50 Criteria-based phased rehabilitation framework for lateral ankle sprain: systematic review, qualitative study, and expert Delphi consensus

Introduction Lateral ankle sprain (LAS) is a common injury resulting in significant time off sport and lasting disability. However, standards for criteria-based phased rehabilitation framework remain unclear. To address this, we conducted three complementary studies.Materials and Methods First, systematic review (SR) identified phase-based LAS rehabilitation trials incorporating progression criteria (8 RCTs; 1,020 participants; PROSPERO: CRD42023393865). Second, semi-structured interviews with healthcare professionals, athletes, and NHS patients (n=32) explored practice, clinical reasoning, and progression priorities (ethics: FHMS 274-0423). Finally, a two-round modified Delphi with multidisciplinary experts (n=11; n=9) reached consensus on criteria-based phased rehabilitation framework, using an 80% agreement threshold (ethics: FMHS 174-0424 ANKLED).Results SR revealed three common phases but substantial inconsistency in reporting progression criteria. Interviews highlighted the need for structured monitoring, earlier functional loading of the joint, psychological readiness, and improved communication. The Delphi process achieved consensus on a three-phase model with defined aims and progression markers. Phase I: aiming to reduce pain and swelling with early movement and strength preservation. Phase II: targeting neuromuscular control, psychological confidence, and strength. Phase III: focused on the return to pre-injury activity through sport-specific exercise. Progression criteria: pain-tolerant weight bearing, restoration of range, strength, normal gait, and neuromuscular control.Conclusion Criteria-based phased rehabilitation framework for LAS was mapped through SR, discussed with end-users through interviews, and finally agreed through Delphi consensus with experts. The figure presents the final synthesis, aligning phase aims, rehabilitation content, and progression markers to support consistent, individualised rehabilitation.