***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To estimate the clinical effectiveness and cost-effectiveness of three methods of ankle support compared with double layer tubular compression b and age . DESIGN A r and omised controlled trial , design ed to reflect practice in UK hospital emergency departments . SETTING Eight emergency departments in Engl and . PARTICIPANTS Aged 16 or over with acute severe ankle sprain , unable to weight bear , no fracture . INTERVENTIONS 584 participants were r and omised to one of four treatment arms : tubular b and age , below knee cast , Aircast ankle brace or Bledsoe boot , all applied 2 - 3 days after presentation to allow swelling to resolve . MAIN OUTCOME MEASURES Response to treatment was assessed using the Foot and Ankle Outcome Score and generic measures ( Functional Limitations Profile , SF-12 and EQ-5D ) . RESULTS When adjusted for age , sex and baseline scores , the below knee cast offered a small but statistically significant benefit at 4 weeks in terms of pain ( FAOS pain difference 5.1 ; 95 % CI 0.4 - 9.8 ) , foot- and ankle-related quality of life ( QoL ) ( FAOS QoL difference 5.9 ; 95 % CI 0.1 - 11.8 ) and the physical component of the SF-12 ( SF-12 score difference 2.2 ; 95 % CI 0.0 - 4.4 ) . Neither the Aircast brace nor the Bledsoe boot was statistically or clinical ly better . At 12 weeks the below knee cast was significantly better than tubular b and age in terms of pain ( FAOS pain difference 5.1 ; 95 % CI 0.3 - 10.0 ) , activities of daily living ( FAOS ADL difference 3.5 ; 95 % CI 0.4 - 6.6 ) , sports ( FAOS sports difference 8.7 ; 95 % CI 1.6 - 15.7 ) and QoL ( FAOS QoL difference 8.7 ; 95 % CI 2.4 - 15.0 ) , and the Aircast brace was better only in terms of ankle-related QoL and mental health . The Bledsoe boot conferred no significant advantage over tubular b and age . By 9 months there were no significant differences . Based on mean direct health-care costs per participant , the Bledsoe boot was the most expensive ( 215 pounds ) and tubular b and age the least so ( 1 pound 44 pence ) . Inclusion of indirect costs ( sick leave ) raised overall costs substantially and removed any significant differences between the therapies . Cost-utility analysis demonstrated that the Aircast brace [ 301 pounds per quality -adjusted life-year ( QALY ) ] and below knee cast ( 339 pounds per QALY ) were more cost-effective than the Bledsoe boot ( 2116 pounds per QALY ) . However , inclusion of indirect costs produced different rank orders , depending on the assumptions made , and results should be treated with caution . CONCLUSIONS The below knee cast and the Aircast brace offered cost-effective alternatives to tubular b and age for acute severe ankle sprain , the former having the advantage in terms of overall recovery at 3 months . As there were no differences in long-term outcome , practitioners should consider likely compliance and acceptability to patients when choosing a brace 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 st and ard treatment with an elastic support b and age against an Aircast ankle brace . Design : Prospect i ve , r and omised controlled trial . Setting : Two accident and emergency departments . Method : Fifty patients presenting consecutively were r and omised into two equal groups : one group was treated with an elastic support b and age and the other with an Aircast ankle brace . All patients were given a st and ardised advice sheet referring to rest , ice , compression , and elevation . Patients were review ed 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 b and age 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 b and age 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 st and ard management with an elastic support b and age Background The optimal management for severe sprains ( Grade s II and III ) of the lateral ligament complex of the ankle is unclear . The aims of this r and omised controlled trial are to estimate ( 1 ) the clinical effectiveness of three methods of providing mechanical support to the ankle ( below knee cast , Aircast ® brace and Bledsoe ® boot ) in comparison to Tubigrip ® , and ( 2 ) to compare the cost of each strategy , including subsequent health care costs . Methods / design Six hundred and fifty people with a diagnosis of severe sprain are being identified through emergency departments . The study has been design ed to complement routine practice in the emergency setting . Outcomes are recovery of mobility ( primary outcome ) and usual activity , residual symptoms and need for further medical , rehabilitation or surgical treatment . Parallel economic and qualitative studies are being conducted to aid interpretation of the results and to evaluate the cost-effectiveness of the interventions . Discussion This paper highlights the design , methods and operational aspects of a clinical trial of acute injury management in the emergency department Abstract The purpose of this study was to analyse objective modalities of ankle joint function after an acute ankle sprain and to see whether treatment with an air-cushioned ankle brace could enhance the restoration of function compared with a traditionally used compression b and age . The study included 73 consecutive patients between 15 and 55 years of age with an acute grade II or III ankle sprain , who sought medical care within 24 h of the time of injury . Patients with recurrent sprain were excluded . The patients were allocated at r and om to treatment with compression b and age or an air-cushioned ankle brace ( Air-Stirrup , Aircast ) . The regimen included early motion and weight-bearing in both groups . The patients were examined initially within 24 h , after 3–5 days , 2 , 4 and 10 weeks after the injury by the following tests : clinical examination including range of motion , recording of postural sway by stabilometry , joint position sense test , isokinetic eversion-inversion muscle torques and figure-of-eight running . A decreased active range of motion in eversion-inversion was observed during the entire follow-up period . Increased postural sway was registered when st and ing on the injured foot up to 4 weeks after the injury , as were a deficit in evertor muscle peak torque and an evertor-invertor muscle imbalance compared with the uninjured side . Women demonstrated a greater impairment in postural sway than men . A longer curve running time with the injured ankle at the outside of the curve was noted at the 10-week follow-up . With the exception of running in a figure of eight , these measures were not influenced by treatment with a semi-rigid ankle brace . The methods used in the present study are well suited for further studies of objective modalities of ankle joint function , with the possible exception of the joint position sense test Objectives : To evaluate the cost effectiveness of a proprioceptive balance board training programme for the prevention of ankle sprains in volleyball . Methods : A total of 116 volleyball teams participated in this study which was carried out during the 2001–2002 volleyball season . Teams were r and omly allotted to an  intervention group ( 66 teams , 628 players ) or a  control group ( 52 teams , 494 players ) . Intervention teams followed a prescribed balance board training programme as part of their warm up . Control teams followed their normal training routine . An ankle sprain was recorded if it occurred as a result of volleyball and caused the subject to stop volleyball activity . The injured player completed a cost diary for the duration of the ankle sprain . Analyses were performed according to the intention to treat principle . Mean direct , indirect , and total costs were calculated and were compared between the two groups . Results : The total costs per player ( including the intervention material ) were significantly higher in the intervention group ( € 36.99 ( 93.87 ) ) than in the control group ( € 18.94 ( 147.09 ) ) . The cost of preventing one ankle sprain was approximately € 444.03 . Sensitivity analysis showed that a proprioceptive balance board training programme aim ed only at players with previous ankle sprains could be cost effective over a longer period of time . Conclusions : Positive effects of the balance board programme could only be achieved at certain costs . However , if broadly implemented , costs associated with the balance board programme would probably be lower 1 . The pressure exerted by two types of b and age used to treat sprained ankles were compared in a study . 2 . Wool and crepe b and ages exert more pressure than elasticated tubular b and age , but this advantage is likely to be short lived . 3 . Neither b and age exerts significant pressure over the sprained ligament A r and omized , controlled , parallel-group study was performed to compare the clinical efficacy of a semi-rigid b and age ( ' Scotchrap ' ) with the st and ard adhesive tape treatment for ankle ligament injuries . The semi-rigid b and age support wrap consists of a knitted fibreglass fabric impregnated with a polyurethane resin . The cotton stockinet and the synthetic cast padding are used for protection of pressure points and any bony prominences . Prior to application , the ' Scotchrap ' must be soaked in water after which it is applied in a way similar to that used for a plaster of paris b and age . The finished b and age remains elastic , allowing normal dorsal and plantar flexion of the foot , but preventing inversion and eversion , and pronation and supination . At rest , the b and age always redresses the immobilized ankle into the neutral position . One hundred and thirty-six patients were included in the study . The semi-rigid b and age  group comprised 59 patients and the tape group had 57 patients . These two groups were statistically comparable . The intake question naire included a general and a specific anamnesis form as well as a physical examination form . Follow-up data were recorded every 2 weeks . After termination of the treatment , the patients evaluated treatment efficacy . Statistical analysis of 126 items per patient with chi 2-tests ( p < or = 0.05 ) and Fisher 's exact tests ( p < or = 0.05 ) revealed no statistical significant differences in treatment result . The patient assessment s of treatment efficacy of both types of b and age were also comparable . Both types of b and age gave sufficient stability ( 98 % ; p < 0.005 ) and were equally effective . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE To compare functional outcome in patients with acute grade 1 or 2 ( mild to moderate ) lateral ankle sprains r and omised to treatment with or without a double tubigrip b and age ( DTG ) .  METHODS 400 patients presenting to the accident and emergency ( A&E ) departments of a teaching hospital and a district general hospital and diagnosed with grade 1 or 2 lateral ankle sprains were r and omised to treatment with or without a DTG b and age .  A st and ardised telephone question naire was performed one week after presentation . The main outcome measures were : number of days until walking unaided , number of days off work , whether the injury kept the patient awake at night , whether analgesia was taken . RESULTS 197 of 400 patients completed follow up . There were no significant differences in terms of age , sex and occupation between the treatment groups . There were no significant differences between those who did and those who did not complete follow up . There was no significant difference between the treatment groups for number of days until walking unaided ( 95 % CI -0.21 to 0.88 days ) , number of days off work ( 95 % CI -0.70 to 1.02 days ) or whether the injury kept the patient awake at night ( 95 % CI -10 to 17 % ) . There was a significant difference between the groups in the use of analgesia ( 95 % CI 10 to 36 % ) ; the difference seemed to 
    Output:
    
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 .