van der Wees Philip J, Lenssen Anton F, Hendriks Erik J M, Stomp Derrick J, Dekker Joost, de Bie Rob A
Department of Epidemiology, Maastricht University, The Netherlands.
Aust J Physiother. 2006;52(1):27-37. doi: 10.1016/s0004-9514(06)70059-9.
This study critically reviews the effectiveness of exercise therapy and manual mobilisation in acute ankle sprains and functional instability by conducting a systematic review of randomised controlled trials. Trials were searched electronically and manually from 1966 to March 2005. Randomised controlled trials that evaluated exercise therapy or manual mobilisation of the ankle joint with at least one clinically relevant outcome measure were included. Internal validity of the studies was independently assessed by two reviewers. When applicable, relative risk (RR) or standardised mean differences (SMD) were calculated for individual and pooled data. In total 17 studies were included. In thirteen studies the intervention included exercise therapy and in four studies the effects of manual mobilisation of the ankle joint was evaluated. Average internal validity score of the studies was 3.1 (range 1 to 7) on a 10-point scale. Exercise therapy was effective in reducing the risk of recurrent sprains after acute ankle sprain: RR 0.37 (95% CI 0.18 to 0.74), and with functional instability: RR 0.38 (95% CI 0.23 to 0.62). No effects of exercise therapy were found on postural sway in patients with functional instability: SMD: 0.38 (95% CI -0.15 to 0.91). Four studies demonstrated an initial positive effect of different modes of manual mobilisation on dorsiflexion range of motion. It is likely that exercise therapy, including the use of a wobble board, is effective in the prevention of recurrent ankle sprains. Manual mobilisation has an (initial) effect on dorsiflexion range of motion, but the clinical relevance of these findings for physiotherapy practice may be limited.
本研究通过对随机对照试验进行系统评价，批判性地回顾了运动疗法和手法松动术在急性踝关节扭伤和功能性不稳中的有效性。从1966年至2005年3月通过电子检索和手工检索试验。纳入了评估运动疗法或踝关节手法松动术且至少有一项临床相关结局指标的随机对照试验。两位评价者独立评估研究的内部效度。在适用时，计算个体数据和汇总数据的相对危险度（RR）或标准化均数差（SMD）。总共纳入了17项研究。13项研究中的干预措施包括运动疗法，4项研究评估了踝关节手法松动术的效果。研究的平均内部效度评分为3.1（范围为1至7，满分10分）。运动疗法在降低急性踝关节扭伤后再次扭伤的风险方面有效：RR为0.37（95%CI为0.18至0.74），在功能性不稳方面：RR为0.38（95%CI为0.23至0.62）。未发现运动疗法对功能性不稳患者的姿势摆动有影响：SMD为0.38（95%CI为-0.15至0.91）。四项研究表明不同方式的手法松动术对背屈活动度有初步的积极影响。包括使用摇摆板在内的运动疗法可能对预防踝关节再次扭伤有效。手法松动术对背屈活动度有（初步）影响，但这些研究结果对物理治疗实践的临床相关性可能有限。
