Assessing Outcomes in People With Chronic Ankle Instability: The Ability of Functional Performance Tests to Measure Deficits in Physical Function and Perceived Instability

Abstract

Study Design Laboratory-based, cross-sectional study. Background Functional performance tests (FPTs) assess short bouts of unilateral hops for either distance or speed. More research is needed to identify specific FPTs that may be useful for measuring asymmetry outcomes related to functional performance and perceived instability deficits in individuals with chronic ankle instability (CAI). Objectives To identify FPTs that are sensitive to subjective and objective deficits associated with CAI. Methods Twenty-four subjects with unilateral CAI (10 male, 14 female; mean ± SD age, 20.7 ± 3.0 years) and 24 healthy, matched controls (10 male, 14 female; age, 20.1 ± 2.6 years) completed 5 unilateral FPTs in random order. Mean FPT scores and functional symmetry percentages were calculated and compared between groups using 2 separate 1-way multivariate analyses of variance (MANOVAs). Perceived instability symmetry percentages were compared between groups using a Mann-Whitney U analysis. Results There were no differences in the mean FPT scores (P>.05) or functional symmetry percentages (P>.05) between groups for any of the 5 FPTs. However, participants with CAI perceived greater instability when using their involved limb during the side hop (P = .02), 6-meter crossover hop (P = .003), lateral hop (P = .007), and figure-of-eight hop (P = .008). Conclusion There were no differences in mean functional scores between groups for all 5 FPTs, and each group performed symmetrically. Regardless, administering a visual analog scale following the completion of the side hop, 6-meter crossover hop, lateral hop, and figure-of-eight hop tests captures subjective reports of perceived instability in the involved limb that can be compared bilaterally throughout treatment. J Orthop Sports Phys Ther 2018;48(5):372-380. Epub 30 Mar 2018. doi:10.2519/jospt.2018.7514.

Systematic review of motor control and somatosensation assessment tests for the ankle

“…More than 10 variations of the Hop Tests have been developed to evaluate coordination and joint stability 36 39 : Single and Triple Hop Test, 36 39 45 46 Lateral or Side-to-Side Hop Test, 47 48 Crossover Hop for Distance, [45][46][47][48] 6 m Timed Hop, 36 39 45 46 Cross 6 m for Time, 36 39 48 Multiple Hop Test (MHT), [49][50][51][52] Agility Hop Test, 53 30 m Single-Leg Agility Hop Test, 54 Figure-of-8 Test 47 48 55 and Square Hop Test. 55 Depending on the particular hop test, the main variable can either be distance, time or number of errors.…”

Anterior Talofibular Ligament and Superior Extensor Ankle Retinaculum Thicknesses: Relationship with Balance

“…Therefore, while these results failed to support the findings of previously published literature, as it has been widely accepted that ligamentous and retinacular tissues both have proprioceptive qualities that, when impaired, may play a role in the resulting balance impairments and decreased functional and sport performance. 4,5,9,10) One factor that may help explain these findings is that the YBT was determined to be a reliable measure of single limb stance excursion distances as a dynamic balance test in male collegiate soccer players. 18) The lack of significant differences between and within groups may be attributed to the fact that our sample population is not consistent with an athletic population for which the YBT was validated upon.…”

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This condition can result in long term functional limitations, such as the inability to perform occupational duties and sporting activities, while also making an individual more susceptible to ankle osteoarthritis, and a diminished quality of life. 4,5) This makes the screening, assessment, and treatment of CAI, and the impairments it creates, a paramount topic for research in the field of rehabilitation science. Dynamic balance deficits in unilateral excursion distances, latency in reaction times, and postural sway are some of the most frequently encountered impairments in the clinical environment for patients affected by CAI.

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“…Brooke Malloy, et al ATFL/SEAR Thickness and Balance ings when comparing dynamic balance in those with and without CAI and history of previous ankle sprains, the tests used in this study to assess dynamic balance may not have been specific enough to account for subtle changes in bal--side, triple-crossover hop for distance, and singleleg hop for distance) was not. Additionally, Madsen et al4) found that while individuals with CAI perceived and reported greater instability during functional performance hop tests, they did not demonstrate significant functional deficits when compared with healthy controls. Though these studies utilized different subjective assessment tools and different functional performance measures than seen in the present study, they support the concept that subjective reports of ankle instability may not coincide with a decreased performance on dynamic balance tests.…”

Development and Validation of a Leg Press Force Measuring Device to Assess Limb Strength Asymmetry

“…[1][2][3] Similarly, limb strength asymmetry is a factor in injury recurrence and is often implicated in different lower extremity joint pathologies such as osteoarthritis, ACL injuries, and chronic ankle instability. [4][5][6] Despite many athletes passing return to sport criteria, many often demonstrate persistent limb asymmetry that may increase their risk of reinjury. 7 Furthermore, it has been shown that individuals who have quadriceps strength asymmetry have decreased knee function compared to those with higher symmetry.…”