A 4-Week Multimodal Intervention for Individuals With Chronic Ankle Instability: Examination of Disease-Oriented and Patient-Oriented Outcomes

• Published in: Journal of athletic training Vol. 54; no. 4; pp. 384 - 396
• Main Authors: Powden, Cameron J, Hoch, Johanna M, Jamali, Beth E, Hoch, Matthew C
• Format: Journal Article
• Language: English
• Published: United States National Athletic Trainers Association 01.04.2019
• Subjects: Adult; Ankle; Ankle Joint - physiopathology; Beliefs; Chronic Disease; Effect Size; Fear; Female; Follow-Up Studies; Humans; Intervention; Joint Instability - diagnosis; Joint Instability - physiopathology; Joint Instability - rehabilitation; Laboratories; Male; Manipulative therapy; Middle Aged; Muscular Strength; Musculoskeletal Manipulations - methods; Outcome Measures; Patient Reported Outcome Measures; Patients; Physical Activities; Postural Balance - physiology; Posture; Predictor Variables; Quality of life; Questionnaires; Range of Motion, Articular - physiology; Rehabilitation; Rehabilitation Programs; Scientific Concepts; Studies; Surveys and Questionnaires; Time Factors; Weight-Bearing; Young Adult; balance training; self-reported function; dorsiflexion; manual therapy; postural control; strength
• ISSN: 1062-6050; 1938-162X
• DOI: 10.4085/1062-6050-344-17

Individuals with chronic ankle instability (CAI) experience disease- and patient-oriented impairments that contribute to both immediate and long-term health detriments. Investigators have demonstrated the ability of targeted interventions to improve these impairments. However, the combined effects of a multimodal intervention on a multidimensional profile of health have not been evaluated. To examine the effects of a 4-week rehabilitation program on disease- and patient-oriented impairments associated with CAI. Controlled laboratory study. Laboratory. Twenty adults (5 males, 15 females; age = 24.35 ± 6.95 years, height = 169.29 ± 10.10 cm, mass = 70.58 ± 12.90 kg) with self-reported CAI participated. Inclusion criteria were at least 1 previous ankle sprain, at least 2 episodes of "giving way" in the 3 months before the study, and a Cumberland Ankle Instability Tool score ≤24. Individuals participated in 12 sessions over 4 weeks that consisted of ankle stretching and strengthening, balance training, and joint mobilizations. They also completed home ankle-strengthening and -stretching exercises daily. Dorsiflexion range of motion (weight-bearing-lunge test), isometric ankle strength (inversion, eversion, dorsiflexion, plantar flexion), isometric hip strength (abduction, adduction, flexion, extension), dynamic postural control (Y-Balance test), static postural control (eyes-open and -closed time to boundary in the anterior-posterior and medial-lateral directions), and patient-reported outcomes (Foot and Ankle Ability Measure-Activities of Daily Living and Foot and Ankle Ability Measure-Sport, modified Disablement in the Physically Active scale physical and mental summary components, and Fear-Avoidance Beliefs Questionnaire-Physical Activity and Fear-Avoidance Beliefs Questionnaire-Work) were assessed at 4 times (baseline, preintervention, postintervention, 2-week follow-up). Dorsiflexion range of motion, each direction of the Y-Balance test, 4-way ankle strength, hip-adduction and -extension strength, the Foot and Ankle Ability Measure-Activities of Daily Living score, the modified Disablement in the Physically Active scale-physical summary component score, and the Fear-Avoidance Beliefs Questionnaire-Physical Activity score were improved at postintervention ( < .001; effect-size range = 0.72-1.73) and at the 2-week follow-up ( < .001; effect-size range = 0.73-1.72) compared with preintervention. Hip-flexion strength was improved at postintervention compared with preintervention ( = .03; effect size = 0.61). Hip-abduction strength was improved at the 2-week follow-up compared with preintervention ( = .001; effect size = 0.96). Time to boundary in the anterior-posterior direction was increased at the 2-week follow-up compared with preintervention ( < .04; effect-size range = 0.61-0.78) and postintervention ( < .04) during the eyes-open condition. A 4-week rehabilitation program improved a multidimensional profile of health in participants with CAI.