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Chronic complaints after ankle sprains: a systematic review on effectiveness of treatments.

STUDY DESIGN
Systematic review. Objective To determine the effectiveness of treatments for patients with chronic complaints after ankle sprain.


BACKGROUND
Though most people recover completely after a lateral inversion ankle injury, a considerable percentage have persistent complaints. Currently, it is still unclear which treatment options are best for these patients.


METHODS
Major databases, including PubMed, Embase, CINAHL, and PEDro, were searched for randomized controlled trials and controlled clinical trials conducted from 1966 to October 2012. Due to clinical heterogeneity, the data were analyzed using a best-evidence synthesis.


RESULTS
A total of 20 randomized controlled trials and 1 controlled clinical trial were included in the analysis. The included studies compared different treatments (training programs, physiotherapy, chiropractic/manual therapy, surgery, postoperative training, and functional treatment). For pain and function outcomes, limited to moderate evidence was found for effectiveness of a training program compared to conservative treatment. Two studies found a decrease of recurrences after a proprioceptive training program. Four studies showed good results for different surgical methods but did not include a nonsurgical control group for comparison. Limited evidence was found for the effectiveness of an early mobilization program after surgery.


CONCLUSION
In chronic ankle complaints after an ankle sprain, a training program gives better results for pain and function, and a decrease of recurrent ankle sprains, than a wait-and-see policy. There was insufficient evidence to determine the most effective surgical treatment, but limited evidence suggests that postoperative, early mobilization was more effective than a plaster cast.


LEVEL OF EVIDENCE
Therapy, level 1a-.