Abstract
BackgroundAcute lateral ankle ligament sprains (LALS) are a common injury seen by many different clinicians. Knowledge translation advocates that clinicians use Clinical Practice Guidelines (CPGs) to aid clinical decision making and apply evidence-based treatment. The quality and consistency of recommendations from these CPGs are currently unknown. The aims of this systematic review are to find and critically appraise CPGs for the acute treatment of LALS in adults.MethodsSeveral medical databases were searched. Two authors independently applied inclusion and exclusion criteria. The content of each CPG was critically appraised independently, by three authors, using the Appraisal of Guidelines for REsearch and Evaluation (AGREE II) instrument online version called My AGREE PLUS. Data related to recommendations for the treatment of acute LALS were abstracted independently by two reviewers.ResultsThis study found CPGs for physicians and physical therapists (Netherlands), physical therapists, athletic trainers, physicians, and nurses (USA) and nurses (Canada and Australia). Seven CPGs underwent a full AGREE II critical appraisal. None of the CPGs scored highly in all domains. The lowest domain score was for domain 5, applicability (discussion of facilitators and barriers to application, provides advice for practical use, consideration of resource implications, and monitoring/auditing criteria) achieving an exceptionally low joint total score of 9% for all CPGs. The five most recent CPGs scored a zero for applicability. Other areas of weakness were in rigour of development and editorial independence.ConclusionsThe overall quality of the existing LALS CPGs is poor and majority are out of date. The interpretation of the evidence between the CPG development groups is clearly not consistent. Lack of consistent methodology of CPGs is a barrier to implementation.Systematic reviewSystematic review registered with PROSPERO (CRD42015025478).
Highlights
Acute lateral ankle ligament sprains (LALS) are a common injury seen by many different clinicians
Two Clinical Practice Guidelines (CPGs) were considered not suitable after discussion and agreement by authors (TG, GW, KF), namely a CPG for return to play after an LALS [34] and a syndesmosis injury CPG [35]
Seven CPGs were suitable for review using Appraisal of Guidelines for REsearch and Evaluation (AGREE) II see Fig. 1: Results of the search strategy for international guidelines that have recommendations for acute management of LALS and Table 1 for details of the included CPGs
Summary
Acute lateral ankle ligament sprains (LALS) are a common injury seen by many different clinicians. An acute LALS is defined as “an acute traumatic injury to the lateral ligament complex of the ankle joint as a result of excessive inversion of the rear foot or a combined plantarflexion and adduction stress to the foot. This injury usually results in initial deficits of function and disability” [4]. This definition of an acute LALS has been endorsed by the International Ankle Consortium [5,6,7]. This acute phase corresponds to the first phase of biological ligament healing known as the inflammatory phase [9]
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