Critical Appraisal
Question 1.
Yes, the trial addressed a focused issue since it aimed to evaluate whether an interactive mobile application, ‘Strengthen your ankle’ app with a proven effective neuromuscular training program for preventing frequent ankle sprains causes high compliance in comparison to regular written exercise material, that is, a booklet. The study concentrated on athletes aged 18 and 70 who had sustained an ankle sprain in the past two months and had access to a mobile phone. The primary outcome measure was compliance with the exercise program, and the secondary outcome was the incidence density of self-reported recurring ankle sprains.
Question 2.
Yes, the assignments of patients in the study were randomized; for instance, the participants were randomly assigned to one of the two groups. A control group (booklet group) received the neuromuscular training program on paper, and an intervention group (App group) got a similar program through the Strengthen Your Ankle mobile application. The randomized trial was done after the participants had ankle sprain treatment through usual medical care and after the baseline questionnaire and consent were given. The random assignment of the participants to the two groups is a primary feature of a randomized controlled trial. It helps minimize bias and provides room for a severe evaluation of the intervention’s effectiveness.
Question 3.
Yes, all the patients selected to participate in the trial were adequately accounted for at its conclusion to the possible extent, and the trial did not stop early. The study involved 220 randomly selected participants allocated into the Booklet and App groups. Some patients stated they wished to discontinue the trial due to a lack of motivation or time constraints. The compliance rate of these patients was set to zero percent, and a small number of them left due to non-ankle injury or personal reasons. The participants’ compliance rate was only included for the weeks they participated in the study.
Question 4.
No, the study fails to mention if patients, health workers, and study personnel were ‘blind’ to treatment. The term ‘blind’ means that the patients and researchers were unaware of the treatment assignments to reduce bias. In a randomized controlled trial, blinding is mainly adopted to prevent expectations from swaying the results.
Question 5.
The groups were similar at the beginning of the trial; for example, Table 2’s baseline characteristics of the study population indicate no significant variances between the App and Booklet groups’ participants. These groups were alike in age, weight, gender distribution, number of patients, level of sport, and height and ankle sprain severity at the time of inclusion. The randomized controlled trial facilitated to ensure that confounding variables were equally spread between the two groups at the commencement of the study.
Question 6.
The study fails to openly state whether the groups were treated equally despite the experimental intervention. Nonetheless, the study mainly focuses on relating the compliance rates and outcomes of injury between the booklet and app groups. The information dwells on randomization interventions, outcome measures, procedures, and results linked to compliance and injury occurrence rates. Also, no details exist of additional interventions or treatments offered to the two groups besides the neuromuscular training program through a booklet or app.
Question 7.
The study assessed the impact of adopting a neuromuscular training program through either traditional written exercise material or mobile apps to prevent frequent ankle sprains in athletes. In the trial, 220 athletes were involved, and half received an eight-week neuromuscular training program through both groups. The primary outcome measured was compliant with the exercise program, while the secondary outcome was the incidence density of self-reported frequent ankle sprains. The findings indicate that the mean compliance rate was 73.3% in the mobile app and 76.7% in the booklet group; slight differences exist between them. Also, the incidence rate of self-reported frequent time loss had a minor difference.
Question 8.
The precise treatment effect estimates are presented through the mean compliance rate in both the App and Booklet groups with their corresponding 95% confidence interval. In eight weeks, the mean compliance with the exercise scheme was 76.7% in the Booklet group (95% CI 71.9% to 82.3%) and 73.3% in the App group (95% CI 67.7% to 78.1%). These confidence intervals offer a range within which one can assert that the narrower the interval, the more precise the estimate. Therefore, the precision is influenced by the width of the confidence interval; a more limited interval indicates a high precision, while a wider interval shows lower precision. The accuracy of estimates assists in evaluating the reliability and strength of findings. For instance, the 95% confidence interval in the data provided is within a reasonable range, signifying a moderate precision level in estimating compliance rates for the two groups over the eight weeks.
Question 9.
The study’s findings suggest that mobile app and booklet methods generate similar rates of compliance among the patients in the effort to prevent ankle sprains. Since the rate of compliance ranges around 75% for the two groups over eight weeks, selecting the app and booklet seems to be okay with the patient’s adherence to a regimen of exercise set. Evaluating the resemblances between the trial patients and the target population is vital for applying the findings to local individuals. It should be done considering age, motivation levels, cultural influences, technology acceptance, and value identity of the study findings. In addition, understanding differences in long-term compliance is critical for developing preventive interventions for the unique features and preferences of the local populations.
Question 10.
The study considered clinically vital outcomes linked to compliance and rates of injury. It addressed whether the techniques of implementing the exercise program through a booklet or an app significantly impacted patient compliance. Also, it investigated the occurrence of self-reported ankle sprains that keep recurring as a measure of the program’s success in preventing injuries. However, an individual may consider additional data regarding the long-term effects of the intervention; the follow-up period was eight weeks. Long-term data could offer insights into compliance sustainability and the prevention of ankle sprains over a prolonged period. Furthermore, investigating patients’ or participants’ satisfaction, qualitative feedback, and commitment might provide a deeper understanding of the user experience and preferences, contributing to a more refined decision-making process.
Question 11.
The study needs to address the benefits, thus making it difficult to evaluate if they are worth the harms and costs of the intervention. The benefits of the neuromuscular training program lie in its capability to prevent frequent ankle sprains, a type of injury in sports. Both booklet and mobile app techniques may be equally effective from a user engagement view since they show similar compliance rates. However, the potential harms must be considered, especially concerning the app. Therefore, poorly executed exercises due to the influence of technology reliance might cause injuries. The interactive app features may improve user experience but also introduce the risk of these consumers failing to exercise properly since they lack proper supervision. In addition, the cost related to creating and maintaining a mobile app, user support, and technology infrastructure might be higher than the booklet, a traditional written material. In the long run, a detailed cost–benefit analysis bearing in mind both long-term and short-term outcomes, economic implications, and user satisfaction would offer a more accurate evaluation. The app’s ease of access and user preferences should be considered as it may appeal to tech-savvy audiences, thus increasing reach amongst particular demographics. Therefore, if the intervention shrinks the incidences of ankle sprains, especially those contributing to time loss, the benefits may offset the harms and costs.