38 A comparison of two interventions in the treatment of severe ankle sprains and distal fibular avulsion fractures: a patient perspective
Stable ankle injuries are highly prevalent in Emergency Departments across the UK. Appropriate management to enable patients to experience a smooth recovery and prevent chronic ankle instability or reoccurrence is a priority. Current literature states that stable ankle fractures and severe ankle sprains can be successfully managed with the below knee plaster or the aircast brace and crutches. The functional brace has proved to be clinically effective in several reports. There has however, been no research to measure patient satisfaction levels between these two treatments.
An experimental, mixed method approach to the researching of this issue was performed in a busy, central London Emergency Department; a randomised controlled trial undertaken to compare the two devices and quantitative and qualitative data collection by means of a tailored questionnaire to determine patient satisfaction. Thirty nine patients were recruited during hospital attendance over 9 months. Patients were requested to complete the questionnaire 7 days into their treatment via post; stamped addressed envelopes were provided. Telephone interview was adopted as a secondary measure when postal responses failed. The primary outcome measured was patient satisfaction levels regarding comfort of the device, pain relief, daily activities, sleep, work, care of dependents and social life measured by use of a likert scale; ranging from very unsatisfactory to very satisfactory. The null hypothesis is that there is no significant difference in satisfaction levels between the two devices. Data was analysed using the unrelated t test.
31 responses were obtained; 16 participants with avulsion fractures to the distal fibular and 15 severe ankle sprains, 16 allocated to the ankle brace and 15 to the plaster. The findings demonstrate that there were statistically significant higher patient satisfaction levels in patients treated with an aircast brace than with the plaster cast. Using a probability level of 0.01, the critical value was 2.756, the t value 4.996; therefore the null hypothesis was rejected. The main indicators contributing to these findings were in the levels of comfort, daily activities, sleep work and social life. Overall it appears that patients preferred treatment with the aircast brace. Both forms of treatment were clinically equally effective in this study.
Evidence indicates that our current department guidelines may need to be re-evaluated. In addition, this a study focused on patient-centred care. The questionnaire developed, could potentially be used to measure patient satisfaction in other fields.