Ability of functional performance assessments to discriminate athletes with and without chronic ankle instability : a case-control study

Abstract

Background The decline in motor function associated with chronic ankle instability (CAI) can be assessed using Functional Performance tests. Ankle muscular strength, endurance and range of motion (ROM) has been assessed in previous studies but functional activities such as sprinting and change of direction are less well studied in athletes with CAI. Hence the aim of this study was to determine how sprint, change of direction, ankle isometric strength, endurance and ROM measures may be associated with discriminate athletes with and without CAI. Methods One hundred and six participants (CAI: n = 53 or no CAI: n = 53) provided informed consent to participate in this study. Participants performed three functional performance tests, (30-m sprint test, Modified Illinois change of direction test (MICODT)) and change of direction test. Range of motion for dorsiflexion was measured using weight bearing lunge test and inversion, eversion and plantarflexion using Saunders® digital inclinometer. Strength was assessed using Baseline® hand-held dynamometer for plantarflexors, dorsiflexors, invertors and evertors. Muscular endurance was assessed by single heel raise test and Modified single heel raise test. Between-group comparisons utilised Student’s t-test and Mann-Whitney U-tests, with a number of unique variable and multivariable binomial logistic regression performed to determine which performance measures may discriminate participants with CAI. Results The CAI participants performed significantly worse in the three functional performance tests as well as multiple measures of ankle ROM, isometric strength and muscular endurance (p < 0.008). While several measures of ROM (plantarflexion and dorsiflexion), strength (inversion and eversion) and both muscular endurance tests were significantly associated with CAI in the univariable analysis, the strongest association was the functional performance tests, especially MICDOT time (odds ratio (95% CI): 0.06 [0.02–0.17], sensitivity 94.3%, specificity 88.7%). Multivariable regression analyses indicated that performance across the functional performance tests were more strongly associated with CAI than any ankle ROM, muscular strength or endurance test. Further, the inclusion of the best ankle range of motion, strength or muscular endurance tests did not significantly improve upon the association of the MICDOT with CAI. Conclusions Chronic ankle instability in athletic populations appears to be highly associated with declines in functional performance and to a somewhat lesser extent, ankle range of motion, strength and muscle endurance measures. This may suggest that optimal rehabilitation for athletes with CAI may require a greater focus on improving sprinting speed and change of direction ability in the mid to latter stages of rehabilitation, with regular assessments of these functional performance tests necessary to guide the progression and overload of this training.

Impairment-based assessments for patients with lateral ankle sprain: A systematic review of measurement properties

“…The novel ankle haptic interface system by Lin and colleagues [ 41 ] could be used to validly measure mobility (r: 0.99). Sensitivity and specificity values for Weight bearing lunge test, Ankle Plantarflexion, Inversion and Eversion were between 37.7 and 77.4 percent [ 38 ] ( Table 6 ).…”

“…The Baseline digital push-pull dynamometer for plantarflexion, dorsiflexion, inversion and eversion testing, showed specificity values between 50.7 and 86.8 percent. Sensitivity values varied from 60.4 to 81.1 percent [ 38 ]. The isokinetic dynamometer could be used to reliably measure force for different angular velocities (120°/s, 30°/s) of inversion or eversion movement in individuals with a chronic condition following LAS (ICC: 0.71 to 0.95) [ 48 ] ( Table 6 ).…”

“…This consensus was based on studies with a relatively heterogeneous or even healthy population [ 76 – 78 ]. In the current review only one study investigated this test showing good responsiveness values [ 38 ]. No information was found for other MPs of this test for the target population.…”

Effects of biofeedback on biomechanical factors associated with chronic ankle instability: a systematic review with meta-analysis

“…We excluded 133 studies due to not meeting the inclusion criteria and included 11 studies after screening the titles and abstracts for further eligibility check. Two studies were added by hand search of reference list of included studies [ 25 , 26 ], leading to a total of 13 included studies [ 1 , 2 , 4 , 5 , 7 , 8 , 13 , 16 , 21 , 24 , 25 , 27 , 28 ]. Figure 1 .…”

“…Lateral ankle sprain (LAS) is one of the most common musculoskeletal injuries in athletes [ 1 ] and the general public. Incomplete recovery and inadequate restoring of function due to lack of appropriate rehabilitation can lead to chronic ankle instability (CAI), resulting in a decreased quality of life [ 2 , 3 ].…”