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Investigation of the effectiveness of double Tubigrip for acute grade 1 and 2 ankle sprains through a randomised controlled trial is commendable.1 However, I feel compelled to comment on aspects of this study. It is interesting that 85 (17.5%) of the 485 patients approached to take part in this study expressed a treatment preference and therefore were not randomised. Given that only 197 patients completed the study, the 85 expressing a treatment preference is equivalent to a third arm of the study. The implication of their reluctance is that patients attending the accident and emergency (A&E) department after ankle injuries expect and want treatment. This confirms what is a commonly held belief in the A&E department—that a double Tubigrip, or some other treatment option is supportive to the patient. While this support may not be of a physical nature, it probably leads to improved patient satisfaction. To that end, I would suggest that the addition of a “patient preference” limb to the study would be as important as the existing two limbs.
It is equally interesting that the authors did not measure patient satisfaction as an outcome in this study. One important facet of any clinical treatment is that it is acceptable to patients—and the application or not of a double Tubigrip after ankle sprain is no exception. Although the authors found the application of a double Tubigrip did not shorten recovery time or number of days off work, it would be helpful to identify whether patient preference and satisfaction would have affected outcome, both in terms of actual recovery time, but also during the recovery period itself.
While in agreement that patient education might reduce reliance on this type of treatment, in the context of a busy A&E department, this may not be practical, and the current approach probably provides efficient patient satisfaction.
We thank Miss Mason for her comments on our paper.1 Firstly, we certainly agree that the investigation of patient preference for a treatment is an important and interesting factor in a study such as ours and indeed we set out to include this group in our research. Patients who expressed a treatment preference and agreed to the follow up telephone questionnaire were enrolled and were given the treatment of their choice. The aim was to compare their outcomes and satisfaction scores (see below) with those who were randomised to treatment. However, because of a communication error at one of the study sites, a large number of the preference group were not followed up, making comparison with the randomised group impossible.
Secondly, we did attempt to measure patient satisfaction as an outcome measure in our study. Patients were asked how strong their preference for treatment with or without a double Tubigrip bandage was on enrolment, using a 0 (no preference) to 10 (very strong preference) scale. When telephoned a week after entry, patients were asked to rate their overall satisfaction with the treatment they had received from 1 (very dissatisfied) to 10 (very satisfied). However, when we came to analyse the data we found that both these questions were poorly answered and we therefore did not include this information in our final paper. The raw results are shown in table 1.
It would seem from these raw data that of those patients who expressed a treatment preference (while agreeing to randomisation), the majority would have preferred to be treated with a double Tubigrip bandage, as expected by most clinicians. However, when asked to rate their overall satisfaction with treatment, there is no difference between the groups.
We feel that provided patients are given comprehensive information about their injury and what they should do to hasten recovery, satisfaction can be maintained without the reflex application of a bandage that adds nothing to recovery and may increase the need for analgesia.
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