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Evidence-based practice of taping, bracing, casting, and splinting

This is an excerpt from Athletic Taping, Bracing, and Casting 5th Edition With HKPropel Access by David H Perrin,Ian A McLeod.

Over the years, evidence-based practice (EBP) has been an integral part of the decision-making process when interacting with athletes and patients. CAATE Standard 62 states “Provide athletic training services in a manner that uses evidence to inform practice” and includes the annotation “Evidence-based practice includes using best research evidence, clinical expertise, and patient values and circumstances to connect didactic content taught in the classroom to clinical decision making” (CAATE, 2022, p. 52). A common definition of EBP is that it is the integration of best research evidence along with clinician expertise and patient needs to inform clinical decisions. Because clinicians spend a significant amount of time (and money) performing taping, bracing, casting, and splinting techniques, it is critically important that the decisions to perform these techniques are based on this EBP model. Application of EBP requires a five-step approach:

1. Create a clinically relevant question.
2. Search for the best evidence.
3. Critically analyze the evidence.
4. Integrate the appraisal with personal clinical expertise and the patient’s preferences.
5. Evaluate the performance or outcomes of the actions.

Therefore, before applying any taping, bracing, or casting technique, or combination of techniques, the purpose of the application should be identified. For many of these techniques, the purpose is to prevent an injury from occurring in the future, but the method used for this prevention can vary. Injuries can be prevented through such methods as restricting range of motion, enhancing proprioception, and improving joint alignment.

The following is an example of how a clinician would use the five-step approach to EBP:

1. “Does the application of ankle bracing reduce the risk of ankle injury?”
2. Table 1.1 outlines the relevant research pertaining to the preceding question.
3. Although all of the studies in table 1.1 were randomized control trials and could be classified as evidence of “good” quality, several other aspects of the research should be considered, such as: How long ago was the study conducted? What type of brace was used? What are the characteristics of the participants? How many participants were included? How long did they follow the participants?
4. Based on this information, the clinician could conclude that lace-up ankle bracing can be effective in preventing ankle sprains in people with a history of ankle injuries. However, it is less clear whether ankle braces are effective in preventing ankle sprains in people without a history of ankle injuries. The clinician would then consider their ability to provide a brace for the patient as well as the patient’s ability to properly wear it. The clinician would also review the patient’s history of previous ankle injuries as well as any considerations related to the patient’s sport or activity or attitude toward bracing.
5. Based on the answers to all of these questions, the clinician would come to an evidence-based conclusion. Finally, the clinician should track the patient’s injury status at 6 and 12 months and 2 years after treatment in an effort to continually provide additional evidence to the model.

Another approach to evaluating research for EBP is to conduct a meta-analysis, a statistical technique that examines data from several independent studies on the same subject to determine overall trends. One such study—“Ankle Bracing Is Effective for Primary and Secondary Prevention of Acute Ankle Injuries in Athletes: A Systematic Review and Meta-Analyses”—was published in Sports Medicine in 2018 (Barelds et al. 2018). This meta-analysis included six studies and found evidence for ankle bracing versus no ankle bracing for primary and secondary prevention of acute ankle injuries.

EBP is only effective when relevant, high-quality studies have been conducted and published. When reviewing the literature on the taping techniques included in this book, it became clear that limited research is available for many of these techniques. Significant work has been done on the foot and ankle, but as you move up the kinetic chain, research resources become limited. Additional research should be conducted, particularly on the upper extremity. Researchers have investigated techniques that use specialized tapes, such as kinesiology and rigid strapping tapes, but even these studies often result in conflicting conclusions.

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