Background: Lateral ankle sprain is the most common sport related injury. In the acute phase patients experience pain and have limited body functions. They are further unable to perform work and sport activities. Standard treatment of acute ankle sprain patients consists of rest, ice, compression and elevation (RICE) to reduce pain and swelling, followed by functional exercise therapy. Exercising at home using specific video games might be an interesting alternative in the treatment of ankle sprain patients.
Research question and hypothesis: The aim of this study is to evaluate the effectiveness of the use of the WII Fit™ for the rehabilitation of acute lateral ankle sprains. We hypothesize that the use of the WII Fit™ for the rehabilitation of acute lateral ankle sprains is at least as effective as physical therapy.
Methods: 60 acute ankle sprain patients (grade I or II) aged from 18 to 64 years were included. The physician provided standard instructions regarding the RICE protocol and pain free movement and they received a semi-rigid Aircast brace. After 4 weeks the patients underwent a baseline measure (evaluation 1) and were thereafter randomly assigned to one of the 3 groups: exercise training with the WII Fit™ during 6 weeks, conventional physical therapy (9 sessions during 6 weeks) or no exercise therapy (control group). Patients underwent follow-up measures to evaluate the effect of the different treatments 6 weeks (evaluation 2) and 6 months (evaluation 3) after the baseline evaluation. Evaluations consist of a clinical assessment (joint swelling, mobility, and strength), a 30 second single-leg balance test under stable and unstable conditions and single-leg jump tests (time to stabilize after a 25 cm jump and maximum distance jump).
Results: Ankle sprain patients showed increased COP excursions, speed and length (P<0.05) compared to healthy persons. In addition, 30% of the ankle sprain patients could not even complete the single-leg balance test under unstable conditions 4 weeks after the ankle sprain. All three groups improved their balance performance over time, no between-group differences were found. At baseline, decreased muscle strength of the ankle was related to a decreased COP performance.
With regard to the jump tests no improvement was found in TTS in any of the groups during the 25 cm jump. For the maximum jump all groups increased their maximum distance significantly 6 weeks after treatment (P<0.05). For both jump tests no between-group differences were found (P>0.05).
Discussion: The WII Fit™ has a good potential as a complementary treatment to physical therapy for acute ankle sprain patients. However, it has to be noticed that the control group showed similar balance and jump performance results as the two treatment groups, which indicates that the natural recovery of an ankle sprain achieve comparable results as currently used rehabilitation strategies until 6 months follow-up. Nevertheless, while interpreting the results of this study it should be considered that 276 patients did decline to participate in the study. The main reason was that they were not willing to be randomly assigned with the option to be allocated to a group without treatment.
