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Date completed: 17-Oct-2014 Ref: MUNRO-10102014-ACURUV503085Literature Search and Enquiry ServiceSearch requested by Nicola Munro Advanced Specialist Orthotist westmarcsouthern general hospital1345 govan rdglasgowG51 4tF ?Search Carried out by Chloe StewartNHSGGC Library Network0141 347 8885chloe.stewart@ggc.scot.nhs.uk SEARCH DETAILSDoes orthotic intervention improve outcomes in patients with foot and ankle oedema ?28 Abstracts FoundThis literature search will contain a selection of material gathered from a search of the evidence base, and is not intended to be comprehensive. Professional judgement should be exercised when appraising the material. The Library takes no responsibility for the wording, content and accuracy of the information supplied, which has been extracted in good faith from reputable sources. NHSGGC is not responsible for the content of external internet sites.For instructions on how to locate and/or order the full text of any articles listed please see the attached guide.Resources Searched?Staffnet, NICE, SIGN, TRIP database, Cochrane Library, Cinahl, Embase, Medline. Embase and Medline references were filtered to retrieve randomised controlled trials and systematic reviews.Notes on Search?I have not found much; I have included some references relating to treatment of swelling in ankle sprain in case these are useful.Search CommandsExplanation/A MeSH subject heading with all subheadings selectedtw/A search for a term in the title or abstractexpThe subject heading was exploded to include the narrower, more specific terms beneath it in the subject headings thesaurus* or $The search term was truncated (eg. therap* searches for therapist, therapists, therapies etc)Adapted from the table used in Prodigy reviews - see strategyExp compression garments or Exp orthopedic footwear or Exp stockings, compression or Exp shoes or Stocking* or Hosiery or Hose or Sole* or Insole* or Support* or footwear or Exp orthoses or Exp orthotic devices or Exp orthosis or Orthos* or Orthot* or Splint* or brac* or strap* or stretch* or immobilis*Exp foot or Exp ankle or foot or feet or ankleExp edema or Exp lymphedema or Exp swelling or Oedema or Lymphoedema or Fluid retention or Water retention or swelling1 or 2 or 31. AMSLER, F. and BLATTLER, W., 2008. Compression therapy for occupational leg symptoms and chronic venous disorders - a meta-analysis of randomised controlled trials. European Journal of Vascular & Endovascular Surgery, 35(3), pp. 366-372.OBJECTIVE: Leg discomfort and oedema are commonly attributed to a venous disorder (CVD) or chronic venous insufficiency (CVI) and treated with compression hosiery. The pressure needed to achieve clinical benefit is a matter of debate. DESIGN: We performed a meta-analysis of randomised controlled trials (RCT) that compared stockings exerting an ankle pressure of 10-20mmHg with placebo or no treatment and with stockings exerting a pressure of more than 20mmHg. METHODS: RCT were retrieved and analysed with the tools of the Cochrane Collaboration. Each study was reviewed independently. Subjective dichotomous and continuous factors and objective findings were pooled for statistical treatment. RESULTS: Eleven RCT fulfilled the predefined criteria. They included 1453 randomised subjects, 794 healthy people exposed to various forms of stress, 552 patients with a chronic venous disorder or chronic venous insufficiency and 141 patients after varicose vein surgery. Over all, compression with 10-20mmHg had a clear effect on oedema and symptoms as compared with 20mmHg stockings. CONCLUSIONS: Despite important methodological heterogeneity and sometimes sub-standard reporting the meta-analysis suggests that leg compression with 10-15mmHg is an effective treatment for CVD. Less pressure is ineffective and higher pressure may be of no additional benefit.; 2. ARCELUS, J.I., et al, 2001. Home use of impulse compression of the foot and compression stockings in the treatment of chronic venous insufficiency. Journal of Vascular Surgery, 34(5), pp. 805-811.PURPOSE: The use of intermittent pneumatic compression, in addition to elastic bandages or stockings, accelerates the healing of leg ulcers in patients with severe chronic venous insufficiency (CVI). There is recent evidence that impulse compression of the plantar venous plexus reduces post-traumatic ankle swelling and prevents postoperative venous thromboembolism. The purpose of this study was to evaluate the clinical and hemodynamic responses after home use of impulse foot compression for 3 months in patients already using therapeutic compression stockings for the management of CVI. METHODS: Twelve extremities from 9 patients with documented CVI, class 4 to 5 according to the Clinical, Etiology, Anatomy, Pathophysiology classification system, were included in this prospective cohort study. All patients were instructed to use a foot pump device at home for 2 hours a day for 3 months in addition to therapeutic compression stockings (30-40 mm Hg) worn during the day. The device was set to three cycles (3 seconds) of compression (120 mm Hg) per minute. A clinical scoring system was completed before foot compression and 1, 2, and 3 months thereafter. In addition, all patients underwent air plethysmography studies at the same time intervals, including venous volume, venous filling index, ejection fraction, and residual volume fraction. RESULTS: Patients reported significant improvement in their scores for swelling (P <.05) and pain (P <.04). Air plethysmography showed a reduction in venous volume and venous filling index, although these differences were not significant. Ejection fraction remained unchanged and residual volume fraction was significantly reduced (P <.05) compared with baseline. The foot compression devices were well tolerated by all the patients in the study. CONCLUSIONS: The use of home foot impulse compression plus elastic stockings significantly reduced the residual volume fraction as measured by air-plethysmography in a group of patients with severe CVI. This favorable hemodynamic response could, in part, explain the clinical improvement achieved by this combined treatment. However, this represents a preliminary pilot study that needs to be confirmed in future randomized controlled studies with more patients included.; 3. BAMIGBOYE, A.A. and HOFMEYR, G.J., 2006. Interventions for leg edema and varicosities in pregnancy. What evidence? European Journal of Obstetrics, Gynecology, & Reproductive Biology, 129(1), pp. 3-8.Leg oedema from venous insufficiency is not dangerous but it can cause women symptoms such as pain, feelings of heaviness, night cramps and paraesthesiae. Leg oedema can be a sign of pre-eclampsia when associated with raised blood pressure or proteinuria. The objective of this review was to assess the effects of treatment to relieve the symptoms associated with varicosity in pregnancy and to reduce leg oedema. We searched the Cochrane Pregnancy and Childbirth Group trials register in October 2004 for randomised trials of any form of treatment for varicosity and or leg oedema in pregnancy. Trial quality was assessed and data were extracted. Four trials of three different treatments were included. In one trial, women given rutoside capsules in the last 3 months of pregnancy noted an improvement in symptoms compared with placebo (relative risk 0.54 95% CI 0.32, 0.89). They had a decrease in ankle circumference at 36 weeks' gestation after 8 weeks of treatment, while women given placebo had a small increase. In one trial, women with ankle oedema had a small non-significant reduction in lower leg volume when treated with external pneumatic intermittent compression for 30 min. In another trial compression stockings prophylactically reduced the emergence of leg symptoms but not venous varicosities (relative risk 0.74 95% CI 0.59, 0.93). Lymphatic reflexology was studied in too few women to draw conclusions. In conclusions, rutosides appear to relieve symptoms of venous insufficiency in late pregnancy. However, it is not known if the drug is safe in pregnancy. External pneumatic compression appears to reduce ankle swelling and compression stockings reduce leg symptoms but not varicose veins. [References: 11]; 4. BLATTLER, W., et al, 2008. Leg symptoms of healthy people and their treatment with compression hosiery. Phlebology, 23(5), pp. 214-221.OBJECTIVES: Occasional leg symptoms, like feelings of heaviness and tension, and occupational or evening oedema are considered typical features of a venous disorder but show low specificity in epidemiological and observational studies. We evaluated the prevalence and nature of such symptoms in subjects with no history or signs of venous disease and investigated the optimal strength that medical compression stockings (MCS) should exert in order to alleviate the symptoms and to prevent leg swelling. METHODS: Specifically designed questionnaires were used to assess the symptoms of 40 healthy employees of a factory producing MCS. Lower leg volumes were quantified in the morning and evening. Calf size hosiery providing documented ankle pressures of 4-9 (mean 7.3), 12-18 (mean 14.9) and 18-22 (mean 19.5) mmHg, respectively, were tested in a prospective, open-label, randomized trial lasting three weeks. Endpoints were the relief of symptoms, prevention of vesperal oedema and comfort in wearing the stockings. RESULTS: Sixty-five percent of the participants reported at least occasional leg symptoms and oedema. Somatic-type symptoms (i.e. pain, heaviness, swelling, unattractive legs) were present in two, psychic-type symptoms (i.e. leg- and personality-related unrest and stress) in 17 and both components in seven of the 40 subjects. MCS exerting 15 and 20 mmHg prevented the symptoms and oedema. Stockings providing 19 mmHg were not well-tolerated. The effect on the somatic-type symptoms was strongly correlated with the amount of lower leg volume which could be reduced by wearing stockings (P = 0.005). No correlation was found between the efficacy of compression and the emotional component of the symptoms. CONCLUSION: The cause of occasional pain in the legs of apparently healthy people is unknown. Some features of the syndrome reflect an emotional disorder while others mirror venous insufficiency. MCS of 15 mmHg effectively relieve the symptoms resembling venous insufficiency, prevent oedema and are well-tolerated.; 5. BLEAKLEY, C.M., et al, 2008. Some conservative strategies are effective when added to controlled mobilisation with external support after acute ankle sprain: a systematic review. Australian Journal of Physiotherapy, 54(1), pp. 7-20.Questions: Which intervention(s) best augment early mobilisation and external support after an acute ankle sprain? What is the most appropriate method of preventing re-injury? Design: A systematic review of randomised controlled trials published from 1993 to April 2005. Participants: People with an acute ankle sprain. Intervention: Any pharmacological, physiotherapeutic, complementary or electrotherapeutic intervention added to controlled mobilisation with external support. Immobilisation, surgical intervention, and use of external ankle supports in isolation were excluded. Outcomes: Pain, function, swelling, re-injury, and global improvement; assessed at short, intermediate, and long-term follow-up. Results: 23 trials were included with a mean PEDro score of 6/10. There was strong evidence that non-steroidal anti-inflammatory drugs can reduce pain and improve short-term ankle function. There was moderate evidence that neuromuscular training decreases functional instability and minimises re-injury; and that comfrey root ointment decreases pain and improves function. There was also moderate evidence that manual therapy techniques improve ankle dorsiflexion. There was no evidence to support the use of electrophysical agents or hyperbaric oxygen therapy. Very few long-term follow-ups were undertaken, and few studies focused on preventing long-term morbidity. Conclusions: Non-steroidal anti-inflammatory drugs, comfrey root ointment, and manual therapy can significantly improve short-term symptoms after ankle sprain, and neuromuscular training may prevent re-injury. More high quality studies are needed to develop evidence-based guidelines on ankle rehabilitation beyond the acute phases of injury management. 6. BOYCE, S.H., et al, 2005. Management of ankle sprains: a randomised controlled trial of the treatment of inversion injuries using an elastic support bandage or an Aircast ankle brace. British journal of sports medicine, 39(2), pp. 91-96.BACKGROUND: Lateral ligament ankle sprains are the single most common sports injury. OBJECTIVE: To determine the functional outcome of the ankle joint after a moderate or severe inversion injury, comparing standard treatment with an elastic support bandage against an Aircast ankle brace. DESIGN: Prospective, randomised controlled trial. SETTING: Two accident and emergency departments. METHOD: Fifty patients presenting consecutively were randomised into two equal groups: one group was treated with an elastic support bandage and the other with an Aircast ankle brace. All patients were given a standardised advice sheet referring to rest, ice, compression, and elevation. Patients were reviewed after 48-72 hours, 10 days, and one month. PRIMARY OUTCOME MEASURE: Ankle joint function assessed at 10 days and one month using the modified Karlsson scoring method (maximum score 90). SECONDARY OUTCOME MEASURE: The difference in ankle girth (swelling) and pain score at 10 days. RESULTS: Seventeen patients in the elastic support bandage group (six defaulted, two excluded) and 18 patients in the Aircast ankle brace group (six defaulted, one excluded) completed the study. There were no significant differences between the two groups at presentation in terms of age (mean 35.3 and 32.6 years respectively), sex, dominant leg, left or right ankle injured, previous injury, time to presentation (median three and four hours respectively), difference in ankle girth (mean 14.5 and 14.3 mm respectively), and pain scores (mean 6.2 and 5.8 respectively). The Karlsson score was significantly higher in the Aircast ankle cast group than in the elastic bandage group at 10 days (mean 50 v 35, p = 0.028, 95% confidence interval (CI) 1.7 to 27.7) and one month (mean 68 v 55, p = 0.029, 95% CI 1.4 to 24.8) (Student's t test). There was no difference between the groups in the secondary outcome measures (swelling, p = 0.09; pain, p = 0.07). When hierarchical multiple regression analysis was used to correct for possible baseline confounding factors, the Aircast ankle brace group was significantly associated with higher Karlsson scores at 10 days (p = 0.009) and one month (p = 0.024). CONCLUSION: The use of an Aircast ankle brace for the treatment of lateral ligament ankle sprains produces a significant improvement in ankle joint function at both 10 days and one month compared with standard management with an elastic support bandage. Brouwer Reinoud W. Et al. (2005) Braces and orthoses for treating osteoarthritis of the knee Cochrane Database of Systematic Reviews 1 . CALLAGHAN, M.J., 1997. Role of ankle taping and bracing in the athlete. British journal of sports medicine, 31(2), pp. 102-108.Adhesive tape is often used to help athletes recover from ligament sprains of the ankle or to prevent further injury. The choice of taping technique or material is often decided by personal preference, superstition, or anecdote. More recently, the use of ankle braces has become more prevalent, but reasons for their use are similarly variable. As ankle sprains are a major cause of an athlete's disability and time off sport, the choice of the method of support should be more scientifically reasoned. This paper attempts to review the literature concerning the effects of various methods of ankle support on swelling, stability, range of movement, proprioception, muscle function, gait, and performance tests. There is still some contradiction in the literature about the effects of taping and braces in both the acute and chronic phases of ligament sprains of the ankle. 8. CAMERON-FIDDES, V. and SANTOS, D., 2013. The use of 'off-the-shelf' foot orthoses in the reduction of foot symptoms in patients with early rheumatoid arthritis. Foot, 23(4), pp. 123-129.Background: Foot pain in patients diagnosed with early rheumatoid arthritis is common. Objectives: To investigate effects of off-the-shelf foot orthoses on outcomes of swollen and tender joints, and pain, in patients with early rheumatoid arthritis. Methods: Thirty-five patients with painful and swollen foot joints were recruited. None had previously used foot orthoses or had contraindications to their use. Any patients with concomitant musculoskeletal disease, endocrine disorders, and neurological disease, were excluded. At baseline, participants were prescribed a customised off-the-shelf foot orthosis with chair-side modifications. Data was collected at baseline, three and six months. Foot pain (using Visual Analogue Scale) and the number of tender and swollen foot joints was measured. Results: There was a trend towards a reduction in the number of swollen and tender joints by 3 months with a further improvement by 6 months. Statistically (. p<. 0.05) and clinically significant reductions in pain levels were also noted. Conclusion: Patients diagnosed with early RA may benefit from using off-the-shelf foot orthoses with the majority of their pain reduction occurring within the first 3 months of use, but with some small further symptomatic improvement up to 6 months. There was a tendency to a reduction in swollen and tender joints although more studies are required to substantiate these findings. 2013 Elsevier Ltd.; 9. CONRAD, K.J., et al, 1996. Impacts of foot orthoses on pain and disability in rheumatoid arthritics. Journal of clinical epidemiology, 49(1), pp. 1-7.Rheumatoid arthritis (RA) frequently causes foot pain and swelling that affect ambulation. Pharmaceutical management of pain and disability is standard in clinical practice. The use of functional posted foot orthoses, as an adjunct to pharmaceutical treatment, is a promising treatment for managing foot pain and disability in RA. Its effectiveness, however, has not been rigorously evaluated. We performed a double-blind clinical trial using foot orthoses vs. placebo orthoses in the management of the rheumatoid arthritic foot, while subjects continued customary treatment. On the basis of findings of no effect on disability and pain measures, this study indicates no benefit of functional posted foot orthoses over placebos.; 10. DISTASIO, A.J.,2ND, et al, 1994. Protected early motion versus cast immobilization in postoperative management of ankle fractures. Contemporary orthopaedics, 29(4), pp. 273-277.Sixty-one active-duty military personnel with operatively treated ankle fractures were randomized into two postoperative immobilization regimens: Group I--six weeks short-leg cast, nonweight-bearing; Group II--six weeks removable orthosis, nonweightbearing. Group I began physical therapy at six weeks postoperatively, and Group II began physical therapy within the first postoperative week. Objective measurements of swelling, strength, range of motion, and functional tests were examined. Subjective scores of pain, function, cosmesis, and motion were recorded. Patients in Group II (early mobilization) had significantly better subjective scores at three and six months postoperatively; however, time to return to duty was not significantly different. Objective tests of swelling, strength, range of motion, and functional tests were not significantly different at three months postoperatively for either group. Early mobilization in a removable orthosis, while not objectively altering the postoperative course, provides a safe, preferable method of treatment in the reliable and cooperative patient.; 11. DOERLER, M., et al, 2014. Foot sling for the treatment of diurnal leg oedema: Effect due to foot muscle pump stimulation?. Phlebologie, 43(2), pp. 84-88.Background and objectives: Prospective pilot case series to evaluate the efficacy, tolerability and ease of use of a novel foot sling (Stimfeet) for the treatment of diurnal leg oedema. Patients and methods: We included 8 female patients with detectable pretibial pitting due to diurnal leg oedema. Hemodynamically relevant reflux or obstruction of the leg veins was ruled out by duplex ultrasonography. The patients wore knee-length medical compression stockings (MCS, 18-23 mmHg) all day for one week and, after a two-day break, used Stimfeet devices (maximum of four hours uninterrupted use) for one week, or vice versa. Before and after each treatment week, two water plethysmographic volume measurements were performed on each leg. Efficacy, tolerability and the ease of use were evaluated by means of a standardised questionnaire. Side effects were documented in a patient diary. Results: Volume reduction was greater with MCS therapy (mean right leg: 39.00 g, left leg: 24.44 g) than with Stimfeet (mean right leg: 5.06 g, left leg: 2.81 g). However, the difference was not significant (t-test: right leg, p=0.55; left leg, p=0.63). More patients preferred the MCS with respect to reduction of impairment (n=5), comfort (n=6), symptom reduction (n=5), improvement in quality of life (n=5), improvement of working conditions (n=5), and meeting expectations (n=5). The ease of use was rated equally. The most commonly reported side effects of Stimfeet were pressure and chafing marks (n=6), and slipping/need for fixation of the device (n=5). Conclusions: MCS therapy was superior to the novel foot sling for the treatment of diurnal leg oedema. However, the Stimfeet device did lead to an improvement of symptoms and reduced oedema in a few of the patients. Its efficacy possibly depends on the stimulation of the foot muscle pump. Methods of activating the foot muscle pump represent a novel therapeutic option for the treatment of diurnal leg oedema. Schattauer 2014.; ; Hagan MJ, Lambert SM (2008) A randomised crossover study of low-ankle-pressure graduated-compression tights in reducing flight-induced ankle oedema. Medical journal of Australia 188 (2) 81-4 . HIRAI, M., et al, 2006. Effect of elastic compression stockings on oedema prevention in healthy controls evaluated by a three-dimensional measurement system. Skin Research & Technology, 12(1), pp. 32-35.BACKGROUND/AIMS: The degree of oedema may differ at various sites on the leg. This study evaluated the degree of oedema at the calf, ankle and foot using a three-dimensional measurement system. METHODS: By three-dimensional measurement system using the grid pattern projection method, the effects of four different types of elastic compression stockings on oedema prevention were compared in healthy subjects. RESULTS: Without stockings, a significant increase in the circumference and volume was seen at the ankle and foot in the evening compared with morning values. The average increase in circumference was greater at the foot than that at the ankle. A significant increase in circumference and volume in the evening after a day without stockings disappeared when elastic compression stockings were worn during the day. The coefficient of variation was greater for measurements at the foot than for those at the calf and ankle. CONCLUSION: Oedema develops easily in order of the foot, the ankle and the calf in healthy populations. Elastic stockings, even with a pressure as low as 8 mmHg, are effective on oedema prevention. In measurement at the foot, further developments are necessary to improve this system.; 13. JONKER, M.J., et al, 2001. The oedema-protective effect of Lycra support stockings. Dermatology, 203(4), pp. 294-298.Background: Oedema may be an early sign of chronic venous insufficiency (CVI), but swelling of the lower legs is a common phenomenon in many people. The distinction between physiological swelling and CVI is not clear. There is a gradual transition between healthy legs and the early stages of CVI. In case of CVI, medical elastic compression stockings are used in order to prevent oedema completely. In case of healthy people without demonstrable CVI, no medical stockings are required in the prevention of oedema but stockings exerting less compression. Objective: The aim of this study was to investigate the effect of mild compression on the development of swelling of the legs and the effect on subjective complaints in healthy subjects. Methods: The diurnal volume change (DVC) of the lower legs during full working days was monitored with an optical leg volume meter in 118 healthy volunteers (60 males, 58 females) without objective symptoms of CVI. The DVCs after wearing two kinds of class I support stockings (X: average pressure at the ankle of almost 14 mm Hg; Y: almost 18 mm Hg) were compared with the DVC after wearing a control stocking (Z: almost 6 mm Hg). Also, the effect on subjective feelings of the legs was noted. Results: It appeared that healthy people have a mean daily volume increase of the legs of 2.3% in females and 1.6% in males. Mild compression stockings reduced this daily increase with 31 and 18% in males and females, respectively, by stocking X and 37 and 32% by stocking Y. Subjective feelings occurred in 57% of all cases. A beneficial effect on subjective feelings, in particular of tired and swollen legs, was found. A difference in this beneficial effect between stocking X and Y was not obvious. Conclusions: Mild compression stockings reduce diurnal oedema and unpleasant feelings of the legs in healthy individuals. Copyright 2001 S. Karger AG, Basel.; 14. KEMLER, E., et al, 2011. A systematic review on the treatment of acute ankle sprain: brace versus other functional treatment types. Ankle injuries, especially ankle sprains, are a common problem in sports and medical care. Ankle sprains result in pain and absenteeism from work and/or sports participation, and can lead to physical restrictions such as ankle instability. Nowadays, treatment of ankle injury basically consists of taping the ankle. The purpose of this review is to evaluate the effectiveness of ankle braces as a treatment for acute ankle sprains compared with other types of functional treatments such as ankle tape and elastic bandages. A computerized literature search was conducted using PubMed, EMBASE, CINAHL and the Cochrane Clinical Trial Register. This review includes randomized controlled trials in English, German and Dutch, published between 1990 and April 2009 that compared ankle braces as a treatment for lateral ankle sprains with other functional treatments. The inclusion criteria for this systematic review were (i) individuals (sports participants as well as non-sports participants) with an acute injury of the ankle (acute ankle sprains); (ii) use of an ankle brace as primary treatment for acute ankle sprains; (iii) control interventions including any other type of functional treatment (e.g. Tubigrip?, elastic wrap or ankle tape); and (iv) one of the following reported outcome measures: re-injuries, symptoms (pain, swelling, instability), functional outcomes and/or time to resumption of sports, daily activities and/or work. Eight studies met all inclusion criteria. Differences in outcome measures, intervention types and patient characteristics precluded pooling of the results, so best evidence syntheses were conducted. A few individual studies reported positive outcomes after treatment with an ankle brace compared with other functional methods, but our best evidence syntheses only demonstrated a better treatment result in terms of functional outcome. Other studies have suggested that ankle brace treatment is a more cost-effective method, so the use of braces after acute ankle sprains should be considered. Further research should focus on economic evaluation and on different types of ankle brace, to examine the strengths and weaknesses of ankle braces for the treatment of acute ankle sprains. 15. KERKHOFFS, G.M., et al, 2002. Different functional treatment strategies for acute lateral ankle ligament injuries in adults. Cochrane database of systematic reviews (Online), (3), pp. 002938.BACKGROUND: Acute lateral ankle ligament ruptures are common problems in present health care. Early mobilisation and functional treatment are advocated as a preferable treatment strategy. However, functional treatment comprises a broad spectrum of treatment strategies and as of yet no optimal strategy has been identified. OBJECTIVES: The objective of this review is to assess different functional treatment strategies for acute lateral ankle ligament ruptures in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (December 2001), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), MEDLINE (1966 to May 2000), EMBASE (1980 to May 2000), CURRENT CONTENTS (1993 to 1999), BIOSIS (to 1999), reference lists of articles, and contacted organisations and researchers in the field. SELECTION CRITERIA: Randomised clinical trials describing skeletally mature individuals with an acute lateral ankle ligament rupture and comparing different functional treatment strategies were evaluated for inclusion. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the quality of included trials and extracted relevant data on treatment outcome. Where appropriate, results of comparable studies were pooled. Individual and pooled statistics are reported as relative risks (RR) for dichotomous outcome and (weighted) mean differences (WMD) for continuous outcome measures with 95 per cent confidence intervals (95%CI). Heterogeneity between trials was tested using a standard chi-squared test. MAIN RESULTS: Nine trials involving 892 participants were included. Lace-up ankle support had significantly better results for persistent swelling at short-term follow up when compared with semi-rigid ankle support (RR 4.19, 95% CI 1.26 to 13.98); elastic bandage (RR 5.48; 95% CI 1.69 to 17.76); and to tape (RR 4.07, 95% CI 1.21 to 13.68). Use of a semi-rigid ankle support resulted in a significantly shorter time to return to work when compared with an elastic bandage (WMD (days) 4.24; 95% CI 2.42 to 6.06); one trial found the use of a semi-rigid ankle support saw a significantly quicker return to sport compared with elastic bandage (RR 9.60; 95% CI 6.34 to 12.86) and another trial found fewer patients reported instability at short-term follow-up when treated with a semi-rigid support than with an elastic bandage (RR 8.00; 95% CI 1.03 to 62.07). Tape treatment resulted in significantly more complications, the majority being skin irritations, when compared with treatment with an elastic bandage (RR 0.11; 95% CI 0.01 to 0.86). No other results showed statistically significant differences. REVIEWER'S CONCLUSIONS: The use of an elastic bandage has fewer complications than taping but appears to be associated with a slower return to work and sport, and more reported instability than a semi-rigid ankle support. Lace-up ankle support appears to be effective in reducing swelling in the short-term compared with semi-rigid ankle support, elastic bandage and tape. However, definitive conclusions are hampered by the variety of treatments used, and the inconsistency of reported follow-up times. The most effective treatment, both clinically and in costs, is unclear from currently available randomised trials.; 16. KERKHOFFS, G.M.M.J., et al, 2001. Immobilisation for acute ankle sprain. A systematic review. Archives of orthopaedic and trauma surgery, 121(8), pp. 462-471.The variation of practice with respect to the treatment of the acutely sprained ankle suggests a lack of evidence-based management strategies for this problem. The objective of this review was to assess the effectiveness of the various methods of immobilisation for acute ankle sprain. An electronic database search was conducted using MEDLINE, EMBASE, BIOSIS, CINAHL, Cochrane Controlled Trial Register and Current Contents. Randomised and quasi-randomised clinical trials describing skeletally mature individuals with an acute ankle sprain and comparing immobilisation for the treatment of injuries to the lateral ligament complex of the ankle were evaluated for inclusion. Two reviewers independently assessed the validity of included trials and extracted relevant data on the treatment outcome. Where appropriate, results of comparable studies were pooled. Individual and pooled statistics are reported as relative risks (RR) for dichotomous outcomes and weighted mean differences (WMD) for continuous outcome measures with 95% confidence intervals (95% CI). Heterogeneity between trials was tested using a standard chi-square test. A total of 22 studies met the inclusion criteria. Statistically significant differences were found for six outcome measures, all in favour of functional treatment compared with immobilisation: return to sports (RR: 1.85; 95% CI: 1.2 to 2.8), (WMD: 4.57 days; 95% CI: 1.5 to 7.6), return to work (WMD: 7.12 days; 95% CI: 5.6 to 8.7), persistent swelling (RR: 1.44; 95% CI: 1.1 to 2.0), objective instability by stress X-ray (WMD: 2.48; 95% CI: 1.3 to 3.6), range of motion (RR: 1.64; 95% CI: 1.1 to 2.6) and patient satisfaction (RR: 6.50; 95% CI: 1.8 to 24). None of the other results were significantly in favour of immobilisation. Sensitivity analysis showed that a non-concealed treatment allocation did not influence the statistical significance of the overall results. Based on our results, functional treatment currently seems a more appropriate treatment and should be encouraged. Concerning effectiveness, immobilisation, if necessary, should be restricted to certain patients and for short time periods.; 17. KHOSHGOFTAR, Z., et al, 2009. Comparison of compression stocking with elastic bandage in reducing postoperative edema in coronary artery bypass graft patient. Journal of Vascular Nursing, 27(4), pp. 103-106.The removal of the saphenous veins in coronary artery bypass graft (CABG) surgery may cause leg edema. Compression therapy is often used to prevent postoperative edema. The objective of this study was to compare the efficacy of medical compression stocking (TED) and elastic bandage-type on donor limbs after CABG. The peripheries of lower limbs were measured at four regions (A: end of tarsal bones, H: heel , B: immediately above the ankle, C: largest circumference of the calf) at admission in 295 patients how CABG candidates and differences in these measurement points at discharge compared to measurements at admission time were calculated. The difference was considered as a measure of the effectiveness of two types of compression to prevent postoperative edema in donor limbs after CABG. The alterations of 396 donor limbs of 295 patients were examined after CABG at admission and discharge time. In 101 patients veins for graft were taken from both lower limbs. After analysis, if subjects had worn TED stockings, the peripheries of donor limbs at discharge were less than at admission time in the A and H regions compared to elastic bandage group (P(A) = 0/009), (P(H) = 0/012). The conclusion reached was that using the kind of knee length compression stocking (TED stocking , Kendall Co.) is more effective edema at foot and heel regions in donor limbs after CABG than elastic bandages.; 18. LIEHR, P., et al, 1992. Effect of venous support on edema and leg pain in patients after coronary artery bypass graft surgery. Heart & Lung, 21(1), pp. 6-11.The purpose of this study was to assess the effect of external venous support on edema and pain in the saphenous graft leg of patients who had coronary artery bypass graft surgery (CABG) 5 days and 1 month after surgery. Fifty-six patients who had CABG surgery were randomly assigned to the experimental (n = 24) or control (n = 32) group. Subjects in the experimental group wore graded compression support hose. Edema was assessed by using ankle, calf, and thigh circumference measurements. Pain was measured on a visual analog scale. Hose were effective in preventing edema during hospitalization, but results at 1 month were inconclusive. There was no difference in leg pain for experimental and control subjects. That a number of patients in the experimental group were unable to complete the study suggests that off-the-shelf, thigh-high support hose may not be useful for individuals with disproportionately large thighs. Further investigation of the long-term effects of support hose is warranted.; 19. LIN, C.C., et al, 2012. Rehabilitation for ankle fractures in adults. Cochrane Database of Systematic Reviews, (11),BACKGROUND: Rehabilitation after ankle fracture can begin soon after the fracture has been treated, either surgically or non-surgically, by the use of different types of immobilisation that allow early commencement of weight-bearing or exercise. Alternatively, rehabilitation, including the use of physical or manual therapies, may start following the period of immobilisation. This is an update of a Cochrane review first published in 2008. OBJECTIVES: To assess the effects of rehabilitation interventions following conservative or surgical treatment of ankle fractures in adults. SEARCH METHODS: We searched the Specialised Registers of the Cochrane Bone, Joint and Muscle Trauma Group and the Cochrane Rehabilitation and Related Therapies Field, CENTRAL via The Cochrane Library (2011 Issue 7), MEDLINE via PubMed, EMBASE, CINAHL, PEDro, AMED, SPORTDiscus and clinical trials registers up to July 2011. In addition, we searched reference lists of included studies and relevant systematic reviews. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials with adults undergoing any interventions for rehabilitation after ankle fracture were considered. The primary outcome was activity limitation. Secondary outcomes included quality of life, patient satisfaction, impairments and adverse events. DATA COLLECTION AND ANALYSIS: Two review authors independently screened search results, assessed risk of bias and extracted data. Risk ratios and 95% confidence intervals (95% CIs) were calculated for dichotomous variables, and mean differences or standardised mean differences and 95% CIs were calculated for continuous variables. End of treatment and end of follow-up data were presented separately. For end of follow-up data, short term follow-up was defined as up to three months after randomisation, and long-term follow-up as greater than six months after randomisation. Meta-analysis was performed where appropriate. MAIN RESULTS: Thirty-eight studies with a total of 1896 participants were included. Only one study was judged at low risk of bias. Eight studies were judged at high risk of selection bias because of lack of allocation concealment and over half the of the studies were at high risk of selective reporting bias.Three small studies investigated rehabilitation interventions during the immobilisation period after conservative orthopaedic management. There was limited evidence from two studies (106 participants in total) of short-term benefit of using an air-stirrup versus an orthosis or a walking cast. One study (12 participants) found 12 weeks of hypnosis did not reduce activity or improve other outcomes.Thirty studies investigated rehabilitation interventions during the immobilisation period after surgical fixation. In 10 studies, the use of a removable type of immobilisation combined with exercise was compared with cast immobilisation alone. Using a removable type of immobilisation to enable controlled exercise significantly reduced activity limitation in five of the eight studies reporting this outcome, reduced pain (number of participants with pain at the long term follow-up: 10/35 versus 25/34; risk ratio (RR) 0.39, 95% confidence interval (CI) 0.22 to 0.68; 2 studies) and improved ankle dorsiflexion range of motion. However, it also led to a higher rate of mainly minor adverse events (49/201 versus 20/197; RR 2.30, 95% CI 1.49 to 3.56; 7 studies).During the immobilisation period after surgical fixation, commencing weight-bearing made a small improvement in ankle dorsiflexion range of motion (mean difference in the difference in range of motion compared with the non-fractured side at the long term follow-up 6.17%, 95% CI 0.14 to 12.20; 2 studies). Evidence from one small but potentially biased study (60 participants) showed that neurostimulation, an electrotherapy modality, may be beneficial in the short-term. There was little and inconclusive evidence on what type of support or immobilisation was the best. One study found no immobilisation improved ankle dorsiflexion and plantarflexion range of motion compared with cast immobilisation, but another showed using a backslab improved ankle dorsiflexion range of motion compared with using a bandage.Five studies investigated different rehabilitation interventions following the immobilisation period after either conservative or surgical orthopaedic management. There was no evidence of effect for stretching or manual therapy in addition to exercise, or exercise compared with usual care. One small study (14 participants) at a high risk of bias found reduced ankle swelling after non-thermal compared with thermal pulsed shortwave diathermy. AUTHORS' CONCLUSIONS: There is limited evidence supporting early commencement of weight-bearing and the use of a removable type of immobilisation to allow exercise during the immobilisation period after surgical fixation. Because of the potential increased risk of adverse events, the patient's ability to comply with the use of a removable type of immobilisation to enable controlled exercise is essential. There is little evidence for rehabilitation interventions during the immobilisation period after conservative orthopaedic management and no evidence for stretching, manual therapy or exercise compared to usual care following the immobilisation period. Small, single studies showed that some electrotherapy modalities may be beneficial. More clinical trials that are well-designed and adequately-powered are required to strengthen current evidence.; CINAHL Note: The Cochrane Collaboration systematic reviews contain interactive software that allows various calculations in the MetaView.] 20. MAN, V.O.W., et al, 2003. Effect of neuromuscular electrical stimulation on foot/ankle volume during standing. Medicine and science in sports and exercise, 35(4), pp. 630-634.Purpose: The purpose of this study was to assess whether the increase in foot and ankle volume after 30 min of motionless standing in healthy subjects could be minimized by neuromuscular electrical stimulation (NMES). Methods: A crossover, counterbalanced design was used where foot and ankle volume in 20 healthy subjects was measured using water volumetry before and after 30 min of motionless standing and standing with NMES applied to the lower leg muscles. The NMES produced repeated tetanic contractions of the gastrocnemius and tibialis anterior muscles causing slight ankle dorsi- and plantar-flexion. Results: Posttest foot and ankle volume was significantly greater than pretest volume after 30 min of motionless standing (t = -7.093, P < 0.001), but no significant differences were found after 30 min of standing with NMES (t = -1.374, P = 0.185). The mean volume changes from pretest to posttest in the conditions without NMES and with NMES were significantly different (51 + 32 mL and 12 + 39 mL, respectively; t = 3.905, P = 0.001). Conclusion: This study demonstrates the potential uses of NMES as a means to reduce swelling in the lower limbs for individuals who do not fully activate the musculo-venous pump. The activation of the musculo-venous pump by NMES-induced muscle contraction may have minimized the increase in foot and ankle volume by increasing venous return, reducing venous stasis, increasing lymph flow, and increasing interstitial hydrostatic pressure, which would reduce capillary filtration and assist fluid reabsorption.; 21. MARIANI, F., et al, 2013. Placebo controlled efficacy of class 2 elastic stockings (23-32 mmHg) in reduction of edema in CVI of the lower limbs. Acta Phlebologica, 14(1), pp. 39-44.Aim. The aim of the study is to compare the efficacy of class II below-knee compression stockings MCS (BSN medical-Jobst UltraSheer RAL, pressure at the ankle 23 to 32 mmHg) to that of placebo stockings PS (pressure at the ankle 3 to 6 mmHg) in reducing venous edema of the lower limbs in patients consulting in general practice for CVI stage CEAP 3. Methods. A 1-week randomized, placebo-controlled clinical trial comparing the efficacy of MCS to that of PS in reducing venous edema of the lower limb (stage CEAP 3). Treatment efficacy was assessed by the following criteria: the thickness of the subcutaneous tissue with the presence of edema at the ankle (point Bl) and the calf (point C) measured by duplex scan sonography (probe 6-10 mHz); the circumferences of the ankle (point Bl) and the calf (point C). Practicability of use of the MCS compared with the treatment with the PS, including treatment time to reduce oedema, comfort/ discomfort, assessment of tolerability (VAS and modified Venkatraman questionnaire). Data were analyzed using SPSS 13.01 (SPSS, Inc., Chicago, IL, USA), Chi Square test and Student t-tests. Results. Edema was significantly reduced after 3 days of treatment with MCS: 22 patients (84.6%) had no oedema. A further improvement occurred between days 3 and 7 for the MCS treatment groups, edema was reduced in 25 patients (96.2%). The mean time of edema reduction is 3,5 days for MCS. MCS is effective to reduce leg circumference and subcutaneous thickness at point Bl and C, the mean reduction of circumferences at point Bl was 3.4 cm, at point C was 1,23 cm. PS is unable to reduce oedema, leg circumferences and subcutaneous thickness. The differences between the two treatment groups are statistically significative in favour to MCS. Conclusion. Our placebo-controlled clinical trial comparing the efficacy of MCS to that of PS shows that compression stockings (23-32 mmHg at the ankle) are effective and well tolerated in the treatment phase of oedema.; 22. MARIANI, F., et al, 2011. Multicenter randomized trial comparing compression with elastic stocking versus bandage after surgery for varicose veins. Journal of Vascular Surgery, 53(1), pp. 115-122.OBJECTIVES: Postoperative limb compression is widely used after venous surgery to prevent thromboembolism and to reduce hemorrhage, edema, hematoma, and pain. Only limited studies have been published regarding the most adequate postoperative compression therapy after varicose vein surgery. This study evaluated the effectiveness of a new stocking kit used for postoperative limb compression. METHODS: The study compared the clinical practicability, ease to use, effectiveness, and safety of a postoperative stocking system (23 to 32 mmHg at the ankle) with compression bandages (control group). This prospective, randomized, open-label clinical trial, was performed in three Italian centers specializing in venous surgery. Sixty consecutive patients (classification CEAP C2,(S)) underwent unilateral varicose vein surgery at one of the three centers. After surgery, patients were randomized for postoperative compression therapy with a new stocking system (Sigvaris Postoperative Kit; Ganzoni Sigvaris Corp, Winterthur, Switzerland) or standard stretch bandages (30 patients per group). Primary end points were incidence of venous thromboembolism, hemorrhage, limb hematoma, or edema. RESULTS: No episodes of venous thromboembolism were observed. The mean area of thigh hematoma on postoperative days 7 and 14 was 75.70 cm2 and 2.93 cm2, respectively, for the stocking group, and 92.97 cm2 and 5.42 cm2 for the bandage group (not significant). On postoperative day 7, edema was found in 50% of the patients wearing bandages and in 20% of the patients wearing the stocking kit, which was a significant reduction. No statistical difference was recorded for postoperative pain; however, better patient acceptance and quality of life after the operation were recorded in the stocking group. CONCLUSION: Patients can be effectively treated with the Sigvaris Postoperative Kit. Patients treated with stockings have less edema compared with standard bandaging, and the application of the stocking kit improves patient quality of life and compliance with postoperative compression therapy. Copyright 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.; 23. MOSTI, G. and PARTSCH, H., 2013. Occupational leg oedema is more reduced by antigraduated than by graduated stockings. European Journal of Vascular and Endovascular Surgery, 45(5), pp. 523-527.Introduction: Elastic compression stockings exerting a progressive pressure, higher at the calf than at the ankle (progressive elastic compression stockings, PECS), have already proved to be more comfortable, easier to put on and more effective in improving venous pumping function compared to graduated compression elastic stockings (GECS). Nevertheless, PECS could have a negative effect on the prevention and treatment of oedema or even favour oedema formation. The aim of the present study was to investigate if, in normal volunteers, PECS are able to prevent leg swelling during their working shift. Methods: A total of 30 normal volunteers (14 males, 16 females aged 36.4 + 6.6 years) staying standing or sitting during their shift were enrolled into the study. Their leg volume was measured at the beginning and at the end of their working shift on 2 consecutive days. On one day, the volunteers did not put on any stockings; on the other day, they wore GECS on one leg and PECS on the other. The difference between the leg volume measured at the end of the shift and the basal volume in the morning was called 'occupational oedema'. Interface pressure at points B1 and C was measured immediately after stockings' application and before removal. The volunteers were asked to report about difficulty of putting on the stockings and comfort during wearing time. The results were submitted to statistical analysis. Results: The GECS and PECS groups had similar baseline leg volumes (3143 vs. 3154 ml) and occupational oedema (134 vs. 137.5 ml); after putting on the stockings, occupational oedema was reduced in both legs but the reduction was significantly greater with PECS (20 vs. 40 ml with GECS) (P < 0.05). Interface pressure at ankle level is higher with GECS both in supine and in standing position while at calf level it is higher with PECS both in supine and standing position. PECS are easier to put on and slightly more comfortable. Conclusion: PECS are easier to put on and more comfortable and produce a significantly higher reduction of occupational oedema compared with GECS in normal volunteers. Nevertheless leg volumetry, providing a global leg-volume evaluation, is not able to localise the oedema reduction and to assess if it occurs more in the calf or the ankle area. Theoretically, despite a global volume reduction, PECS could even promote a slight oedema formation at ankle level over-compensated by a greater oedema reduction at calf level. Further studies need to concentrate on patients with venous disease and on the local distribution of this global effect. 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.; 24. PITTALUGA, P. and CHASTANET, S., 2013. Value of postoperative compression after mini-invasive surgical treatment of varicose veins. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 1(4), pp. 385-391.Objective: It is customary to recommend wearing elastic band compression or compression stockings after treatment of varicose veins. Our aim was to evaluate the benefit from wearing elastic compression stockings after surgical treatment of varicose veins. Methods: Prospective nonrandomized study with inclusion of consecutive patients operated on for unilateral varicose veins during a 6-month period with distribution in two groups: group 1, in which the patients were wearing an 18-mm Hg thigh compression stocking from the day of the operation until the postoperative consultation and group 2, in which the patients were wearing an 18-mm Hg thigh compression stocking for only 36 hours after surgery. The evaluation of outcomes was made at the postoperative consultation and concerned pain (self-evaluation by visual analog scale) and analgesic consumption, ecchymosis (self evaluation by visual analog scale), edema (circumference of the ankle), deep or superficial venous thrombosis (ultrasound duplex), quality of life by Chronic Venous Insufficiency Quality-of-Life questionnaire, and duration of postoperative sick leave. Results: Fifty patients were included in each group for a total of 100. There was no significant difference between the two groups with regard to demographics, to clinical and hemodynamic characteristics, and to the type of surgery performed (phlebectomy, 32% vs 32%; ambulatory selective varices ablation under local anesthesia, 46% vs 48%; stripping, 10% vs 12%; redo surgery for recurrence, 12% vs 8%). All the surgical procedures were carried out under tumescent local anesthesia. At the postoperative consultation, we did not observe any significant difference between group 1 and group 2 for pain score (0.6 vs 0.8; P = .35), analgesic consumption frequency (8% vs 12%; P = .50), ecchymosis score (1.3 vs 1.2; P = .49), and quality-of-life score (7.00 vs 8.64; P = .43). The circumference of the ankle was not significantly different for the side operated on before and after surgery, for group 1 (25.6 cm vs 26.2 cm; P = .30) and for group 2 (25.5 cm vs 26.2 cm; P = .28). No superficial or deep vein thrombosis was found. There was no difference in sick leave frequency (26.7% vs 32.3%; P = .57) and duration (2.6 vs 2.3 days; P = .83). Conclusions: We found no benefit from wearing the compression stocking beyond the first postoperative day for pain, ecchymosis, quality of life, and thrombosis after a mini-invasive surgical treatment for varicose veins carried out under tumescent local anesthesia with immediate ambulation. 2013 by the Society for Vascular Surgery.; ; Preston Nancy J, Seers Kate, Mortimer Peter S (2004) Physical therapies for reducing and controlling lymphoedema of the limbs Cochrane Database of Systematic Reviews 4 . STUART, P.R., et al, 1989. Comparative study of functional bracing and plaster cast treatment of stable lateral malleolar fractures. Injury, 20(6), pp. 323-326.In a prospective, randomized study, the use of the Aircast pneumatic air stirrup was compared with a standard below-knee walking cast in the management of Lauge-Hansen supination-eversion, stage II ankle fractures. Forty patients were randomly allocated to the two treatment groups. The use of the air stirrup led to a significant improvement in early patient comfort, post-fracture swelling, range of ankle motion at union, and time to full rehabilitation. We advocate the use of pneumatic air stirrup in the cost-effective management of stable ankle fractures.; 26. SULTAN, M., J., et al, 2014. Compression stockings in the management of fractures of the ankle: a randomised controlled trial. Bone & Joint Journal (British), 96-B(8), pp. 1062-1069.In this randomised controlled trial, we evaluated the role of elastic compression using ankle injury stockings (AIS) in the management of fractures of the ankle. A total of 90 patients with a mean age of 47 years (16 to 79) were treated within 72 hours of presentation with a fracture of the ankle, 31 of whom were treated operatively and 59 conservatively, were randomised to be treated either with compression by AIS plus an Aircast boot or Tubigrip plus an Aircast boot. Male to female ratio was 36:54. The primary outcome measure was the functional Olerud-Molander ankle score (OMAS). The secondary outcome measures were; the American Orthopaedic Foot and Ankle Society score (AOFAS); the Short Form (SF)-12v2 Quality of Life score; and the frequency of deep vein thrombosis (DVT). Compression using AIS reduced swelling of the ankle at all time points and improved the mean OMAS score at six months to 98 (95% confidence interval (CI) 96 to 99) compared with a mean of 67 (95% CI 62 to 73) for the Tubigrip group (p < 0.001). The mean AOFAS and SF-12v2 scores at six months were also significantly improved by compression. Of 86 patients with duplex imaging at four weeks, five (12%) of 43 in the AIS group and ten (23%) of 43 in the Tubigrip group developed a DVT (p = 0.26). Compression improved functional outcome and quality of life following fracture of the ankle. DVTs were frequent, but a larger study would be needed to confirm that compression with AISs reduces the incidence of DVT. Cite this article: Bone Joint J 2014; 96-B:1062-9. 27. VAN GEEST, A.J., et al, 2000. The effect of medical elastic compression stockings with different slope values on edema. Measurements underneath three different types of stockings. Dermatologic Surgery, 26(3), pp. 244-247.BACKGROUND. Medical elastic compression stockings are widely used in venous diseases. Their effects on the venous system have been shown in the past. Up to now, little is known about the slope or stiffness factor of stockings. OBJECTIVE. To evaluate the effect of different slope and stiffness factors of medical elastic compression stockings on the venous system. METHODS. Examinations were carried out in 29 legs of 25 different patients (12 men, 13 women) with a mean age of 66.0 years. All patients were known with chronic venous insufficiency. On all these patients three different elastic medical compression stockings were tested; one with a low slope, one with a high slope, and one with a low slope but a higher pressure at the ankle. The tests were carried out by determining capillary filtration rate (CFR) with air-plethysmography (APG) while wearing the stockings. RESULTS. The mean value of the CFR without wearing a stocking was 4.65 ml/min (SD = 1.68), with Compriform (low slope, 30 mmHg) the mean CFR was 3.54 ml/min (SD = 1.22), with Bellavar (high slope, 30 mmHg) a mean CFR of 3.15 ml/min (SD = 1.17) was found, and the mean CFR related to Fast-fit (low slope, 34.5 mmHg) was 3.02 ml/min (SD = 1.12). There is a highly statistically significant difference in CFR between no stockings and wearing a stocking (paired Student's t-test; P < 0.01). Regarding the individual stocking, there is a highly statistically significant difference in CFR between the Compriform and the other two stockings (paired Student's t-test; P < 0.01). Between Bellavar and the Fast-fit the difference was not statistically significant. CONCLUSIONS. There is a statistically significant difference in CFR, and consequently in the development of edema, between not wearing an elastic compression stocking and wearing an elastic compression stocking. There is also a statistically significant difference in CFR between elastic compression stockings with the same compression, but a low slope profile and a high slope profile. Stockings with a low slope, but a higher compression may perform as well as stockings with a higher slope but a lower compression in reducing the CFR. In patients with a strong tendency to develop edema it may be advisable to prescribe stockings with a high slope profile.; 28. VAN OS, A., et al, 2005. Comparison of conventional treatment and supervised rehabilitation for treatment of acute lateral ankle sprains: a systematic review of the literature. Journal of Orthopaedic & Sports Physical Therapy, 35(2), pp. 95-105.Study Design: Systematic literature review.; Objective: To compare the effectiveness of conventional treatment complemented by supervised rehabilitation training (supervised exercises) with conventional treatment alone for the rehabilitation of acute lateral ankle sprains.; Background: Conventional treatment is advocated as a preferable treatment strategy. Whether supervised exercises should complement conventional treatment is unclear.; Methods and Measures: We searched 5 computerized databases from 1966 to March 2004, checked the reference lists of all studies that fulfilled our eligibility criteria, and searched for nonindexed journals available on the Internet. Three reviewers independently selected randomized controlled trials (RCTs), and controlled clinical trials (CCTs), comparing conventional treatment alone with conventional treatment combined with supervised exercises for treating patients with an acute lateral ankle sprain. Two reviewers independently assessed the methodological quality of each included study. Two reviewers extracted data regarding outcomes, interventions, and results. Follow-up measurements were grouped as (a) immediate term, (b) short term, (c) intermediate term, and (d) long term. A best-evidence synthesis was conducted, weighting the studies with respect to their internal validity and statistical significance of the outcomes.; Results: Seven RCTs were included. The quality assessment resulted in 1 high quality and 6 low-quality studies. There is limited evidence that the addition of supervised exercises to a conventional treatment approach results in greater reduction in swelling and faster return to work. Studies reporting a lack of difference between treatment approaches did not report statistical power, making interpretation of those results difficult.; Conclusions: The retrieved data failed to demonstrate a clearly superior treatment approach, although preliminary support exists for supervised exercises. Additional high-quality RCTs are needed that are appropriately designed and reported. ................
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