# Clinical assessment of lateral ankle sprains among Swedish physiotherapists: a nationwide survey comparing practice to international and locally modified frameworks

## TL;DR

Swedish physiotherapists generally do not follow international guidelines for assessing lateral ankle sprains, with urban practitioners and modified frameworks showing better adherence.

## Contribution

This study is the first to assess adherence to international and modified LAS assessment frameworks among Swedish physiotherapists.

## Key findings

- Most physiotherapists used fewer than 50% of the original ROAST criteria.
- Urban-based physiotherapists showed significantly higher adherence to modified frameworks.
- Only 6.5% regularly used patient-reported outcome measures for return-to-sport decisions.

## Abstract

Lateral ankle sprains (LAS) are among the most common musculoskeletal injuries globally. Although international frameworks such as the Rehabilitation-Oriented Assessment Tool (ROAST) and Ankle-GO provide structured approaches for LAS assessment and return-to-sport (RTS) evaluation, their implementation in Sweden has not been investigated.

A cross-sectional online survey was distributed to registered Swedish physiotherapists managing patients with LAS. The survey assessed adherence to the original ROAST, as well as modified versions of the frameworks (ROASTmodified and Ankle-GOmodified). Additionally, physiotherapists’ self-rated confidence in their methods was assessed to explore potential discrepancies between perceived competence and framework adherence. Descriptive and inferential statistics were used to analyse associations between reported assessment practices and physiotherapists’ workplace location, educational level, and clinical experience.

A total of 124 physiotherapists responded. Most (87.1%) reported using fewer than 50% of ROAST criteria, while 48.4% met at least 50% of ROASTmodified criteria. Adherence was significantly higher among those working in urban areas (p = 0.032), with no significant differences based on educational level or years of clinical experience. Regarding RTS, 36.7% of physiotherapists applied methods aligned with Ankle-GOmodified, but only 6.5% regularly used patient-reported outcome measures (PROMs) in this context. The most commonly used assessment domains were gait pattern, range of motion, and muscle strength, while PROMs and physical activity level were rarely included.

Adherence to international frameworks for LAS assessment was generally low among Swedish physiotherapists, but higher when modified versions were applied. Urban-based physiotherapists reported higher adherence compared to their rural counterparts, while educational level and experience had little influence. A discrepancy between perceived confidence and actual adherence suggests a gap between self-assessed competence and implementation.

The online version contains supplementary material available at 10.1186/s13102-025-01505-8.