Tag: HRQoL

Patient-Reported Outcomes at Return to Sport After Lateral Ankle Sprain Injuries

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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?

Association Between Ankle Osteoarthritis, Injury, Surgery, Health Related Quality of Life

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Blog Post Author Biography:  Erik Wikstrom is an Associate Professor and Athletic Trainer at the University of North Carolina at Chapel Hill.  Dr. Wikstrom has spent the last 20+ years studying the consequences of and optimizing interventions for ankle sprains and chronic ankle instability.

Citation:  Paget L, Aoki H, Kemp S, Lambert M, Readhead C, Stokes K, Viljoen W, Reurink G, Tol J, Kerkoffs G, Gouttebarge V.  Ankle osteoarthritis and its association with severe ankle injuries, ankle surgeries and health-related quality of life in recently retired professional male football and rugby players: a cross-sectional observational study.  BMJ Open. 2020;10:e036775.  Doi:10.1136/bmjopen-2020-036775.

Take-to-the-clinic message: A history of severe ankle injury and/or ankle surgery increases a professional footballer’s risk of ankle osteoarthritis (OA).  Educating professional footballers, and all athletes, about the long-term risks of ankle injuries and surgeries will be critical to engaging athletes in ankle injury prevention as well as proper treatment protocols post injury and post operatively.  While the presence of ankle OA did not reduce mental or physical quality of life at the time of assessment (~5 years post retirement, ~36 years of age) the impact of ankle OA later in life has been shown to be more severe in other investigations. 

Background: Ankle injuries are very common in football (soccer) and rugby.  Previous ankle injuries, including ankle sprains, are an important risk factor for ankle OA and the presence of OA, in any joint, has been associated with poor mental and physical health-related quality of life.  However, there is limited data on how ankle injuries and surgeries relate to ankle OA and quality of life in retired football and rugby players.

Purpose: The aims of the study were to determine: i) the prevalence of ankle OA in recently retired professional football and rugby players, ii) the association between ankle injury, ankle surgery, and ankle OA, and iii) differences in mental and physical quality of life between those with and without ankle OA.

Methods: A cross-sectional questionnaire based observational study of recently retired male professional football and rugby players was conducted.  A total of 401 foot and 152 rugby players volunteered and completed the survey (response rate of 56%).  The survey captured demographics, severe ankle injury and ankle surgery history, presence of an ankle OA diagnosis, and quality of life via the PROMIS General Health short form. A logistic regression determined the association between severe ankle injuries and surgeries with ankle OA after adjusting for age and BMI while Mann-Whitney U tests compared quality of life between those with and without ankle OA.

Results: Recently retired professional footballers and rugby players were more likely to have ankle OA than the general population.  Retired football, but not rugby, players with a history of severe ankle injuries and/or ankle surgeries had an increased risk of developing ankle OA compared to their counterparts who did not sustain such injuries or undergo ankle surgeries.  The presence of ankle OA did not reduce mental or physical quality of life of recently retired footballers who were about 5 years post retirement.

Rolling the field forward: This research is part of a growing body of evidence highlighting the long-term negative impact of ankle injuries and surgeries among both athletes and the physically active.  This knowledge helps to further emphasize the need to educate athletes and other stakeholders on the importance of primary and secondary preventive measures for ankle injuries in order to reduce the burden of such injuries after the athlete’s playing career and later in life.

Question for the researchers: Why did the authors choose a whole body questionnaire instead of a region-specific questionnaire such as the Foot and Ankle Ability Measure?  With hindsight, do the authors believe that a more region-specific questionnaire may have been more sensitive to potential quality of life declines in this relatively young sample?