis, the results of comparable studies were pooled using fixed- or random-effects models. After deduction of the overlaps among the different databases, text compression phd thesis, evaluation of the abstracts, and contact with some authors, 24 potentially eligible trials remained. The full text compression phd thesis of these articles were retrieved and thoroughly assessed as described, text compression phd thesis.
This resulted in the inclusion of 11 trials involving patients. The main reason for exclusion was that the authors did not describe a well-defined control group without the intervention of interest.
Insufficient evidence is available from randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults.
Treatment decisions must be made on an individual basis, carefully weighing the relative benefits and risks of each option, and must be based on expert opinions and national guidelines. Randomized controlled trials provide insufficient evidence to determine the effectiveness of rest, ice, compression, and elevation RICE therapy for acute ankle sprains in adults.
Treatment decisions must be made on an individual basis, carefully weighing the relative risks and benefits of each option, and must be based on expert opinions and guidelines. Sufficiently powered, high-quality, and appropriately reported randomized trials of the different elements of RICE therapy for acute ankle sprains are needed.
Ankle sprains are one of the most prevalent injuries of the musculoskeletal system. The treatment of inversion ankle injuries is provided by emergency and primary health care physicians, athletic trainers, physiotherapists, and orthopaedic and trauma surgeons. Each year, approximately 1 million patients with acute lateral ankle ligament injuries are examined by primary care physicians in the United States.
The ankle ligaments are the anterior talofibular ligament ATFL text compression phd thesis, calcaneofibular ligament CFLand posterior talofibular ligament PTFLand together they form the lateral ligament complex of the ankle. The PTFL usually is not injured unless a true dislocation of the ankle occurs. Accumulation of fluid and edema around an injury site also increases tissue damage, delays healing, and can result in some degree of chronic disability.
According to the Dutch Quality Institute for Healthcare CBO consensus guidelines, 19 RICE therapy is the preferred treatment for the first 4 to 5 days. After this period, the physical text compression phd thesis provides a high-quality assessment. Rest, ice, compression, and elevation therapy is an accessible and popular modality in the treatment of acute ankle sprains, text compression phd thesis.
Therefore, the objective of our study was to analyze the effectiveness of applying RICE therapy begun within 72 hours after trauma for patients in the initial period of ankle sprain. The specific null hypotheses included the following: 1 No differences existed in outcome measurements between using rest, immobilization, or no movement or mobilization and using early text compression phd thesis or movement for acute treatment of ankle sprains; 2 No differences existed in outcome measurements between using ice, cold, cold therapy, cryotherapy, or cooling and using no ice, no cold, or heat for acute treatment of ankle sprains; 3 No differences existed in outcome measurements text compression phd thesis using compression and using no compression for acute treatment of ankle sprains; and 4 No differences existed in outcome measurements between using elevation and using no elevation for acute treatment of ankle sprains.
In addition to other reviews concerning the treatment of acute lateral ankle sprains 22 — 28 also G. Rest is required to reduce the metabolic demands of the injured tissue and thus avoid increased blood flow, text compression phd thesis. It also is needed to avoid stress on the injured tissues that might disrupt the fragile fibrin bond, which is the first element of the repair process.
Rest can be applied selectively to allow some general activity, but the patient must avoid any activity that induces stress or strain to the injured area and thus can compromise the healing process. Ice is the most common means by which cooling is achieved. We use text compression phd thesis term ice to represent the application of cryotherapy in general, with the different means by text compression phd thesis this can be achieved being considered in more detail later.
Ice is used to limit the injury-induced damage by reducing the temperature of the tissues at the site of injury and consequently reducing metabolic demand, inducing vasoconstriction, and limiting the bleeding. It also can reduce pain by increasing threshold levels in the free nerve endings and at synapses and by increasing nerve conduction latency to promote analgesia. The goal of text compression phd thesis is to stop hemorrhage and reduce swelling. Compression is applied to limit the amount of edema caused by the exudation of fluid from text compression phd thesis damaged capillaries into the tissue.
Controlling the amount of inflammatory exudate reduces the amount of fibrin and ultimately the production of scar tissue and helps to control the osmotic pressure of the tissue fluid in the injured area. Elevation of the injured part lowers text compression phd thesis pressure in local blood vessels and helps to limit the bleeding. It also increases drainage of the inflammatory exudate through the lymph vessels, reducing and limiting edema and its resultant complications.
Two independent researchers M. performed a search in the following databases: MEDLINE from to JulyCochrane Clinical Trial Register from to AugustCINAHL from to Augustand EMBASE from January to August to identify all studies concerning the application of at least 1 of the components of RICE therapy for an acute ankle sprain.
The search terms used were ankle injuriesrupturetext compression phd thesis, ankle jointlateral ligamentssprainsrandomized clinical trialrandom allocationplaceborestimmobilizationicecoldtherapycryotherapycoolingcompressionand elevation Table 1. References listed in the retrieved publications also were examined manually to identify additional studies. Papers in English were considered for this review, and papers in other languages were considered if translation was available.
Abstracts from scientific meetings, unpublished reports, ongoing studies, and review articles were excluded. The search of the literature was limited to original randomized or quasi-randomized controlled trials concerning at least 1 of the 4 components of RICE therapy in the treatment of acute ankle sprains.
Quasi-randomization is a method of allocating participants to a treatment that is not strictly random eg, date of birth, hospital text compression phd thesis number, alternation, text compression phd thesis.
Inclusion was limited to articles on skeletally mature individuals with an acute diagnosis within 1 week after trauma ankle sprain. Trials including children, in whom growth plate injuries predominate, or patients with congenital deformities or degenerative conditions were excluded. A mixed population of adults and children was included if the adult population could be analyzed separately. Patients who had ankle sprains and symptoms of pain and swelling after an inversion trauma were included.
A reliable diagnosis of a sprained or ruptured ligament can be made 5 to 7 days after injury. Patients with chronic instability have symptoms of pain, swelling, recurrent sprains, and instability for more than 6 months. We categorized 4 general components of RICE therapy in the treatment of acute lateral ankle sprains and included trials in which researchers made at least 1 of the following comparisons: 1 immobilization versus mobilization, 2 ice versus no ice, 3 compression versus no compression, and 4 elevation versus no elevation.
Treatment had to be initiated within 72 hours after the trauma. The authors had to describe an adequate follow-up of at least 24 hours. Studies concerning brace, tape, elastic bandage, or soft-cast treatment for acute ankle sprains were excluded because these are not treatments used in the first 5 days after the trauma according to the Dutch guidelines. Data were sought for the following: 1 pain yes or no ; continuous data2 swelling yes or no ; continuous data3 ankle mobility or range of motion ROM continuous datatext compression phd thesis, 4 return to sports yes or no ; time to achieve return to sports was defined as a return to participating in the previously performed sport at the same level5 return to work yes or no ; time to achieve6 complications and side effects sensory deficit, infection, allergic reaction, hypothermia, stiffness yes or noand 7 patient satisfaction interval, continuous, or dichotomous data.
From the title and abstract, we reviewed the literature searches to identify potentially relevant articles. The full article was retrieved when the title, key words, or abstract revealed insufficient information to determine appropriateness for inclusion. For each text compression phd thesis article, the full article was retrieved for final assessment. All identified studies were assessed independently by 2 reviewers M. and L. for inclusion using the text compression phd thesis described.
Disagreements between reviewers were resolved by discussion and with arbitration by a third reviewer C. when text compression phd thesis remained. The most common reason for exclusion was that the researchers did not describe a well-defined control group without the intervention of interest but described a control group with another form of intervention.
The study by Tsang et al 32 was excluded because the follow-up was too short. The publication dates spanned 34 years; Basur et al 33 was the earliest report, and Bleakley et al 34 was the most recent publication, text compression phd thesis.
Different inclusion criteria, durations of treatments, outcome measurements, and timing of outcome measurements text compression phd thesis the trials prohibited pooling of the results and statistical comparison among the included trials. The searches yielded articles for the intervention rest. Full texts of 8 articles were retrieved for further analysis, and 5 articles were included in this review.
Full texts of 11 articles were retrieved for further analysis, and 5 articles were included in this review.
Full texts of 5 articles were retrieved for further analysis, and 1 article was included in this review. Full text of 1 article was retrieved for further analysis. However, no articles were included in this review concerning the comparison of elevation and no elevation in the treatment of acute ankle sprains.
The data from the included studies that could be meta-analyzed were extracted by 1 reviewer M. using a prepiloted data-extraction tool and were verified by the second reviewer L. Disagreements were resolved in a consensus meeting or, if necessary, by third-party adjudication G.
Articles were not blinded for author, affiliation, or source. Two independent reviewers P. obtained the full text of all potentially eligible articles for independent methodologic assessment. Any disagreement was resolved by consensus or third-party adjudication M.
If possible, the results of comparable studies were pooled using fixed- or random-effects models where appropriate. Heterogeneity among trials was analyzed using a χ 2 test. If possible, sensitivity analyses were conducted to assess the effects of excluding the trials in which the quasi-randomization method was used.
Because the trial results were heterogeneous, the results were analyzed according to best evidence analysis using a rating system with levels of evidence based on the overall quality and the outcomes of the studies used. Moderate evidence was defined as generally consistent findings in 1 high-quality RCT and 1 or more low-quality RCTs.
Limited evidence was defined as only 1 RCT either high or low quality or generally consistent findings in controlled clinical trials. No evidence was defined as no controlled clinical trials or no RCTs. The methodologic quality and the quality of reporting data were very poor in the trial published by Brooks et al. Patients who had their ankles immobilized required more days missed from work and text compression phd thesis visits to a clinic for follow-up.
Eisenhart et al 36 reported that standard treatment RICE with or without pain medications and standard treatment with additional osteopathic manipulative treatment led to improvement at 1-week follow-up in patients with unilateral ankle sprains.
Activity level was higher in the exercise group than in the standard intervention group as measured by time spent walking 1. Sloan et al 37 compared a cooling anklet used with 45° of elevation and a dummy anklet used without elevation, text compression phd thesis.
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