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Met ongeveer 480 duizend gevallen per jaar is lateraal enkelbandletsel (een blessure aan de buitenste banden) een van de meest voorkomende sportblessures in Nederland. Het risico op herhaald letsel is bovendien groot. De maatschappelijke kosten van enkelblessures in Nederland zijn zo’n 187 miljoen euro per jaar. Alleen al daarom is effectieve preventie van groot belang. Een achtweeks trainingsprogramma vermindert dit risico, maar alleen als een sporter tenminste driekwart van het programma uitvoert. Versterk je Enkel draagt hier met twee toegankelijke tools aan bij, te weten een mobiele App en een informatieve folder. Uit gerandomiseerd onderzoek blijkt nu dat beide tools effectief de therapietrouw vergroten. Het aanbieden van het programma op deze twee manieren maakt het mogelijk voor atleten en (para) medici om de gewenste methode te kiezen. Dit komt de therapietrouw ten goede omdat bij een vrije keuze de methode van aanbieden beter aansluit bij de patiënt. Deze keuzevrijheid faciliteert verdere therapietrouw van het gebruik en de naleving van het Versterk je enkel programma.

Resultaten
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Het huidige project toonde aan dat de wijze van uitvoering van de oefeningen door middel van een App of schriftelijk materiaal niet leidt tot verschillen in naleving van het oefenprogramma. Beide methoden laten zien dat ongeveer 75% van de deelnemers het programma voldoende uitvoert. Bij beide tools is de therapietrouw met respectievelijk 73% (app) en 77% (uitvouwkaart) hoog te noemen. Wel kunnen met de app meer mensen bereikt worden. Logischerwijs leidt de wijze van uitvoering van de oefeningen met behulp van de App of schriftelijk materiaal ook niet tot een verschil in incidentie van recidiverende enkeldistorsies op de lange termijn, evenmin heeft de wijze van informatievoorziening ook geen effect op kosten van recidief letsel noch op resterende functiebeperking of pijn. Beide tools vullen elkaar goed aan; sporters kunnen zelf de keuze maken voor één van beide methoden of voor een combinatie.

Samenvatting van de aanvraag

Samenvatting
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BACKGROUND

Ankle sprains continue to pose a significant burden to the individual athlete, as well as society as a whole. However, despite ankle sprains being the single most common athletic injury and despite an active approach by various Dutch organizations in implementing our epidemiological knowledge on cost-effectiveness, large-scale community uptake of preventive measures, and thus actual prevention of ankle sprains, is lagging well behind.

In an attempt to bridge this implementation gap VeiligheidNL looked into the possible role of new (social) media and has developed an freely available interactive App ('Versterk je enkel'; available for iOS and Android) that contains - next to general advice on bracing and taping - the cost-effective neuromuscular program. This provides the user with, amongst others, video's and an interactive exercise schedule.

It is general belief that such interactive, online and mobile methods of information transfer are the way forward in implementation efforts. However, this has not yet been formally established for the uptake of evidence injury preventive measures, and - although user reviews are positive - the 'Versterk je enkel' App has not been evaluated against the 'regular' approach to advocate the neuromuscular program on paper and DVD.

AIM

The aim of the proposed project is to evaluate the implementation value of the 'Versterk je enkel' App as compared to the usual practice of providing injured athletes written materials. Our hypothesis is that use of the 'Versterk je enkel' App will increase compliance to the prescribed program and, consequently, will decrease ankle sprain recurrence incidence.

DESIGN

The proposed study will be a randomised controlled trial. After stratification for ankle sprain severity and main medical caregiver participants will be randomised to two study groups. One group will receive care as usual, i.e. a standardized eight-week proprioceptive training programme [10,11] consisting of a balance board and an instructional booklet. The other group will receive the same programme and balance board. However, for this group the instructional booklet is exchanged by the interactive 'Versterk je enkel' App.

OUTCOME MEASURES & FOLLOW-UP

The primary outcome measure will be compliance to the prescribed eight-week program. Secondary outcome measures include injury recurrence incidence, costs of injury (and cost-effectiveness of the intervention), as well as barriers and facilitators towards the use of the eight-week training program, including knowledge and attitude regarding the prevention of ankle sprain recurrences.

Compliance (primary outcome) follow-up measurements will commence after randomisation (i.e. after treatment and at the start of the allocated intervention), and will take place weekly for the duration of the program (8 weeks). The follow-up measurements will gather information for each participant on the number, sets and repetitions of prescribed exercises undertaken. In addition questions will be asked about the clarity of the instructions and difficulty of the exercises.

After 8 weeks a follow-up questionnaire will measure residual complaints of the initial ankle sprain. Both pain and feeling of giving way will be scored on five-point Likert scale for a series of questions. At this last follow-up knowledge, attitude, barriers and facilitators regarding (recurrent) ankle sprain prevention will be measured again in all participants.

Recurrence injury incidence and cost of injury outcomes will take place once a month for a total period of 12 months. The follow-up measurements will gather information for each participant on ankle sprains sustained during the preceding month (including details & mechanisms of this sprain and absence from sports due to the ankle sprain recurrence as a measure of recurrence severity), and time at risk during the preceding month (exposure). Finally, the follow-up questionnaires will measure residual complaints of the initial ankle sprain. Both pain and feeling of giving way will be scored on five-point Likert scale for a series of questions, e.g. do you feel pain when being active, do you feel pain when getting out of bed in the morning, do you feel your ankle giving way when walking across the street, etc. At the last follow-up (12 months) knowledge, attitude, barriers and facilitators regarding (recurrent) ankle sprain prevention will be measured again in all participants.

In order to evaluate the cost-effectiveness of the allocated interventions, subjects who sustain an ankle sprain recurrence will receive a cost-diary. From these cost-diaries direct and indirect costs resulting from the sustained ankle sprain recurrence can be calculated for use in an economic evaluation. The economic evaluation will be performed from a societal perspective.

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