We have had some radio silence in past months due to a busy conference schedule, but regular work still continued. Last week, for instance, our cost effectiveness trial comparing bracing with neuromuscular training for the prevention of recurrent ankle sprains got published in the American Journal of Sports Medicine. To our knowledge the third full economic evaluation in sports injury prevention ever, and an outcome that may stir some discussion.
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. This study evaluated the cost-effectiveness of the separate and combined use of bracing and neuromuscular training for the prevention of the recurrence of ankle sprains. 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.
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%. In conclusion we found bracing to be the dominant secondary preventive intervention over both neuromuscular training and the combination of both measures.
As a side note to these results. This study only looked at the secondary prevention of ankle sprains and presents the cost-effectiveness as such. Other outcomes (e.g. pain, instability, or return to sport) were not taken into account and, as such, the outcomes of this manuscript are limited to a single outcome alone.
Janssen, K. W., Hendriks, M. R. C., van Mechelen, W., & Verhagen, E. (2014). The Cost Effectiveness of Measures to Prevent Recurrent Ankle Sprains: Results of a 3-Arm Randomized Controlled Trial. The American Journal of Sports Medicine, 0363546514529642. doi:10.1177/0363546514529642