Patient, Treatment, and Cost Characteristics Associated With Sport-Related Ankle Sprains: A Report From the Athletic Training Practice-Based Research Network
2019; Volume: 12; Issue: 4 Linguagem: Inglês
10.3928/19425864-20190521-01
ISSN1942-5872
AutoresAshley N. Marshall, Teresa M. Kikugawa, Kenneth C. Lam,
Tópico(s)Lower Extremity Biomechanics and Pathologies
ResumoOriginal Research freePatient, Treatment, and Cost Characteristics Associated With Sport-Related Ankle Sprains: A Report From the Athletic Training Practice-Based Research Network Ashley N. Marshall, PhD, ATC, , , PhD, ATC Teresa M. Kikugawa, DAT, ATC, , and , DAT, ATC Kenneth C. Lam, ScD, ATC, , ScD, ATC Ashley N. Marshall, PhD, ATC , Teresa M. Kikugawa, DAT, ATC , and Kenneth C. Lam, ScD, ATC Athletic Training & Sports Health Care, 2019;12(4):173–180Published Online:May 21, 2019https://doi.org/10.3928/19425864-20190521-01PDFAbstract ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInRedditEmail SectionsMoreAbstractPurpose:To describe patient, treatment, and cost characteristics associated with complete ankle sprain patient cases managed by athletic trainers.Methods:Electronic patient records for complete ankle sprain cases documented within the Athletic Training Practice-Based Research Network were identified and reviewed. Summary statistics were calculated for patient, treatment, and cost characteristics. Treatment characteristics included type of athletic training service, duration of care, episodes of care, and amount of care. Direct costs of care were estimated by applying the Centers for Medicare and Medicaid Services Physician Fee Schedule for non-facility organizations.Results:One hundred thirty patient cases (male = 60%, secondary school setting = 101 [76.5%], age = 16.6 ± 1.9 years, height = 172.7 ± 9.9 cm, mass = 72.1 ± 15.5 kg) were identified. The most frequently used treatments were hot/cold pack (22.6%), therapeutic exercise (22.2%), and strapping (9.2%). The duration of care was 21.9 ± 18.5 days across 7.6 ± 5.0 episodes of care per case. The amount of care was 17.6 ± 12.6 services per case and 2.3 ± 1.3 services per episode of care. The estimated direct cost of care was $533.72 ± $508.88 per case and $70.73 ± $45.60 per episode of care.Conclusions:Athletic trainers appear to be underutilizing treatments that are effective in reducing recurrence and long-term complications, such as therapeutic activities, neuromuscular reeducation, and manual therapies. The estimated direct costs of care rendered from athletic training services for these injuries provide insight into the valuable role of athletic trainers in the management of ankle sprains.[Athletic Training & Sports Health Care. 2020;12(4):173–180.]IntroductionAnkle sprains are one of the most common musculoskeletal injuries associated with physical activity. An estimated 2.15 new injuries occur per 1,000 person-years in the United States,1 and 30% of those occur within organized sport.2 In the 2004–2005 secondary academic year alone, just over 7 million high school students participated in athletics, which increased to nearly 8 million by 2017.3 Of all recorded sport-related injuries during this time period, 50% of lower extremity injuries were ligament sprains and 40% of these sprains were to ligaments in the ankle.4 Similar statistics are reported in collegiate athletics, as lateral ligament complex ankle sprains have been the most commonly reported injury diagnosis.5 Although lateral ankle sprains are the most common injury in an athletic population,2,6,7 clinicians are also tasked with managing the less commonly diagnosed deltoid and tibiofibular ligament sprains.7Ankle sprains are generally thought to be "mild" injuries, but they are associated with long-term consequences including diminished function,8 reduced physical activity,9 and deficits to health-related quality of life.10 Furthermore, these injuries have been associated with chronic conditions, such as chronic ankle instability11 and post-traumatic osteoarthritis.12 Due to the potential for poor outcomes13 and high risk of reinjury14 following an ankle sprain, there has been an increased focus on the proper management and treatment of these injuries. Recently, Simon et al15 evaluated athletic training services provided for ankle sprain injuries in the high school setting through the National Athletic Treatment, Injury and Outcomes Network (NATION) database, and reported that athletic trainers are generally following treatment guidelines set forth by the National Athletic Trainers' Association position statement.16 For example, athletic trainers frequently provided therapeutic exercise and neuromuscular reeducation for both time-loss and non–time-loss ankle sprain injuries.15 This strategy is in line with best practice for prevention of recurrent sprain,16 addressing deficits to strength, balance, and function.Although recent findings have evaluated the services athletic trainers are providing for ankle sprains,15,17 several gaps in the literature still exist. First, injury documentation is often cited as a limitation within athletic health care research,18 and limits the ability to observe the athletic training services provided over the entire duration of care. Simon et al15 noted that their dataset may have been incomplete and, as a result, athletic trainers may not have reported all of the care provided for ankle sprain injuries. Incomplete documentation of athletic injuries is problematic and may lead to the underestimation or overestimation of findings. However, analyzing the services provided for complete patient cases from intake to discharge may provide a better estimation of treatment patterns at the point-of-care. Additionally, there has been limited evidence regarding the estimated direct costs associated with treatment and the care provided for these injuries. It has been proposed that athletic trainers reduce health care costs by limiting the number of referrals to other health care professionals15; however, the value of the athletic training services provided for these injuries has not been investigated. Both treatment strategy and estimated direct costs of care are important to the athletic training profession because they characterize and quantify the value of the care being provided to athletes. Therefore, the purpose of this study was to describe patient, treatment, and cost characteristics associated with complete ankle sprain patient cases managed by athletic trainers.MethodsDesign and SettingThis study was a retrospective analysis of de-identified patient electronic medical records (EMRs) collected within the Athletic Training Practice-Based Research Network (AT-PBRN). The AT-PBRN and its features, including its EMR system, infrastructure, clinician training, and data collection methods, have been described in previous studies.17,19 All patient records were created by the participating athletic trainer providing care within the secondary school or collegiate setting. For this study, there was a total of 43 clinical practice sites (secondary school = 39, college = 4) across 11 states (Arizona, Florida, Kansas, Massachusetts, Minnesota, Missouri, New Hampshire, New York, Utah, Virginia, and Wisconsin). Clinical practice sites were predominantly public high schools (83.7%), set in an urban area (41.9%), and employed one certified athletic trainer (48.8%).ParticipantsA total of 113 athletic trainers practiced at these clinical practice sites during the study period. Most athletic trainers were female (60.2%) and held a master's degree (76.7%). On average, the athletic trainers were 30.0 ± 11.2 years old, certified for 3.9 ± 5.1 years, and employed at their current site for 0.7 ± 2.2 years, on a part-time (41.8%) or full-time (37.2%) basis. This study was deemed exempt by the university's institutional review board because it was a retrospective analysis of de-identified patient records.ProceduresAll data were collected by a participating athletic trainer within the AT-PBRN using the web-based CORE-AT EMR system.19 Patient records from each of the AT-PBRN clinical practice sites between 2009 and 2017 were reviewed. Patient cases were first identified using the International Classification of Disease, version 9 (ICD-9) diagnostic codes in the injury demographics form of the EMR, following standard procedures used in previous studies.17,19 Cases were retained if the ICD-9 code matched one of the following: 845.0 (ankle sprain/strain), 845.1 (deltoid ligament sprain), or 845.3 (tibiofibular ligament sprain). In an effort to ensure quality data, only complete patient cases were included, defined as injuries that had (1) a documented first encounter or injury demographics form, (2) injury evaluation, (3) daily treatment forms with at least one encounter per week for the duration of care, and (4) discharge form (the last documented session with the patient). These data were used to analyze patient characteristics, treatment procedures, and associated cost for each ankle sprain injury.Patient characteristic variables extracted from the demographics form included sex, sport, activity during injury (ie, practice or competition), mechanism of injury, and diagnosis. Procedures obtained from the daily treatment forms consisted of all of the current procedural terminology codes (CPT) that the athletic trainer implemented during each episode of care (ie, documented patient encounter) (Table 1). Each CPT code was associated with a direct cost of care, estimated by implementing the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule for non-facility (ie, non-hospital) organizations (Table 1).20 Direct cost was calculated based on the fee associated with the CPT code and the number of 15-minute increments documented. The estimated direct cost of care for each treatment and the number of services rendered were used to calculate the average total direct cost per ankle sprain case and average direct cost per episode of care.Table 1 Athletic Training Services Provided for the Management of Lateral Ankle SprainsTreatment or ProcedureCPT CodeMean Fee (2009–2017)Fee Range (2009–2017)Aquatic therapy97113$40.87$34.26 to $43.78Athletic trainer evaluation97005$76.85$69.97 to $86.49Athletic trainer reevaluation97006$45.39$37.51 to $58.74Contrast bath97034$17.24$14.79 to $18.33Electrical stimulation97014$18.42$16.23 to $19.40Gait training97116$27.41$24.53 to $28.75Hot or cold pack97010$0.00$0.00 to $0.00Infrared97026$5.77$5.05 to $6.12Iontophoresis97033$28.51$22.25 to $33.06Manual therapy techniques97140$28.95$25.97 to $30.51Massage97124$25.33$22.36 to $26.95Neuromuscular reeducation97112$32.36$28.85 to $34.45Physical performance test or measurement97750$32.20$28.85 to $33.67Strapping: ankle29540$33.53$26.23 to $39.09Strapping: knee29230$43.19$28.75 to $53.76Therapeutic activities97110$33.66$29.57 to $35.53Therapeutic exercises97530$31.11$28.13 to $33.02Ultrasound97035$12.45$11.54 to $12.94Vasopneumatic devices97016$18.29$15.15 to $19.74Whirlpool97022$21.94$17.31 to $24.05CPT = Current Procedural TerminologyInstrumentationThe CORE-AT ( www.core-at.com)19 uses four forms for full documentation of an injury from first contact with the athletic trainer through discharge. After a patient has been entered into the system, the athletic trainer completes the injury demographics (eg, sex, sport, age, height, and mass), initial evaluation, daily treatments (ie, procedural summaries), and discharge (ie, functional and special tests used for decision making regarding discharge from care) forms throughout the duration of the injury. Patient data were formatted as structured variables within the EMR and recorded using either a drop-down menu or radio buttons. In-depth features and functionality of the CORE-AT have been thoroughly described in previous studies generated through the AT-PBRN.17,19AnalysisSummary statistics (frequency, percentage, and mean ± standard deviation) were calculated for all variables. Treatment characteristics included the type (CPT code), amount of care (number of services per case), and duration of care (number of days between intake and discharge). Direct cost characteristics included the number of services per case and procedural total cost per case and per episode of care. Additional calculations estimated the minimum, maximum, median, and interquartile range for the cost variables. All analyses were conducted using IBM SPSS Statistics software (version 24; IBM Corporation, Armonk, NY).ResultsPatient CharacteristicsDuring the study period, 1,104 ankle sprains were documented, of which 130 patient cases were complete (males = 78 [60%]; secondary school setting = 101 [76.5%], age = 16.6 ± 1.9 years; height = 172.7 ± 9.9 cm; mass = 72.2 ± 15.5 kg). Of the complete cases, the most commonly documented diagnosis was sprain/strain (ICD-9 code: 845.0, n = 107, 82.3%), followed by tibiofibular ligament sprain (ICD-9 code: 845.1, n = 19, 14.6%) and deltoid ligament sprain (ICD-9 code 845.3, n = 4, 3.1%). Mechanism of injury included contact (n = 39, 39%), twisting (n = 37, 35.6 %), non-contact (n = 31, 23.8%), and falls (n = 23, 17.7%), and injuries were most likely to occur in football (n = 45, 34.6%), basketball (n = 22, 16.9%), soccer (n = 20, 15.4%), and volleyball (n = 11, 8.5%) (Table 2). Within each sport, in-season practices (n = 51, 39.2%) and in-season games (n = 51, 39.2%) were equally the most reported activities during injury (Table 3). Patients resumed full function 6.92 ± 14.39 days following injury.Table 2 Frequency of Ankle Sprain Cases According to SportSportNo. (%)Football45 (34.6)Basketball22 (16.9)Soccer20 (15.4)Volleyball11 (8.5)Track9 (6.9)Tennis5 (3.8)Gymnastics4 (3.1)Baseball4 (3.1)Lacrosse3 (2.3)Field hockey3 (2.3)Softball2 (1.5)Cross-country1 (0.8)Other1 (0.8)Total130 (100)Table 3 Activity During Ankle Sprain InjurySportNo. (%)Pre-season conditioning4 (3.1)Pre-season scrimmage5 (3.8)In-season practice51 (39.2)In-season game51 (39.2)Post-season practice1 (0.8)Post-season game0 (0.0)Off-season conditioning1 (0.8)Off-season practice5 (3.8)Not sports related12 (9.2)Total130 (100)Treatment CharacteristicsA total of 2,292 procedures were documented for the treatment of patient cases, with 17.6 ± 12.6 services provided per case (range: 3 to 63 services). From first documented encounter to discharge, the duration of care lasted 21.5 ± 18.5 days (range: 1 to 88 days). The most commonly used procedures were hot/cold packs (n = 519, 22.6%), therapeutic exercise (n = 508, 22.2%), athletic trainer reevaluation (n = 382, 16.7%), and strapping (ie, taping and bracing; n = 210, 9.2%). The least used procedures were infrared (n = 1, < 0.1%), contrast bath (n = 6, 0.3%), and neuromuscular reeducation (n = 6, 0.3%) (Table 4). The average number of episodes of care per patient case was 7.55 ± 5.0 (range: 2 to 29), and patients received 2.3 ± 1.3 treatments per episode of care.Table 4 Athletic Training Services Provided During Patient EncountersTreatment or ProcedureNo. (%)Hot or cold pack519 (22.6)Therapeutic exercise508 (22.2)Athletic trainer reevaluation382 (16.7)Strapping: ankle and/or foot210 (9.2)Athletic trainer evaluation141 (6.2)Therapeutic activities137 (6.0)Electrical stimulation117 (5.1)Massage91 (4.0)Whirlpool86 (3.8)Manual therapy techniques35 (1.5)Ultrasound25 (1.1)Vasopneumatic devices14 (0.6)Physical performance test or measurement9 (0.4)Contrast bath6 (0.3)Neuromuscular reeducation6 (0.3)Aquatic therapy3 (0.1)Strapping: knee2 (0.1)Infrared1 (0)Total2,292 (100)Cost CharacteristicsPatients received a total of 18.6 ± 13.7 services per case, rendering a total procedural direct cost of $533.72 ± $508.88 (median = $359.17, range = $75.44 to $2,856.21, interquartile range = $145.90 to $572.45; Figure 1). Patients received 2.34 ± 1.3 services per episode of care, resulting in a procedural direct cost of $70.73 ± $45.6 per episode of care (median = $65.08, range = $0.00 to $280.32, interquartile range = $33.79 to $96.37).Figure 1. Total direct costs of care for ankle sprain cases. Bee swarm box plot of all results. The box indicates the 25th and 7th quartiles and the central line is the median. The ends of the whiskers are the 2.5% and 97.5% values. Each dot represents the total cost of care for one entire ankle sprain case.DiscussionTo the best of our knowledge, this is the first study to describe patient, treatment, and cost characteristics specific to complete ankle sprain patient cases evaluated and managed by athletic trainers. The patient characteristics in this study were in line with previous point-of-care evidence17,19,21 because injuries occurred primarily within in-season practices and competitions during football, basketball, and soccer. Not only is the ankle the most commonly injured body part in sports, but it has also been reported that it is the most frequently treated by athletic trainers,21 highlighting the role that athletic trainers play in the athletic health care system. Although Simon et al15 reported the number of episodes of care and athletic training services per injury, they did not report the duration of care for these ankle sprain injuries. In the current study, ankle sprain injuries were treated for an average of 3 weeks and, to our knowledge, this is the first study to report such data. Previous investigations have provided insight into practice characterization, explained treatment strategies, and described time from injury until return to sport22; however, limited information is available regarding the services provided by athletic trainers for ankle sprains over the duration of care and the value of these services.In the current study, athletic trainers provided an average of 18 services over 3 weeks for each ankle sprain case. The most frequently documented services included hot/cold pack (22.6%), therapeutic exercise (22.2%), reevaluation (16.7%), and strapping (9.2%). Of these procedures, therapeutic exercise is supported with the best evidence,16,23 because it has been shown to consistently improve self-reported function and prevent recurrent injury following acute ankle sprains, particularly when prescribed in high doses (ie, > 900 minutes of therapeutic exercise).24 A recent consensus statement25 recommended that clinicians use a rehabilitation-oriented assessment to develop appropriate management strategies and effectively target mechanical and sensorimotor impairments during rehabilitation. Furthermore, combining functional rehabilitation with an external support (eg, bracing, taping) has also been identified as an effective strategy to improve function and reduce recurrent sprains.23 Although evidence suggests that cryotherapy provides a temporary improvement in secondary outcomes (eg, pain),26 there is disparity over whether it improves primary outcomes (eg, self-reported function and clinical outcomes).16 As a result, it is important to consider the context of how the clinician incorporates this modality when treating ankle sprain injuries. Ice, or some other form of cryotherapy, is often immediately applied to provide an analgesic effect, control excess swelling, and reduce the risk of secondary hypoxic tissue damage.26 Due to the popularity of cryotherapy in athletic health care following an acute injury, evidence is limited as to whether cryotherapy on its own will improve primary outcomes; however, treatment success has been noted when ice is combined with therapeutic exercise.23Simon et al15 reported that athletic trainers provided an average of 22 services per ankle sprain injury, listing therapeutic activities or exercises (47.4%), neuromuscular reeducation (16.6%), strapping (14.2%), and modalities (11.5%) as the most common services provided. In comparison, athletic trainers in the current study had a low use of neuromuscular reeducation (n = 6, 0.3%). It is possible that athletic trainers within the AT-PBRN may have been documenting this procedure under a different category, such as functional rehabilitation, or as a therapeutic activity. However, even if athletic trainers documented neuromuscular reeducation using the CPT code for therapeutic activities, there is a low prevalence of this treatment category being reported (n = 137, 6%). Although patients in the current study received an average of 3 weeks of care, the type of care provided may not have allowed for functional rehabilitation, strength, and sensorimotor deficits to be truly addressed and corrected. In addition, athletic trainers in the current study returned athletes to full sport participation approximately 1 week following injury. This finding is in line with previous evidence highlighting that there is a 95% probability that patients who suffer a first-time ankle sprain will return to full participation within 10 days.27 Nevertheless, a large proportion of patients who suffer an acute lateral ankle sprain experience prolonged mechanical and sensorimotor deficits following injury.11 This disparity between a seemingly not ideal rehabilitation progression and early return to sport is likely contributing to the high rate of injury recurrence and poor long-term outcomes following ankle sprain injuries.25,28 Moreover, previous investigations have identified that evidence-based rehabilitation reduces the risk of recurrent injury.29 Thus, it is imperative that clinicians assess mechanical and sensorimotor deficits on initial evaluation and throughout the rehabilitation process to appropriately manage these injuries and mitigate negative long-term consequences.25The use of non-steroidal anti-inflammatory drugs, a treatment strategy supported by quality evidence,16 was not documented within this study or the study by Simon et al.15 Even over-the-counter medications require parental consent to be administered to minors, and the ability to obtain consent may hinder athletic trainers from providing non-steroidal anti-inflammatory drugs for the management of ankle sprains. However, parents or guardians may have been providing patients with these medications outside of the purview of the athletic trainer. Additionally, manual therapy was one of the least used services in both studies (approximately 3% of all treatments), although joint mobilizations are known to increase dorsiflexion range of motion and correct positional faults.30 Although additional research is warranted to determine the appropriate frequency and duration of this treatment, it is interesting that athletic trainers are generally not employing this type of intervention with athletes who have suffered an ankle sprain.Methodologically, several differences exist between the current study and the study conducted by Simon et al.15 For instance, the AT-PBRN uses the CORE-AT EMR for all participating athletic trainers,19 whereas the NATION data collection tools are embedded into commercially available EMRs.31 The data are then sent to the Datalys Center for Sports Injury Research and Prevention, Inc., and combined across the numerous EMRs.15,31 Thus, variation may exist between how AT-PBRN participating athletic trainers and NATION participating athletic trainers are instructed to document injury treatment, and within the type of data analyzed (ie, structured vs unstructured variables).Recently, there have been calls to highlight the value of athletic trainers in athletic health care. In a series of Value Models,32,33 the National Athletic Trainers' Association proposed that the value of the services provided must be established to eventually determine the value of those services, and ultimately demonstrate why athletic trainers are vital health care providers. Despite these calls, there is limited information regarding the estimated direct costs associated with services provided for ankle sprain injuries specifically by athletic trainers. In the United States alone, an ankle sprain averages $1,211.15 per emergency department visit,34 which typically consists of unnecessary imaging to rule out fracture and little to no follow-up treatment. In fact, approximately 80% to 90% of patients who report to the emergency department for an ankle sprain undergo imaging, but fewer than 15% of patients actually have a fracture.34 Feger et al35 estimate the financial burden associated with the diagnosis and management of lateral ankle sprain injuries to be $152 million in the United States, with most of the cost related to physician evaluations and only 7.9% resulting from physical therapy.According to our study, the median cost per case was $359.17, comprising only services provided by athletic trainers and not unnecessary imaging or potentially un-warranted referrals. Eleven of these cases were identified as outliers, for which the direct cost of care was substantially higher than the rest of the cases. On further investigation, it was determined that nine of the outliers were injuries that occurred and were treated in the collegiate setting. It is likely that the athletic trainers treating these patients had a greater number of resources than those treating patients in the secondary school setting, contributing to the increased cost. Further, according to the Centers for Medicare and Medicaid Services,20 the CPT code for hot/cold pack does not render a cost associated with the treatment. Similarly, athletic trainers are often reevaluating and reassessing the status of an injury throughout the treatment process to monitor progress, but evaluation and reevaluation CPT codes can only be billed every 14 days. Both of these circumstances contribute to a potential underestimation of the direct cost of care for the actual services rendered.In the current study, only 11.77% of the ankle sprain injuries documented during the study period met the criteria to be considered a complete patient case. We opted to only evaluate complete patient cases in an effort to combat some of the issues regarding documentation habits within the athletic training profession18; however, complete and consistent documentation of all patient care provided by athletic trainers would deliver stable data for point-of-care research. Future investigations should focus on a cost savings analysis within athletic training practice. To truly measure cost savings to the health care system as a result of services provided by an athletic trainer, we must first determine the worth of the services rendered, assess the quality of these services through the incorporation of patient outcomes, and incorporate stakeholders to ultimately estimate the value the care provided. In addition, although this study provides an estimate of the direct costs of care for the management of ankle sprains, indirect costs (eg, time loss or follow-up care) add to the societal burden following these injuries.11 Future investigations should also seek to determine the indirect costs of these injuries and how they are influenced by management strategies.Implications for Clinical PracticeAlthough athletic trainers are generally following recommendations for the management of ankle sprain injuries, they appear to be underutilizing treatments that are effective in reducing recurrence and long-term complications, such as therapeutic activities, neuromuscular reeducation, and manual therapies. The estimated direct costs of care rendered from athletic training services for these injuries provide insight into the valuable role of athletic trainers in the management of ankle sprains.1.Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont PJ. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010; 92:2279–2284.10.2106/JBJS.I.01537 CrossrefGoogle Scholar2.Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007; 42:311–319. Google Scholar3.National Federation of High School Associations. 2016–2017 High School Athletics Participation Survey. 2017; www.nfhs.org/ParticipationStatistics/PDF/2016-17_Participation_Survey_Results.pdf. Accessed July 1, 2018. Google Scholar4.Fernandez WG, Yard EE, Comstock RD. Epidemiology of lower extremity injuries among U.S. high school athletes. Acad Emerg Med. 2007; 14:641–645.10.1197/j.aem.2007.03.1354 CrossrefGoogle Scholar5.Roos KG, Kerr ZY, Mauntel TC, Djoko A, Dompier TP, Wikstrom EA. The epidemiology of lateral ligament complex ankle sprains in National Collegiate Athletic Association sports. Am J Sports Med. 2017; 45:201–209.10.1177/0363546516660980 CrossrefGoogle Scholar6.Nelson AJ, Collins CL, Yard EE, Fields SK, Comstock RD. Ankle injuries among United States high school sports athletes, 2005–2006. J Athl Train. 2007; 42:381–387. Google Scholar7.Swenson DM, Collins CL, Fields SK, Comstock RD. Epidemiology of U.S. high school sports-related ligamentous ankle injuries, 2005/06–2010/11. Clin J Sport Med. 2013; 23:190–196.10.1097/JSM.0b013e31827d21fe CrossrefGoogle Scholar8.Arnold BL, De La Motte S, Linens S, Ross SE. Ankle instability is associated with balance impairments: a meta-analysis. Med Sci Sports Exerc. 2009; 41:1048–1062.10.1249/MSS.0b013e318192d044 CrossrefGoogle Scholar9.Hubbard-Turner T, Turner MJ. Physical activity levels in college students with chronic ankle instability. J Athl Train. 2015; 50:742–747.10.4085/1062-6050-50.3.05 CrossrefGoogle Scholar10.Houston MN, Van Lunen BL, Hoch MC. Health-related quality of life in individuals with chronic ankle instability. J Athl Train. 2014; 49:758–763.10.4085/1062-6050-49.3.54 CrossrefGoogle Scholar11.Gribble PA, Bleakley CM, Caulfield BM, et al.Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med. 2016; 50:1496–1505.10.1136/bjsports-2016-096189 CrossrefGoogle Scholar12.Golditz T, Steib S, Pfeifer K, et al.Functional ankle instability as a risk factor for osteoarthritis: using T2-mapping to analyze early cartilage degeneration in the ankle joint of young athletes. Osteoarthritis Cartilage. 2014; 22:1377–1385.10.1016/j.joca.2014.04.029 CrossrefGoogle Scholar13.Anandacoomarasamy A, Barnsley L. Long term outcomes of inversion ankle injuries. Br J Sports Med. 2005; 39:e14.10.1136/bjsm.2004.011676 CrossrefGoogle Scholar14.McKay GD, Goldie PA, Payne WR, Oakes BW. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med. 2001; 35:103–108.10.1136/bjsm.35.2.103 CrossrefGoogle Scholar15.Simon JE, Wikstrom EA, Grooms DR, Docherty CL, Dompier TP, Kerr ZY. Athletic training service characteristics for patients with ankle sprains sustained during high school athletics. J Athl Train. 2019; 54:676–683.10.4085/1062-6050-449-16 CrossrefGoogle Scholar16.Kaminski TW, Hertel J, Amendola N, et al.National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train. 2013; 48:528–545.10.4085/1062-6050-48.4.02 CrossrefGoogle Scholar17.Lam KC, Snyder Valier AR, Valovich McLeod TC. Injury and treatment characteristics of sport-specific injuries sustained in interscholastic athletics: a report from the Athletic Training Practice-Based Research Network. Sports Health. 2015; 7:67–74.10.1177/1941738114555842 CrossrefGoogle Scholar18.Bacon CEW, Eppelheimer BL, Kasamatsu TM, Lam KC, Nottingham SL. Athletic trainers' perceptions of and barriers to patient care documentation: a report from the Athletic Training Practice-Based Research Network. J Athl Train. 2017; 52:667–675.10.4085/1062-6050-52.3.15 CrossrefGoogle Scholar19.Valovich McLeod TC, Lam KC, Bay RC, Sauers EL, Snyder Valier AR. Practice-based research networks, part II: a descriptive analysis of the Athletic Training Practice-Based Research Network in the secondary school setting. J Athl Train. 2012; 47:557–566.10.4085/1062-6050-47.5.05 CrossrefGoogle Scholar20.U.S. Centers for Medicare & Medicaid Services. Physician Fee Schedule Search. 2019; https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx. Accessed February 13, 2019. Google Scholar21.Lam KC, Valier AR, Anderson BE, McLeod TC. Athletic training services during daily patient encounters: a report from the Athletic Training Practice-Based Research Network. J Athl Train. 2016; 51:435–441.10.4085/1062-6050-51.8.03 CrossrefGoogle Scholar22.McCann R, Kosik K, Terada M, Gribble P. Residual impairments and activity limitations at return to play from a lateral ankle sprain. Int J Athl Ther Train. 2018; 23:83–88.10.1123/ijatt.2017-0058 CrossrefGoogle Scholar23.Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med. 2017; 51:113–125.10.1136/bjsports-2016-096178 CrossrefGoogle Scholar24.Bossard DS, Remus A, Doherty C, Gribble PA, Delahunt E. Developing consensus on clinical assessment of acute lateral ankle sprain injuries: protocol for an international and multidisciplinary modified Delphi process. Br J Sports Med. 2018; 52:1539.10.1136/bjsports-2017-099007 CrossrefGoogle Scholar25.Delahunt E, Bleakley CM, Bossard DS, et al.Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium. Br J Sports Med. 2018; 52:1304–1310.10.1136/bjsports-2017-098885 CrossrefGoogle Scholar26.Knight KL. Cryotherapy in Sport Injury Management. Champaign, IL: Human Kinetics; 1995. Google Scholar27.Medina McKeon JM, Bush HM, Reed A, Whitington A, Uhl TL, McKeon PO. Return-to-play probabilities following new versus recurrent ankle sprains in high school athletes. J Sci Med Sport. 2014; 17:23–28.10.1016/j.jsams.2013.04.006 CrossrefGoogle Scholar28.Gribble PA, Bleakley C, Caulfield B, et al.2016 consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med. 2016; 50:1493–1495.10.1136/bjsports-2016-096188 CrossrefGoogle Scholar29.Bleakley C, Taylor J, Dischiavi S, Doherty C, Delahunt E. Rehabilitation exercises reduce re-injury post-ankle sprain, but the content and parameters of an optimal exercise program have yet to be established: a systematic review and meta-analysis [published online ahead of print October 26, 2018]. Arch Phys Med Rehabil.10.1016/j.apmr.2018.10.005 CrossrefGoogle Scholar30.Hoch MC, Andreatta RD, Mullineaux DR, et al.Two-week joint mobilization intervention improves self-reported function, range of motion, and dynamic balance in those with chronic ankle instability. J Orthop Res. 2012; 30:1798–1804.10.1002/jor.22150 CrossrefGoogle Scholar31.Dompier TP, Marshall SW, Kerr ZY, Hayden R. The National Athletic Treatment, Injury and Outcomes Network (NATION): methods of the surveillance program, 2011–2012 through 2013–2014. J Athl Train. 2015; 50:862–869.10.4085/1062-6050-50.5.04 CrossrefGoogle Scholar32.National Athletic Trainers' Association. Secondary School Value Model. 2015. https://www.nata.org/sites/default/files/secondary_school_value_model.pdf. Accessed June 3, 2018. Google Scholar33.National Athletic Trainers' Association. College-University Value Model. 2013. https://www.nata.org/sites/default/files/college-value-model.pdf. Accessed June 3, 2018. Google Scholar34.Shah S, Thomas AC, Noone JM, Blanchette CM, Wikstrom EA. Incidence and cost of ankle sprains in United States emergency departments. Sports Health. 2016; 8:547–552.10.1177/1941738116659639 CrossrefGoogle Scholar35.Feger M, Glaviano N, Donovan L, et al.Current trends in the management of lateral ankle sprain in the United States. Clin J Sport Med. 2017; 27:145–152.10.1097/JSM.0000000000000321 CrossrefGoogle Scholar Previous article Next article FiguresReferencesRelatedDetails Request Permissions InformationCopyright 2019, SLACK IncorporatedThe authors thank the participating members of the Athletic Training Practice-Based Research Network for their work to develop and promote the network. Clinicians interested in joining the network can find more information at www.atpbrn.orgPDF downloadCorrespondence: Ashley N. Marshall, PhD, ATC, Department of Health and Exercise Science, Appalachian State University, ASU Box 32071, 1179 State Farm Road, Boone, NC 28608. Email: [email protected]eduFrom the Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, Arizona (ANM, TMK, KCL); and Northwestern University Health Services, Evanston, Illinois (TMK).The authors have no financial or proprietary interest in the materials presented herein. Received1/14/19Accepted3/01/19
Referência(s)