Accepted for/Published in: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Jun 15, 2021
Date Accepted: Jul 30, 2021
Date Submitted to PubMed: Sep 9, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Digital rehabilitation for acute ankle sprains: prospective longitudinal cohort study
ABSTRACT
Background:
Ankle sprains are one of the most prevalent soft-tissue injuries worldwide. Physical therapy, and especially progressive exercise, has proven effective in improving function, while preventing recurrence.
Objective:
We aimed to present the results of a fully remote and digitally guided rehabilitation program for acute ankle sprains.
Methods:
Prospective, longitudinal cohort study of individuals referred for digital rehabilitation therapy for ankle sprain, and eligible for workers’ compensation. 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 -sports (FAAM-Sports). Participants were assessed at baseline, end-of-program and 6-months after program completion. Secondary outcomes included digital therapy dosage, pain and fatigue during sessions, and satisfaction.
Results:
Ninety-three patients (89.4%) completed the program and seventy-nine were available for follow-up (76.0%). Changes in the primary outcomes between baseline and the 6-months follow-up were both statistically significant (P<.001) and clinically meaningful: mean difference of -2.72 points (95% CI -3-31 to -2.13) in NPRS (49.8% reduction), 21.7 points (95% CI 17.13 to 26.27) in FAAM-ADL (41.1% increase) and 37.8 points (95% CI 30.45 to 45.15) in FAAM-Sports (151.8% increase). Longer waiting periods between accident date and treatment initiation were found to negatively impact functional status at baseline and end-of-program, triggering extended program duration. Total training volume (12.5 h, sd=10.5) was similar to other interventions for ankle sprains, but dosage per week was much higher (2.4 h per week, sd=0.87). Mean patient satisfaction score was 8.8/10 (sd=1.57). Among program completers, 83.9% attained full recovery and were discharged with no residual disability.
Conclusions:
Being far less demanding in terms of human resources, the digital program presented constitutes a viable, clinically effective and convenient solution for ankle sprains rehabilitation, particularly in pandemic times. This is the first study presenting a fully remote home-based rehabilitation program for acute ankle sprains, with patients achieving sustained long-term results, comparable to those published for face-to-face interventions. Clinical Trial: NCT04819022; https://clinicaltrials.gov/ct2/show/NCT04819022
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