Acute lateral ankle sprain accounts for 85% of sprains. The lateral sprain is associated with other ligament injuries e.g. medial and syndesmosis sprain. Long-term, approximately 20% of acute lateral sprains develop into chronic lateral ankle instability (CLAI) which includes persistent pain, and recurring ankle sprains. This study evaluated the grade of an ankle ligament injury by ultrasonography (US) and compared the findings to the outcome of patient-reported questionnaires. 48 subjects (18–40 years) diagnosed with an ankle sprain attended a clinical and US examination of ankle ligaments within two weeks after the sprain. Evaluation was done by US of acute lateral ligament injuries (ATFL, CFL), syndesmosis injury (AiTFL), and medial injury (dPT, TCt) only in participants with the positive clinical signs of medial injury. Participants were then mailed a questionnaire (PROMQ) every third month for a year. 29 women and 19 men participated with a mean age at 26.50 years. One-year follow-ups need to be analyzed further for final results. Temporary results include data based on the initial 26 patients: Two clinical signs statistically correlated. Multiple logistic regression analysis confirmed the results. Positive palpated tenderness AiTFL predicted with partial ruptured ATFL and reported pain during active plantar flexion of ankle predicted with normal CFL confirmed by the US. Patients with partial rupture of ATFL presented with tenderness at AiTFL point. Patients presenting with intact CFL reported pain during active plantar flexion. Compared to the US findings, the overall examinations were inconclusive in predicting ATFL, CFL, AiTFL, and medial ligament injuries.
To compare the effectiveness of the McKenzie method and spinal manipulation when used adjunctive to information and advice for patients with clinical signs suggestive of disc-related symptoms for duration of more than 6 Weeks. The conclusions drawn from previous randomised studies have been contradictory. The need for studies testing treatment strategies to specific diagnostic subgroups has been emphasised.Purpose
Background
The prevalence of back pain has remained relatively constant in the population in spite of previous interventions. Persons with sub-acute back pain are assumed to benefit from extended multidisciplinary, interdisciplinary or transdiciplinary and multisectorial, intersectorial or trans-sectorial interventions as an alternative to traditional mono-professional interventions. The purpose of this health technology assessment (HTA) was to document the possible effect of such interventions in patients suffering from back pain of 4-12 weeks duration. A systematic literature review is the overall basis for this HTA and the analysis of the interventions in relation to technology, patients, organization, and economics. HTA reports, systematic reviews, and recent primary studies were included. Further, primary data from Danish institutions (public and private) with experience in working with this technology were collected. There is moderate evidence that early multidiciplnary, interdisciplinary and transdiciplinary interventions are more effective than monodiciplinary interventions or no interventions in primary care. The effects are mainly seen in relation to reduced sick leave at or beyond 12-months follow-up and not in relation to reduced pain or improved function. The interventions appear to be cost-effective. Danish back centers mainly use sequential and/or parallel collaborative models.Background and purpose
Methods and results
