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The Placebo Effect on College Athletes from an Ankle Tape Job Research Team: Joel Tidman, ATS and Colin Foley, ATS Investigation advisory Committee: Kris Johnson ATC, Dennis Cobbler, Ed.D, ATC, Ryan Lockwood, MS, PT, CSCS, and Joe Vess 12/04/2016 Table of Contents CLINICAL SCENARIO........................................................2 FOCUSED CLINICAL QUESTION....................................
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   The Placebo Efect on College Athletes roman Ankle Tape Job Research Team: Joel Tidman, ATS and Colin Fole, ATS!n estigation ad isor Committee: #ris Johnson ATC,$ennis Cobbler, Ed%$, ATC, Ran &ock'ood, (S, PT, CSCS,and Joe )ess*+-.+-*/  Table of Contents CLINICAL SCENARIO........................................................2 F 0C1SE$  C &!2!CA&  3 1EST!02 %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%+#  E450R$S %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%+ SUMMARY OF SEARCH..................................................2-3 S EARC6  S  TRATE74 %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%8S 01RCES   0F  E )!$E2CE  S EARC6E$ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%89 EST  E )!$E2CE  R E)!E5E$ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%8. CLINICAL BOTTOM LINE...................................................4 ! (P&!CAT!02S   F0R  C &!2!CA&  P RACT!CE %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%.R EC0((E2$AT!02S   F0R  F 1T1RE  R ESEARC6 %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%. REFERENCES................................................................... *  CLINICAL SCENARIO Summary of Problem and Background: There are 28,000 ankle injuriesin the United States each day !or an athletic trainer, #$ of all athletic injuries in%ol%e the ankle &t is re'orted that 8#$ of those ankle injuries are s'rains, most often lateral s'rains in%ol%ing the lateral ligaments (&)* is the generally acce'ted acute treatment for ankle s'rains including (est, &ce, )om'ression, and *le%ation This is ty'ically follo+ed +ith a rehabilitati%e treatment 'rogram 'rior to return to s'orts nkle s'rain can lead to decreased -uality of life and  'artici'ation in s'orts as +ell as osteoarthritis nkle re.injury is common !ollo+ing ankle s'rain and return to s'orts, ankle ta'ing is commonly used The e/act mechanism is ho+ this +orks is uncertain There are t+o theories regarding the eects of ankle ta'ing: one is mechanical and the other 'ro'rioce'ti%e 1echanically, ta'ing is belie%ed to limit e/treme ankle in%ersion, e%ersion, and 'lantare/ion 1echanical su''ort of ta'ing generally decreases +ith athletic acti%ity3 ob%iously, this de'ends on the 'erson and ty'e and intensity of athletic acti%ity 4o+e%er, mechanical su''ort can be signi5cantly reduced in as little as ten minutes of acti%ity !rom a 'ro'rioce'ti%e stand'oint, ta'ing could enhance 'ro'rioce'tion in'ut from muscle aerents and cutaneous rece'tors &ncreased 'ro'rioce'ti%e res'onses ha%e been 'ro%en more accurate in athletes +ithout 'rior ankle s'rain as com'ared to those +ith 'rior injury Since mechanical su''ort and 'ro'rioce'ti%e res'onse of ta'ing do not lend all the ans+ers to the une/'lained success of ankle ta'ing,it becomes im'ortant to e/amine other factors including a 'lacebo eect  'lacebo is described as 6a thera'eutic 'rocedure +hich is gi%en deliberately to ha%e an eect, or unkno+ingly has an eect, on a 'atient, sym'tom, syndrome, or disease, but +hich is objecti%ely +ithout s'eci5c acti%ity for the condition being treated7 &n other +ords, the athlete belie%es that the inter%ention +ill ha%e an im'act and eect Fo! se# Cl$n$!al % est$on& hat is the Placebo *ect on )ollege thletes from an nkle Ta'e 9ob 'e()o*#s& Placebo *ect, nkle S'rain, nkle &nstability, nkle Ta'ing +  SUMMARY OF SEARCH   (esearched studies that com'ared 'hysical 'erformance tests +ith ankle instability 'atients from 're%ious injury and also e/amined  'ossible 'lacebo or 'sychological eect   Studies that had statistically signi5cant 5ndings Sea*!+ St*ate,(& Po'ulation: )ollege thletes +ith history of ankle s'rain or ankle instability &nter%ention: nkle Ta'ing and 'hysical 'erformance test )ontrol: ;o ankle ta'ing and 'hysical 'erformance test <utcome: 1easurement of 'lacebo eect  So *!es of E$#en!e Sea*!+e#& =atabases searches included: Pub1ed> 1edline and )&;4? @ )umulati%e &nde/ to ;ursing and llied 4ealth ?iterature Best E$#en!e Re$e)e#& A Study by Sa+kins, et al e/amined 0 'artici'ants C2A  years D or @  yearsE each +ith 'rior history of unilateral or bilateral ankle s'rain and ankle instability as de5ned by )&T C)umberland  nkle &nstability ToolE scores =i%ided the 'artici'ants into three grou's: one grou' recei%ed ankle ta'ing 'rocedure, one grou' recei%ed a 'lacebo ta'ing 'rocedure and last grou' or control had no ta'ing The grou' that recei%ed 'lacebo ta'ing in%ol%ed a single 'ieceof ta'e 'laced along the lo+er leg near the lateral malleolus ll  'artici'ants had skirts 'laced on their ankle so they could not %isually see the ta'ing, or lack of ta'ing !ollo+ing, each 'artici'ant +as e%aluated used a 4o''ing Test and 1odi5ed Star */cursion Balance Test CS*BTE There +as not a statistical dierence signi5cant dierence in the 'erformance for the three grou's on the 4o''ing Test C' F 08G#E or the 1odi5ed Star C'F0 HAE 4o+e%er, an analysis of  'erce'tions of the 'artici'ants did note im'ro%ed 'erce'tions of stability, con5dence, and reassurance 2Study by =elahunt, etal */amined AG indi%iduals from college cam'us all +ith )hronic nkle &nstability ll subjects had had 2 or more in%ersion s'rains and ankle instability ratings on the )&T ll subjects 'artici'ated in study under three se'arate conditions These included no ankle ta'e a''lied, or lateral subtalar sling ta'ing, or 5nally 5bular re'ositioning ta'ing ll 'artici'ated in the S*BT under each of the three conditions There +as no statistical dierence in the reach distance on the S*BT in all conditions C'I0#E  !eelings of stability, feelings of con5dence, and feelings of reassurance +ere 8
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