Investigation of factors affecting return to play following acute lateral ankle sprains

Abstract

Lateral ankle sprain is a common injury amongst the sport population, yet uncertainty exists regarding what influences return to play (RTP), as there is a lack of evidence-based guidance on RTP in the current literature. The identification of relevant influencing factors may help to construct guidance that informs effective practice in terms of optimising sport performance and prevention of recurrent injuries. Knowledge of such factors will help clinicians making safe and timely decisions for RTP. Consequently, the aim of this thesis was to explore factors, specifically physiological, clinical and personal, that influence RTP among sportspeople with a conservatively treated lateral ankle sprain using a mixed methods investigative approach.

A systematic review of the literature (thesis study one) was first conducted to examine the current evidence related to factors influencing RTP. The findings of the review showed that there is a lack of evidence on the factors influencing RTP after a lateral ankle sprain, most notably poor understanding of both personal and clinical factors. In response to this, three investigations were planned that followed both quantitative and qualitative approaches. In the first study (thesis study two), the epidemiological investigation included a population of patients, which was characterised by their demographic, clinical and sport factors, with lateral ankle sprain presenting to a UK emergency department. The population at risk of lateral ankle sprain, as defined by cause of injury and primary sport, was also described. In addition, the investigation identified important clinical factors, including the fact that the majority of patients were discharged without adequate information about conservative treatment nor were they given advice on when would be safe to RTP once their ankle injury had recovered.

The next investigation (thesis study three) involved a retrospective observational study of the associations between a self-reported demographic, sport related and clinical factors and RTP in a sports population of individuals who had had a lateral ankle sprain. Three factors were found to be important contributions to influencing RTP: 1) mechanism of injury, 2) restricted active dorsi flexion because of pain, and 3) treatment methods. The findings from thesis study three also revealed that the majority of participants did not receive any professional treatment and resumed training with residual symptoms. A final follow-up qualitative study (thesis study four), with a similar population to thesis study three, explored the reasons behind that behaviour and the various influencing factors for RTP. Eight themes were identified as main influencing factors for RTP 1) Previous negative experience with health care services. 2) Limitation of resources. 3) Level of sport played. 4) Self-management of injury towards RTP. 5) Perception of self, injury and RTP. 6) Previous history of managing ankle injury. 7) Symptoms dictating RTP. 8) External motivation, expectations and support. In addition, although participants recognised resolving symptoms such as pain as indicators for recovery, they resumed their training with residual symptoms. It was evident that they had different priorities related to their behaviour that led them to resume training with symptoms. Future researchers may consider investigating the patterns of behavior surrounding the decision to return to playing their sports in more depth to provide measurable strategies to correct them.

Therefore, to improve clinical outcomes following lateral ankle sprain, it is recommended that the next stage of work should focus on the development of an educational programme that focuses on why it is important to RTP safely following a lateral ankle sprain, which should be a pre-cursor to a rehabilitation programme plan.

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Identifiers

ORCID for Martin Warner: orcid.org/0000-0002-1483-0561

ORCID for Lucy Gates: orcid.org/0000-0002-8627-3418

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