A qualitative study of health professions curricula and management of lateral ankle ligament sprain demonstrates inconsistency

Abstract

Background:Health educators aim to graduate students who are safe, effective and practice evidence-basedmedicine (EBM). Clinical Practice Guidelines (CPGs) are tools for translating evidence into clinical practice for healthprofessionals and educators who lack time to appraise the evidence. There have been CPGs published for lateralankle ligament sprains (LALS) for physiotherapists, nurses, and doctors. Clinical decision rules have also beendeveloped for LALS to increase the safety of practice. The Ottawa Ankle Rules (OAR) were developed to screen forthe need for an x-ray following an ankle or foot injury.Methods:Educators from the Australasian College of Sports and Exercise Physicians (ACSEP), St John Ambulancefirst aiders, pharmacy, nursing, and physiotherapy disciplines were participants in this study. Using purposeful samplingwith semi-structured questions and a LALScase study, 19 Australian educators were interviewed. Curricula and textbookswere also collected and analysed. Two researchers independently analysed the data using a deductive method.Results:Analysis found that no educator used a CPG to inform their teaching. There was no common LALS curriculumfor the five groups studied. There were two approaches: a triage curriculum (St John Ambulance, pharmacy, nursing) anda reflective curriculum (ASCEP and physiotherapy). Textbooks influenced curriculum for physiotherapy, pharmacy and firstaid educators. The triage curricula recommend rest, ice, compression and elevation (RICE) alone, while the reflectivecurricula uses OAR, RICE, immobilisation if the LALS is severe, functional support (brace), exercises and manual therapy. Inaddition, ACSEP and physiotherapy do not recommend electrotherapy. All five groups were cautious about the use ofnon-steroidal anti-inflammatory drugs (NSAIDs).Conclusions:Physiotherapy and ACSEP educators teach OAR. Despite not using the CPGs to inform curriculum,physiotherapy and ACSEP have unintentionally aligned their curriculum with current LALS CPG recommendations.However, nursing, pharmacy and first aid trainers are not teaching OAR or aligned with LALS CPGs. Educators inpharmacy,nursingandfirstaidshouldre-examinetheircurriculaandconsiderpossiblyteachingOARandusingCPG.Clinical practice guideline developers should consider pharmacists and first aiders as users of their LALS CPGs.Keywords:Curricula, Lateral ankle ligament sprains, Clinical practice guidelines, Ottawa ankle rules