预防复发性踝关节扭伤措施的成本效益：一项三臂随机对照试验的结果
The Cost-Effectiveness of Measures to Prevent Recurrent Ankle Sprains: Results of a 3-Arm Randomized Controlled Trial.
作者信息
Janssen Kasper W, Hendriks Marike R C, van Mechelen Willem, Verhagen Evert
机构信息
Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands Department of Human Movement Sciences, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands.
出版信息
Am J Sports Med. 2014 Jul;42(7):1534-41. doi: 10.1177/0363546514529642. Epub 2014 Apr 21.
BACKGROUND
Ankle sprains are the most common sports-related injury, associated with a high rate of recurrence and societal costs. Recent studies have emphasized the effectiveness of both neuromuscular training and bracing for the secondary prevention of ankle sprains.
PURPOSE
To evaluate the cost-effectiveness of the separate and combined use of bracing and neuromuscular training for the prevention of the recurrence of ankle sprains.
STUDY DESIGN
Economic and decision analysis; Level of evidence, 2.
METHODS
A total of 340 athletes (157 male and 183 female; aged 12-70 years) who had sustained a lateral ankle sprain up to 2 months before inclusion were randomized to a neuromuscular training group (n = 107), brace group (n = 113), and combined intervention group (n = 120). Randomization was stratified by medical treatment of the inclusion sprain. Participants in the neuromuscular training group underwent an 8-week home-based exercise program. Participants in the brace group received a semirigid ankle brace to be worn during all sports activities for a period of 12 months. Participants allocated to the combined group underwent both interventions, with the ankle brace to be worn during all sports activities for a period of 8 weeks. The recurrence of ankle sprains and associated costs were registered during the 1-year follow-up.
RESULTS
There were no differences between groups at baseline with regard to age, sex, sports participation, previous injury, or knowledge of preventive measures. The incremental cost-effectiveness ratio (ICER) of the brace group in comparison with the combined group was -€2828.30 (approximately--US$3865.00), based on a difference in the mean cost of -€76.16 (approximately--US$104.00) and a difference in the mean effects of 2.68%. The ICER of the neuromuscular training group in comparison with the combined group was €310.08 (approximately US$424.00), based on a difference in the mean cost of -€28.37 (approximately--US$39.00) and a difference in the mean effects of 9.15%.
CONCLUSION
Bracing was found to be the dominant secondary preventive intervention over both neuromuscular training and the combination of both measures.
背景
踝关节扭伤是最常见的与运动相关的损伤，复发率高且社会成本高昂。最近的研究强调了神经肌肉训练和支具对踝关节扭伤二级预防的有效性。
目的
评估单独使用支具和神经肌肉训练以及两者联合使用预防踝关节扭伤复发的成本效益。
研究设计
经济与决策分析；证据级别，2级。
方法
共有340名运动员（157名男性和183名女性；年龄12 - 70岁）在纳入研究前2个月内发生过外侧踝关节扭伤，被随机分为神经肌肉训练组（n = 107）、支具组（n = 113）和联合干预组（n = 120）。随机分组按纳入时扭伤的治疗情况进行分层。神经肌肉训练组的参与者接受为期8周的居家锻炼计划。支具组的参与者获得一个半刚性踝关节支具，在所有体育活动期间佩戴12个月。分配到联合组的参与者接受两种干预，踝关节支具在所有体育活动期间佩戴8周。在1年的随访期间记录踝关节扭伤的复发情况及相关费用。
结果
在年龄、性别、运动参与情况、既往损伤或预防措施知识方面，各组在基线时无差异。与联合组相比，支具组的增量成本效益比（ICER）为-€2828.30（约- US$3865.00），基于平均成本差异为-€76.16（约- US$104.00），平均效果差异为2.68%。与联合组相比，神经肌肉训练组的ICER为€310.08（约US$424.00），基于平均成本差异为-€28.37（约- US$39.00），平均效果差异为9.15%。
结论
发现支具是比神经肌肉训练以及两种措施联合使用更具优势的二级预防干预措施。
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