Blog Post Author Biography:  Alexandra DeJong Lempke is an Assistant Professor in the Department of Physical Medicine & Rehabilitation at Virginia Commonwealth University, and has a clinical background as a certified athletic trainer. Dr. DeJong Lempke’s research focuses on biomechanical gait assessments of lower limb and ankle injuries through wearable technologies.

Citation: Kenneth C. Lam, Ashley N. Marshall, R. Curtis Bay, Erik A. Wikstrom; Patient-Reported Outcomes at Return to Sport After Lateral Ankle Sprain Injuries: A Report From the Athletic Training Practice-Based Research Network. J Athl Train. 2023; 58 (7-8): 627–634. doi: https://doi.org/10.4085/1062-6050-0111.22

Take-to-the-clinic message: Athletes across the United States self-reported residual pain, dysfunction, and disability at the time of return to sport after a lateral ankle sprain. Clinicians should implement patient-reported outcomes to catch lingering deficits post-ankle sprain to help guide return to sport decision-making.

Background: Lateral ankle sprains (LAS) are extremely common in sport and are often viewed as insignificant injuries with quick recoveries. Most patients return to sport within 10 days of injury, yet it is not clear if athletes may have lingering symptoms that may affect their long-term health. Understanding how patients with ankle sprains feel at the time of return to sport is important to catch residual problems post-injury and help with clinical decision-making.

Purpose: The purpose of this study was to evaluate self-reports of improvement, pain, function, and disability at return to sport after an LAS injury using single-item patient-reported outcome measures.

Methods: This was a retrospective study of 637 patients with LAS who returned to sport within 60 days of injury. The researchers identified LAS cases from electronic medical records within the 2010-2021 Athletic Training Practice-Based Research Network database (AT-PBRN; 69 clinical practice sites with athletic trainers). The research team assessed pertinent patient details, such as school level, gender, and sport. They also assessed patient-reported outcome measures relevant to LAS at initial injury evaluation and at the time of return to sport:

• Improvement – Global Rating of Change
• Pain – Numeric Pain Rating Scale
• Function – Global Rating of Function
• Disability – Global Rating of Disability

Results: The LAS patients assessed in this study were about equal genders (53.2% males), were primarily secondary school aged (79.1% of the sample) and participated in field or court sports (78% played in either basketball, football, soccer, or volleyball). Most patients returned to sport within 8 days after LAS. About 2 in every 3 patients reported a meaningful improvement at return to sport, or feeling at least “quite a bit better” on the Global Rating of Change scale. Most patients also still felt they had lingering deficits at return to sport, particularly for lingering pain (~65%), reduced function (~86%), and residual disability (~36%).

Rolling the field forward: This research shows that although LAS patients improve after their injury, many patients still feel like they have not fully recovered when they return to their sport. Clinicians should incorporate objective measures like patient-reported outcomes into return-to-sport decisions to best understand deficits related to LAS and advocate for athlete well-being.

Question for the researchers: Do you think that incorporating patient-reported outcome measures specific to the ankle would have uncovered more lingering deficits at return to sport? How do you think external pressures, such as competition timepoints, may have influenced the findings? Would it be possible to determine if repeat injuries occurred among those with lingering deficits, signaling Chronic Ankle Instability?