Preventative Ankle Taping and Bracing. Lauren C. Olmsted, MEd, ATC EATA 2004 Philadelphia, PA

Transcription

1 Preventative Ankle Taping and Bracing Lauren C. Olmsted, MEd, ATC EATA 2004 Philadelphia, PA

2 Background Ankle sprains are among the most common injuries that occur in athletic participation Treatment strategies may be ineffective in preventing re-injury Residual disability after ankle sprain has been reported in as many as 70% of people suffering lateral ankle sprain

3 Background Preventative measures such as taping and bracing were developed to lower the incidence of sprain and decrease residual symptoms Several studies have shown that taping and bracing may decrease ROM, increase proprioception, decrease pain, and improve function BUT WHAT ARE THE PROBLEMS???????????

4 The problems are. Although taping and bracing affect neuromuscular characteristics, do they really lower the incidence of injury? Is the cost of taping and bracing and the time required by athletic trainers to tape athletes beneficial? Which athletes should be taped or braced?

5 A quote. as the status of the athletic trainer increases and the true value of his services are fully recognized, it becomes essential that members of the profession recognize the paucity of scientific evidence to support many of it s traditional practices Today s demands on the athletic trainer s time and budget no longer warrant the retention of practices which fail to survive the critical scrutiny of a controlled study (Simon, 1969)

6 Penn State Project Purpose 1: To review the literature to examine the effectiveness of taping and bracing using a medical model for injury prevention known as Numbers Needed to Treat (NNT) Purpose 2: To apply a cost-benefit analysis to the NNT values to examine the advantages and disadvantages of taping and bracing

7 Literature Review Original research papers were examined from Papers were excluded if they did not examine the effects of taping and bracing on injury rates Our search produced 8 articles which reported injury rates but only 3 allowed us to calculate NNT

8 5 Excluded Articles Methodological Problems No control group No random assignment of subjects Groups were not similar at baseline No exposure or injury data collected Compliance was not monitored

9 Using NNT Statistic used when trying to ascertain the clinical benefit of a treatment 1,2,3 Defined by the number of treatments necessary to prevent one injury Calculation: 1 (P2-P1) P2 = injury rate in control group P1 = injury rate in treatment group

10 What is needed for NNT Injury incidence Athlete exposures # of injuries Control group Treatment Group Injury History

11 Cost Benefit Analysis Cost of Prophylaxis Tape: $1.37/roll of J&J Zonas (Medco) Brace: $35.00 for Air Cast (Medco) Interventions Tape: 78 (6 practices/week x 13 weeks) Brace: 1 (same brace for entire season)

12 Cost Benefit Analysis Cost per Ankle Sprain NNT x cost of prophylaxis Total Cost per Season Cost per Ankle Sprain x # of interventions

13 Garrick and Requa intramural basketball players at the University of Washington from Intervention: ankle taping ATC s and ATS at UW taped all athletes and recorded athlete exposures

14 Garrick and Requa 4 NNT Results Incidence (History) Control: 24 sprains/434 exposures =.0553 Treatment: 13 sprains/794 exposures =.0164 NNT = 26 Incidence (No History) Control: 12 sprains/670 exposures =.0179 Treatment: 4 sprains/367 exposures =.0109 NNT = 143

15 Garrick and Requa 4 Cost Benefit Results (Season) History Taping: $2779 Bracing: $910 No History Taping: $15,281 Bracing: $5005

16 Sitler intramural basketball cadets at the USMA in West Point, NY from Intervention: Ankle bracing (Aircast Sports Stirrup) Research Team member assured compliance before each game

17 Sitler 5 NNT Results Incidence (History) Control: 6 sprains/90 subjects =.067 Treatment: 1 sprain/87subjects =.011 NNT = 18 Incidence (No History) Control: 29 sprains/722 subjects =.040 Treatment: 10 sprains/702 exposures =.014 NNT = 39

18 Sitler 5 Cost Benefit Results (Season) History Taping: $1924 Bracing: $630 No History Taping: $4168 Bracing: $1365

19 Surve male soccer players from 4 divisions in the Western Province of South Africa Intervention: Ankle bracing (Aircast Sports Stirrup) Coaches monitored compliance

20 Surve 6 NNT Results Incidence (History) Control: 42 sprains/131 exposures =.321 Treatment: 16 sprains/127 exposures =.126 NNT = 5 Incidence (No History) Control: 33 sprains/129 exposures =.256 Treatment: 32 sprains/117 exposures =.274 NNT = 57

21 Surve 6 Cost Benefit Results (Season) History Taping: $534 Bracing: $175 No History Taping: $6091 Bracing: $1995

22 Conclusions Taping and bracing are beneficial in reducing the incidence of ankle sprains in people WITH a previous history of sprain Bracing may offer a more cost-effective and time sensitive preventative measure

23 Limitations All three studies used different calculations of exposures making comparisons across each study difficult Although the studies we used for calculation of NNT revealed meaningful findings, it is difficult to generalize these results across all sports and all age groups

24 What is needed Large Scale Research Project Examining: Large number of athletes (1000 s) Group 1: ankle sprain history Group 2: control group Different sports represented Different age groups represented Different preventative measures Exposure data collected across seasons

25 Thank you

26 References 1. Bandolier Extra. Calculating and using NNTs. Available at Accessed February Chattellier G, Zapletal E, Lemaitre D, Menard J, Degoulet P. The number needed to treat: a clinically useful nomogram in its proper context. BMJ 1996;312: Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ 1995;310: Garrick JG, Requa RK. Role of external support in the prevention of ankle sprains. Med Sci Sports Exerc. 1973;5: Sitler M, Ryan J, Wheeler B, McBride J, Arciero R, Anderson J, Horodyski M. The efficacy of a semirigid ankle stabilizer to reduce acute ankle injuries in basketball. Am J Sports Med. 1994;22: Surve I, Schwellnus MP, Noakes T, Lombard C. A fivefold reduction in the incidence of recurrent ankle sprains in soccer players using the sport stirrup orthosis. Am J Sports Med. 1994;22: