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109 An unsupervised e-health supported neuromuscular training program is not effective in the prevention of recurrent ankle sprains in patients in primary care: the trAPP-study
  1. Adinda Mailuhu1,
  2. Evert Verhagen2,
  3. John Van Ochten1,
  4. Patrick Bindels1,
  5. Sita Bierma-Zeinstra1,
  6. Marienke Van Middelkoop1
  1. 1Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, Netherlands
  2. 2Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands


Background Ankle sprains are one of the most frequent injuries of the musculoskeletal system. No optimal treatment strategy has proven to be effective in general practice, however promising results were achieved in a preventive trial among athletes

Objective To examine the effectiveness of an unsupervised e-health supported neuromuscular training program in combination with usual care in general practice compared to usual care alone in patients with acute lateral ankle sprains in general practice

Design Randomised Controlled Trial

Setting Primary care

Patients (or Participants) Patients (14–65 years) who visited a general practitioner with an acute lateral ankle sprain within three weeks of injury

Interventions (or Assessment of Risk Factors) The intervention group received, in addition to usual care, an unsupervised e-health supported neuromuscular training program, and the control group received usual care alone

Main Outcome Measurements The primary outcome was self-reported recurrent sprains during follow-up. Secondary outcomes were ankle function (Ankle Function Score 0–100), pain in rest and during activity (numerical rating scale 0–10), subjective recovery and return to the same type and level of sport.

Results 165 participants were included with a mean age of 38.3 (SD 14.2) years and 41.8% were male. No difference in the occurrence of a recurrent sprain was found between the intervention (n=17; 20.7%) and control group (n=20; 24.1%) (HR 1.14; 95% CI 0.59–2.21). Also, no differences in secondary outcomes were found between groups. The compliance rate with the program was low (6.1%).

Conclusions Although the recurrence rate of ankle sprains was relatively high, an unsupervised e-health supported neuromuscular training program is not effective in preventing recurrent sprains in patients with an acute lateral ankle sprain in general practice. More research is necessary to indicate the best treatment modality for this group of patients.

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