Does early taping have superior outcomes when compared to traditional bracing in ankle rehabilitation?”

Clinical Question: Does early taping have superior outcomes when compared to traditional bracing in ankle rehabilitation?

Citation: Lardenoye S, Theunissen E, Cleffken B, Brink PR, de Bie RA, Poeze M. The effect of taping versus semi-rigid bracing on patient outcome and satisfaction in ankle sprains: a prospective, randomized controlled trial. BMC Musculoskelet Disord 2012; 13(81).

Diagnosis code: 845 – Sprains and strains of ankle and foot

Practice Pattern D- Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Connective Tissue Dysfunction.

Article Summary

The purpose of this study was to determine the effect of treatment with tape vs. brace on outcomes and satisfaction in patients with ankle sprains. 148 subjects were recruited. Inclusion criteria was Grade II or III sprain operationally defined as the presence of lateral hematoma and tenderness at the ATFL with/without anterior drawer instability. The exclusion criteria was undergoing preventative treatment of recurrent ankle sprains, fracture, age under 16 or over 55 years old, previous ankle sprain/fracture, sustained swelling that made treatment with tape impossible, mentally disabled, unwilling to participate in the study. 100 of the participants were found to be eligible for this study. 81 (39 F+ 43 M) completed the study. 38% of injuries were sport related; 3% of injuries were grade III lateral ankle sprains.

Methods

The subjects were examined in the emergency room. After ruling out fracture using Ottowa ankle rules, non-standardized crutches and pain medications were prescribed. Initial treatment consisted of a compressive bandage together with RICE protocol. Patients revisited the outpatient clinic within 5-7 days after the trauma. After ruling in Grade II/III sprains and obtaining informed consent, patients were randomized into two equal groups (N=49) by an independent research assistant using a computer-generated randomization schedule with random block size. Both the treating physicians and patients were blinded to the randomization process.

The taping group received 3 layers of Coumans-bandage. The first was to protect the skin, the second was non-elastic strapping tape used for support, the third was for fixation of the second layer. The tape was applied 5-7days post trauma and was reapplied at least once after 2 weeks or when the patients indicated that stability was lost, for hygienic purposes, or for skin-related problems. The treatment was for 4 weeks. The bracing group wore a semi-rigid brace (AirLocW Bauerfeind, Zeulenroda, Germany) 5-7 days post-trauma and for 4 weeks. Both groups performed supervised proprioceptive exercises starting one week after trauma. A HEP consisting of proprioception, range of motion, and strength exercises was given. Follow up took place at week 3, 5, 9 and 13 post-injury which was indicated in the study as week 2, 4, 8, and 12 after the start of the study treatment.

Outcomes (at 2, 4, 8 and 12 weeks)

  • Patient satisfaction survey is measured verbally on a verbal rating scale: poor (5) to excellent (1) both at 2 and 4 weeks after start of the study treatment.
  • Function was assessed using the validated Karlsson scoring scale (consists of eight categories with a total of 90 points, assessing pain, swelling, instability, stiffness, stair climbing, running, work activities and support)
  • ROM
  • Pain was evaluated using a 5-point pain scale: no pain (1) to (5) worst pain ever.

Results

During the 4th week treatment period, patient satisfaction was significantly higher in the brace group at 3 and 5 weeks (P < 0.05). While satisfaction in the tape treatment significantly decreased from week 1 till week 5 (P < 0.05), the patient-rated satisfaction improved significantly in the patients treated with a brace comparing week 3 with the start of the treatment. Of all patients treated with tape 59.1% experienced complications, including contact dermatitis, bullae formation or skin abnormalities due to increased local pressure, requiring local skin treatment or cessation of the treatment. This rate of complications was significantly lower in the brace group (14.6%, P<0.0001).

The Karlsson score increased significantly during the 4 weeks treatment and further increased thereafter until 8 weeks, after which the functional level stabilized at a mean score of 84/90. There was no difference in this increased functional ability between the two groups including time to return to normal work and sport activities.

The passive and active range of motion, expressed as the difference between the uninjured and injured ankle improved similarly in both groups.

The pain score was similar between the tape and brace treatment.

Discussion

The results of this randomized controlled trial comparing semi-rigid ankle brace with tape treatment demonstrated improved patient satisfaction with less local complications in patients treated with a semi-rigid brace but overall showed no improved in functional outcome, ROM and pain levels. However, tape treatment resulted in significantly more complications such as skin irritations, bullae formation, and hygiene problems when compared with the brace.

Clinical Application

Fifty percent of these injuries arise in sports and seventy-five percent is caused by an inversion trauma1. In the United States ankle sprains occur in an estimated 23,000 people per day, which equals about 8.4 million people per year2. In an outpatient setting, ankle sprains are one of the most common diagnoses. Ankle taping, which is performed post acute stage can be used to improve proprioception and mechanical stability3. Our clinical question was, “Does early taping have superior outcomes when compared to traditional bracing in ankle rehabilitation?” According to this study, the functional outcomes, ROM, and pain had no significant differences between the groups. Also, of all patients treated with tape, 59.1% experienced complications, including contact dermatitis, bullae formation, or skin abnormalities due to increased local pressure. These complications required local skin treatment or cessation of the treatment. According to these findings, taping is not superior to semi-rigid bracing for rehabilitation of grade II/III acute ankle sprains.

Additional References

1.  Van der Wees PJ, Lenssen AF, Feijts YAEJ, Bloo H, Van Moorsel SR, Ouderland R, et al: KNGF-richtlijn Enkelletsel. Suppl Ned Tijdschr Fysiotherapie 2006, 116:1–12.

2.  Kannus P, Renstrom P: Treatment for acute tears of the lateral ligaments of the ankle: operation, cast or early controlled mobilization. J Bone Joint Surg [Am] 1991, 73:305–312.

3. Stoffel KK, Nicholls RL, Winata AR, Dempsey AL, Boyle JJ, Lloyd DG. Effect of Ankle Taping on Knee and Ankle Joint Biomechanics in Sporting Tasks. Med Sci Sport Exer. 2010 ;42(11):2089-2097.

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