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Economic evaluations of diagnostic tests, treatment and prevention for lateral ankle sprains: a systematic review
  1. Chung-Wei Christine Lin1,
  2. Kimi Uegaki2,
  3. Veerle M H Coupé3,
  4. Gino M Kerkhoffs4,
  5. Maurits W van Tulder2
  1. 1Musculoskeletal Division, The George Institute for Global Health and Sydney Medical School, The University of Sydney, Sydney, Australia
  2. 2Department of Health Sciences and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
  3. 3Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
  4. 4Department of Orthopedic surgery, Orthopedic Research Center, Academic Medical Centre, Amsterdam, The Netherlands
  1. Correspondence to Maurits W van Tulder, Department of Health Sciences and EMGO Institute for Health and Care Research, VU University, De Boelelaan 1085, U454, 1081 HV Amsterdam, The Netherlands; maurits.van.tulder{at}


Objective To assess and summarise the economic evidence regarding diagnostic tests, treatment and prevention for lateral ankle sprains.

Methods Potential studies were identified from electronic databases and trial registries and by scanning reference lists. Risk of bias and methodological quality were evaluated. Two independent reviewers screened, assessed studies and extracted data. Data were synthesised descriptively due to study heterogeneity.

Results A total of 230 records were identified; 10 studies were included. Five studies conducted a full economic evaluation and five studies involved cost analyses. Lack of blinding was the main risk of bias. The methodological quality of the full economic evaluations was fairly good. Valuation of costs, measurement of outcomes and sensitivity analysis were points for improvement. Single studies showed that the Ottawa ankle rules (OAR) was cost effective for diagnosing lateral ankle sprains in the emergency setting compared with existing hospital protocols; acute treatment with anti-inflammatory medication and the plaster cast for severe sprains appeared cost effective; and neuromuscular training was cost effective in preventing ankle re-injury.

Conclusions Results of this current systematic review supplements the evidence provided by reviews of effectiveness. There is evidence to support the implementation of OAR in the emergency setting, the use of anti-inflammatory medication and the plaster cast in the acute phase, and the prescription of neuromuscular exercises to prevent re-injury. Although the evidence is limited due to the low number of studies, shortcomings in methodological quality and small sample sizes, the findings may be used to inform clinical practice and practice guidelines.

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  • ▸ Supplementary tables S1 and S2 are published online only. To view the fi les please visit the journal online (

  • Funding This research was funded by The Netherlands organisation for health research and development (ZonMw) within the framework of the program ‘Management of Knowledge, Quality Curative Care’. CL is funded by a fellowship from the Australian National Health and Medical Research Council.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • ▸ References to this paper are available online at