Iammarino Kathryn, Marrie James, Selhorst Mitchell, Lowes Linda P
Sports and Orthopedic Physical Therapy Department. Nationwide Children's Hospital, Columbus, OH, USA.
Int J Sports Phys Ther. 2018 Feb;13(1):1-11.
Ankle injuries account for up to 40% of all sport related injuries. These injuries can result in weeks to months of missed sport or work. The PRICE (Protection, Rest, Ice, Compression, Elevation) treatment is standard care for most acute ankle sprains. Recently, early mobilization in adults has been shown to decrease time off from sport or work, and the likelihood of developing chronic instability. To date, no research has been performed assessing the effectiveness of early mobilization in pediatric patients (<18 years). Purpose: There were two objectives of this study: (1) to determine if early ankle joint mobilization using elastic band traction is effective and (2) assess the occurrence of adverse events with this technique in the pediatric population.
Patients with an acute ankle sprain of <7 days referred to physical therapy were randomly assigned to receive early mobilization or PRICE. Early mobilization was performed using a stretch band ankle traction technique. Both groups received a standardized rehabilitation program. Pain, edema, ankle strength using hand-held dynamometry, and Foot and Ankle Disability Index (FADI) were measured at both initial evaluation and at discharge. The number of days before return to sport and the number of treatment sessions were also variables of interest.
Forty-one pediatric patients were recruited for participation (mean age 14.6 + 1.9 years). Both treatment groups had clinically significant improvements in pain, edema, strength, and FADI scores. No significant differences in outcomes were noted between treatment groups. Mean number of days for return to sport for the PRICE group was 26.33 + 7.14 and the early mobilization group was 26.63 + 14.82, the difference between groups was not significant ( = 0.607). The number of total visits for the PRICE group of 8.07 + 2.63 and the early mobilization groups of 8.5 + 1.57, was also not statistically significantly different ( = 0.762). There were no reported adverse events with early mobilization.
Early mobilization appears to be a safe intervention in pediatric patients with an acute ankle sprain. Early mobilization resulted in similar outcomes when compared to traditional PRICE treatment. A high drop-out rate in both treatment groups was a limitation of this randomized trial.
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踝关节损伤占所有运动相关损伤的40%。这些损伤可能导致数周甚至数月无法参加运动或工作。PRICE（保护、休息、冰敷、加压、抬高）治疗是大多数急性踝关节扭伤的标准护理方法。最近，研究表明成人早期活动可减少运动或工作的缺勤时间以及发生慢性不稳定的可能性。迄今为止，尚未有研究评估早期活动对儿科患者（<18岁）的有效性。目的：本研究有两个目标：（1）确定使用弹力带牵引进行早期踝关节活动是否有效；（2）评估该技术在儿科人群中不良事件的发生情况。
转诊至物理治疗科的急性踝关节扭伤<7天的患者被随机分配接受早期活动或PRICE治疗。早期活动采用弹力带踝关节牵引技术进行。两组均接受标准化康复计划。在初始评估和出院时测量疼痛、水肿、使用手持测力计测量的踝关节力量以及足踝功能障碍指数（FADI）。恢复运动前的天数和治疗次数也是感兴趣的变量。
招募了41名儿科患者参与研究（平均年龄14.6±1.9岁）。两个治疗组在疼痛、水肿、力量和FADI评分方面均有临床显著改善。治疗组之间在结果上未发现显著差异。PRICE组恢复运动的平均天数为26.33±7.14天，早期活动组为26.63±14.82天，两组之间的差异不显著（P = 0.607）。PRICE组的总就诊次数为8.07±2.63次，早期活动组为8.5±1.57次，也无统计学显著差异（P = 0.762）。早期活动未报告不良事件。
早期活动似乎是急性踝关节扭伤儿科患者的一种安全干预措施。与传统的PRICE治疗相比，早期活动产生了相似的结果。两个治疗组的高退出率是该随机试验的一个局限性。
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