P3.R360: The Effectiveness of School-based, Athletic Trainer-led Rehabilitation for Ankle Sprain in Student-Athletes in an Urban Public School District

Background: Athletic Trainer (AT) presence in the school setting is associated with lower rates of musculoskeletal injury and recurrent injury rates in student-athletes (SAs). However, there are research gaps for measuring the impact of AT-delivered care in that population. Patient Reported Outcomes (PROs) are central to delivering patient-centered health care, measuring what is important to the patient, and assessing the effectiveness of interventions provided for a condition. ATs acknowledge the value of PROs but have found barriers to using them, both in the collegiate and secondary school setting. Subsequently, no prior research has investigated the effectiveness of AT intervention using PROs. The aim of this study is to analyze scores from the Foot and Ankle Ability Measure (FAAM) PRO for SAs presenting to their AT with a grade 1-2 ankle sprain and correlate scores related to number of sessions and total contact time with their AT.

Methods: This was a prospective cohort study of male and female SAs, ages 12-18, who were participating in a sport and presented to their school AT with a grade 1-2 ankle sprain within 3 days of injury. Intervention sessions were standardized according to Standing Operating Procedures already existing for Sports Medicine ankle sprain care and included: cryotherapy, taping, therapeutic exercise, manual therapy, and/or electrical stimulation. Twenty-three SAs were enrolled in this study. FAAM scores, including sports and activities of daily living (AoDL) subscales, were obtained on the date of injury, 7-days after, 30-days after, and the date of return-to-play (RTP).

Results: On average, there were 9.95 (SD = 4.62, minimum = 2 and maximum = 19) intervention sessions for each ankle sprain. The number of sessions did not significantly correlate with changes in the FAAM sports subscale scores from date of injury to scores of 7 days (r = 0.21) and 30 days after injury (r = 0.14).
There was a significant difference in scores of the FAAM in both the AoDL, F(3, 54) = 27.24, p < .001, η_p^2=0.60, and sports subscales, F(3, 54) = 29.66, p < .001, η_p^2=0.62. Post hoc analyses revealed that for both subscales there was a significant improvement in scores from the date of injury to both subscale scores obtained 7-days later (both subscales p<.001). The sports subscale score increased from 71.95±18.32 to 92.53±7.98, while the AoDL score increased from 59.05±24.79 to 84.00±14.93. There were no significant differences (improvements) in subscale scores among 7-days, 30-days, and RTP.

Conclusion: There were no significant improvements in FAAM subscale scores after 7-days from the time of injury. This suggests that grade 1-2 ankle sprain evaluation and treatment by an AT soon after injury (within 3 days, in this study) may improve outcomes for grade 1-2 ankle sprains.