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Scand J Med Sci Sports. 2018 Feb;28(2):641-648. doi: 10.1111/sms.12915. Epub 2017 Jun 19.

Preventing recurrent ankle sprains: Is the use of an App more cost-effective than a printed Booklet? Results of a RCT.

Van Reijen M1,2, Vriend I1,2,3, van Mechelen W1,2,4,5,6, Verhagen EA1,2,6,7.

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Amsterdam Collaboration on Health and Safety in Sports, IOC Research Center, VUmc/AMC, Amsterdam, The Netherlands.
Department of Public & Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
VeiligheidNL, Amsterdam, The Netherlands.
School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland.
School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Qld, Australia.
UCT/MRC Research Unit for Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa.
Australian Centre for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, Vic., Australia.


Recurrent ankle sprains can be reduced by following a neuromuscular training (NMT) program via a printed Booklet or a mobile application. Regarding the high incidence of ankle sprains, cost-effectiveness regarding implementation can have a large effect on total societal costs. In this economic analysis, we evaluated whether the method of implementing a proven effective NMT program using an App or a Booklet resulted in differences in injury incidence rates leading to costs and hence to differences in cost-effectiveness. In total, 220 athletes with a previous ankle sprain were recruited for this randomized controlled trial with a follow-up of 12 months. Half of the athletes used the freely available "Strengthen your ankle" App and the other half received a printed Booklet. After the 8-week program, athletes were questioned monthly on their recurrent injuries. Primary outcome measures were incidence density of ankle injury and incremental cost-effectiveness ratio (ICER). During follow-up, 31 athletes suffered from a recurrent ankle sprain that led to costs resulting in a hazard ratio of 1.13 (95% CI: 0.56-2.27). The incremental cost-effectiveness ratio of the App group in comparison with the Booklet group was €361.52. The CE plane shows that there was neither a difference in effects nor in costs between both intervention methods. This study showed that the method of implementing the NMT program using an App or a Booklet led to similar cost-effectiveness ratios and the same occurrence of recurrent injuries leading to costs. Both the App and the Booklet can be used to prevent recurrent ankle injuries, showing no differences in (cost-) effectiveness at 12-month follow-up.


Injury prevention; ankle injury; cost analysis; e-health

[Indexed for MEDLINE]

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