The regression Bcl-2 inhibitor analyses of possible prognostic factors at baseline for persistent complaints could not identify a strong predictor for the Modulators outcome at the 12 month follow-up.

The analyses for the prognosis in the subgroup of non-recovered participants at 3 months follow-up showed that factors from the 3 month questionnaire can better predict the outcome than the factors from the physical examination at 3 months. At 12 months, 28% of the participants reported at least one re-sprain, which is in line with earlier studies reporting that 29% (Holme et al 1999) and 54% (Wester et al 1996) of the participants receiving usual care sustained a re-sprain at approximately 12 months follow-up. In our study, 49% of the participants were regarded as recovered at 12 months. This is comparable with the outcome of a recent systematic review showing that MK-2206 36% to 85% of the patients reported full recovery at 2 weeks to 36 months follow-up after ankle sprain injuries (van Rijn et al 2008). The wide recovery

range found in the different studies could be related to the definition of recovery. A widely used and accepted definition of recovery would therefore be very useful for future studies. Several studies investigated pain after a lateral ankle sprain (Moller-Larsen et al 1988, Nilsson 1983, O’Hara et al 1992). The proportion of patients experiencing pain after at least 12 months ranged from 5% to 33% (van Rijn et al

2008). Our study results are similar to these findings, but only 8% of our participants Tolmetin reported pain during walking while 22% still experienced some pain during running at 12 months. We did not find prognostic factors at baseline for the prediction of outcome at 12 months of follow-up. None of the 11 possible prognostic factors was univariately associated with any of the outcome measures. The fact that we did not find any significant association could be related to the small number of participants included in the analyses. Further, it might be possible that there are other prognostic factors, not included in our analyses, which can predict the outcome at 12 months follow-up. To our knowledge, the study from Linde and colleagues (1986) is the only study evaluating prognostic factors for incomplete recovery and re-sprains. In this study, sporting activity at a high level (training ≥ 3 times per week) was a significant prognostic factor for residual symptoms compared with sporting activity at a low level (training < 3 times per week) and no sporting activity. Unfortunately, our questionnaire did not include detailed questions about the sporting activities of the participants. However, we did ask the participants if the ankle was loaded during their sporting activities, and this factor does not appear to have a positive or negative influence on recovery, re-sprains, or pain among our participants.