@article{42ccdb25b722412ab3dec0319ec34a2f,
title = "Delayed Rehabilitation Is Associated with Recurrence and Higher Medical Care Use after Ankle Sprain Injuries in the United States Military Health System",
abstract = "OBJECTIVE: To investigate the influence of time taken to begin musculoskeletal rehabilitation on injury recurrence and ankle-related medical care use at 1 year after ankle sprain. DESIGN: Retrospective cohort study of all beneficiaries of the US Military Health System seeking care for an ankle sprain over a 4-year period. METHODS: Individuals were classified according to whether they did or did not receive physical rehabilitation. For those who received rehabilitation (n = 6150), linear relationships (with appropriate covariate controls) were analyzed with generalized linear models and generalized additive models to measure the effects of rehabilitation timing on injury recurrence and injury-related medical care use (costs and visits) at 1 year after injury. The nonlinear effect of rehabilitation timing on the probability of recurrence was assessed. RESULTS: Approximately 1 in 4 people received rehabilitation. The probability of ankle sprain recurrence increased for each day that rehabilitation was not provided during the first week. The probability of ankle sprain recurrence plateaued until about 2 months after initial injury, then increased again, with 2 times greater odds of recurrence compared to those who received physical rehabilitation within the first month. When rehabilitation care was delayed, recurrence (odds ratio [OR] = 1.28), number of foot/ankle-related visits (OR = 1.22), and foot/ankle-related costs increased (OR = 1.13; up to $1400 per episode). CONCLUSION: The earlier musculoskeletal rehabilitation care started after an ankle sprain, the lower the likelihood of recurrence and the downstream ankle-related medical costs incurred.",
keywords = "Ankle sprain, Health services research, Physical rehabilitation, Recurrence",
author = "Rhon, {Daniel I.} and Fraser, {John J.} and Jeff Sorensen and Greenlee, {Tina A.} and Tarang Jain and Cook, {Chad E.}",
note = "Funding Information: 1Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX. 2Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD. 3The Geneva Foundation, Tacoma, WA. 4Directorate for Operational Readiness and Health, Naval Health Research Center, San Diego, CA. 5Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ. 6Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC. The study protocol was approved by the Brooke Army Medical Center Institutional Review Board, in compliance with all applicable federal regulations governing the protection of human subjects. Research data were derived from an approved Brooke Army Medical Center Institutional Review Board protocol (number C.2016.048n). This research was supported by the US Department of Defense Clinical and Rehabilitative Medicine Research Program (award W81XWH-18-1-0788, under program number W81XWH-17-DMRDP-CRMRP-NMSIRRA), and in part by the Uniformed Services University{\textquoteright}s Musculoskeletal Injury Rehabilitation Research for Operational Readiness program (HU00011920011). The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of Brooke Army Medical Center, the US Army Office of the Surgeon General, the Department of the Army, the Department of the Navy, the Defense Health Agency, the Department of Defense, or the US Government. Several coauthors are military service members or employees of the US Government, and this work was prepared as part of their official duties. Title 17, USC, §105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17, USC, §101 defines a US Government work as a work prepared by “an officer or employee of the US Government as part of that person{\textquoteright}s official duties.” Dr Chad Cook is a member of the JOSPT Editorial Board. Address correspondence to Dr Daniel Rhon, Primary Care Musculoskeletal Research, Department of Rehabilitation Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, Joint Base San Antonio-Fort Sam Houston, TX 78234. E-mail: daniel.i.rhon.ctr@mail.mil U Copyright 2021 JOSPT {\textregistered}, Inc Funding Information: The study protocol was approved by the Brooke Army Medical Center Institutional Review Board, in compliance with all applicable federal regulations governing the protection of human subjects. Research data were derived from an approved Brooke Army Medical Center Institutional Review Board protocol (number C.2016.048n). This research was supported by the US Department of Defense Clinical and Rehabilitative Medicine Research Program (award W81XWH-18-1-0788, under program number W81XWH-17-DMRDP-CRMRP-NMSIRRA), and in part by the Uniformed Services University's Musculoskeletal Injury Rehabilitation Research for Operational Readiness program (HU00011920011). The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of Brooke Army Medical Center, the US Army Office of the Surgeon General, the Department of the Army, the Department of the Navy, the Defense Health Agency, the Department of Defense, or the US Government. Several coauthors are military service members or employees of the US Government, and this work was prepared as part of their official duties. Title 17, USC, ?105 provides that ?Copyright protection under this title is not available for any work of the United States Government.? Title 17, USC, ?101 defines a US Government work as a work prepared by ?an officer or employee of the US Government as part of that person's official duties.? Dr Chad Cook is a member of the JOSPT Editorial Board. Address Publisher Copyright: Copyright {\textcopyright} 2021 JOSPT{\textregistered}, Inc",
year = "2021",
month = dec,
doi = "10.2519/jospt.2021.10730",
language = "English (US)",
volume = "51",
pages = "619--627",
journal = "Journal of Orthopaedic and Sports Physical Therapy",
issn = "0190-6011",
publisher = "JOSPT",
number = "12",
}