The effect of taping versus semi-rigid bracing on patient outcome and satisfaction in ankle sprains: a prospective randomized controlled trial
Lardenoye S, Theunissen E, Cleffken B, Brink PRG, de Bie RA, and Poeze M. BMC Musculoskeletal Disorders. 2012 May 28.
Among musculoskeletal injuries sustained during athletic activity one of the most common are inversion ankle sprains. While many effective treatments for ankle sprains exist, little research has examined patient satisfaction with regards to different treatment options. Therefore, Lardenoye and colleagues completed a prospective randomized controlled trial to assess patient satisfaction of two commonly used methods of functional treatment: semi-rigid bracing and taping. Patients included in this study had either a grade II or III ankle sprain (grade II = presence of a lateral hematoma or tenderness; grade III = hematoma, tenderness and anterior drawer instability) that was assessed by a physician in an outpatient clinic. Patients were excluded from this study if patients, a) were undergoing preventative treatment, b) were diagnosed with a fracture, c) had a previous ankle sprain for fracture, or d) had swelling which would impede proper taping. Initial treatments for all ankle sprains consisted of a compressive bandage, rest, ice, and elevation. Participants were instructed to return to the clinic in 5-7 days to be reassessed. At that point all grade II and III ankle sprains were randomized into two treatment groups (group 1 = tape, group 2 = semi-rigid ankle brace: AirLoc®). Taping was applied by experienced healthcare professionals and consisted of latex-free adhesive bandages then 2.5 cm non-elastic strapping tape for support then 6 cm elastoplast for fixation of the second layer. The tape was applied once a week (or when the patient felt stability was lost) for 4 weeks. Both groups also performed proprioceptive exercises (first supervised then given with verbal and written instructions). Follow-up occurred at weeks 2, 4, 8, and 12 after the start of the treatment. The authors assessed the outcomes with verbal rating scale (patient satisfaction), Karlsson score scale (joint function, 0-90 points), and ankle range of motion. Self-reported pain and hygiene were also recorded using a 5-point Likert scale. Overall 100 patients were included in the study of which 70 (71%) had all outcomes assessed (both groups had a similar loss to follow-up rate). During the 4-week period patient satisfaction was significantly higher in the bracing group at weeks 2 and 4 than the taping group. Conversely, patient satisfaction in the taping group significantly decreased from week 1 until week 5. Self-reported patient hygiene score were also significantly higher in the bracing group at all time points. While all subjective scores supported the use of bracing over taping, functional scores did not differ between the two groups with respect to range of motion or Karlsson score (assessing pain, swelling, instability, stiffness, stair climbing, running, work activities and support).
Overall this study seems to support that ankle sprain patients who are treated with semi-rigid ankle braces are more satisfied with their treatments than those who are treated using tape. These results must be interpreted cautiously however as little detail was provided for the exact method that the tape was applied in the taping group. Without this information it is difficult to determine how the method of taping used in this study compares to the various taping methods commonly deployed in the clinical setting. Clinically though, this data suggests that while bracing after an ankle sprain leads to better patient satisfaction, there is no functional differences between those receiving tape versus bracing. This has strong implications for all clinicians, but especially for those with whom budgetary restrictions are an issue. It would be interesting to see if the same results would be found if this study’s patient population was different (e.g., patients who endured an ankle sprain while wearing a preventative brace). What are your experiences with taping and bracing after an ankle injury? Do your patients seem to respond better to ankle bracing than taping when treating an ankle sprain? Is treating ankle sprains with bracing an option in your day-to-day practice? Tell us why.
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
Sacha Lardenoye, Ed Theunissen, Berry Cleffken, Peter RG Brink, Rob A de Bie and Martijn Poeze (2012). The effect of taping versus semi-rigid bracing on patient outcome and satisfaction in ankle sprains: a prospective, randomized controlled trial BMC Musculoskeletal Disorders, 13 DOI: 10.1186/1471-2474-13-81