Timing of Rehabilitation is Associated with Recurrence After Ankle Sprain Injury in the Military Health System - MHSRS 2021

Rhon D, Greenlee t, Fraser J

Abstract accepted as a poster for 2021 MHSRS

The purpose of this paper was to investigate the influence of time taken to begin physical rehabilitation after ankle sprain on injury recurrence and medical costs. Because comorbidities can influence costs, we also investigated the effect modification of select comorbidities on the relationship between the timing of rehabilitation and these outcomes (injury recurrence and injury-related costs).

Less than half of individuals that sought care for an ankle sprain received any physical rehabilitation procedures as part of their care. For patients that underwent physical rehabilitation, longer times to the first rehabilitation visit were associated with a higher risk for injury recurrence. The exception was with the isolated lateral ankle sprain group. However, the large majority of ankle sprains in the “unspecified sprain” subgroup were likely lateral ankle sprains. This was the case regardless of whether the ankle sprain was first managed in military versus civilian clinics. Longer times to rehab were also associated with greater total ankle-related medical costs for the year following the initial injury. Individuals that sought care for pain-related comorbid medical conditions in the prior year were more likely to experience a recurrent ankle sprain injury (those with anxiety and PTSD) and more likely to have increased ankle-related medical costs ( those with insomnia, sleep apnea, anxiety, PTSD, and substance abuse disorders), highlighting the potentially complex and multivariate relationships that influence recovery after injury.

This is the first study to assess the influence of timing of rehab on outcomes after ankle sprains injuries. For individuals who undergo rehab for an ankle sprain, the earlier they start rehab, the lower their likelihood of recurrence and the lower the number of downstream ankle-related visits and costs they will incur.