Balance is impaired in symptomatic ankle osteoarthritis: A cross-sectional study

Smith, Michelle D.; Rhodes, Jonah; Mahrouqi, Munira Al; MacDonald, D. A.; Vicenzino, B.

doi:10.1016/j.gaitpost.2021.08.002

Cited by 7 publications

(4 citation statements)

References 32 publications

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“…Although the statistical correlations between the mean DPPS values and pre-and post-operative pain were not statistically significant, the role of osteoarthritic and postsurgical painful symptomatology in the proprioception of the joints and how it can affect the postural control has placed points of discussion in the scientific community. Smith et al [37] described how patients with asymptomatic ankle OA and healthy control subjects reported similar results in balancing performance, unlike those with symptomatic OA, suggesting that from a clinical point of view, postural control deficits may be predominantly affected by pain. Similar aspects have been confirmed by other authors [38][39][40], placing pain at the center of postural deficits.…”

Section: Discussionmentioning

confidence: 99%

Proprioception and Balance Control in Ankle Osteoarthritis and after Total Ankle Replacement: A Prospective Assessment

Caravelli,

Bragonzoni,

Vocale

et al. 2024

Applied Sciences

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Total Ankle Replacement (TAR) could, in theory, partially restore joint sensation and motion, enhancing motor coordination, functional stability, and proprioception in a joint affected by osteoarthritis. The aim of this study is to evaluate ankle proprioception before and after a Total Ankle Replacement via an instrumental objective assessment. The evaluation of proprioceptive stability was carried out using the dedicated Delos Postural Proprioceptive System (DPPS). The clinical evaluation was performed by administering validated questionnaires, namely the American Orthopaedic Foot and Ankle Society (AOFAS) score and Short Form-36 (SF-36). Twenty patients were selected, undergoing a complete procedure with clinical and instrumental pre-operative and post-operative evaluation at the end of the follow-up. AOFAS ankle–hindfoot and SF-36 both showed a statistically significant improvement between the pre-operative and post-operative state. The postural tests performed using the DPPS showed that the affected limb showed results slightly lower than in pre-operative. In conclusion, according to the current data, the TAR does not show an improvement in proprioceptive joint stability, and although the registered mean values do not present a statistical significance, the stabilometry shows data lower than the healthy limb. In this perspective, further studies are recommended to highlight any rehabilitation scheme or protocols, using wider case series.

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Section: Discussionmentioning

confidence: 99%

Proprioception and Balance Control in Ankle Osteoarthritis and after Total Ankle Replacement: A Prospective Assessment

Caravelli,

Bragonzoni,

Vocale

et al. 2024

Applied Sciences

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“…While these exercise interventions appear to target ankle muscle strength, range of motion and postural control/balance, the lack of reporting of the specific exercises and prescription parameters (e.g., load, repetitions) makes appraisal and implementation of the exercise program difficult [52]. In light of deficits in ankle muscle strength and endurance [12, 13], range of motion [12, 13], postural control/balance [53, 54] and ambulatory function [13] present in individuals with ankle OA, it is hypothesized that appropriately prescribed exercises may address deficits, and in turn improve mobility, function, participation and QoL. The exercise program in our trial specifically targets impairments in ankle OA that have been identified in case‐control studies, and includes exercises to improve proximal muscle function (e.g., squats and pelvic lift/supine bridge) which is impaired in people with chronic ankle problems [55].…”

Section: Discussionmentioning

confidence: 99%

Protocol for a randomised feasibility trial comparing a combined program of education and exercise versus general advice for ankle osteoarthritis

Smith,

Vuvan,

Collins

et al. 2023

Journal of Foot and Ankle Research

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Background Ankle osteoarthritis (OA) is a serious problem with high associated pain and disability. While education and exercise are recommended for the initial management of OA, this has not been investigated in ankle OA. The primary aim of this study is to establish the feasibility of running a full-scale randomised controlled trial (RCT) investigating a combined education and exercise program compared to a general advice program for people with ankle OA. The secondary aims are to collect preliminary data which will inform sample size calculations, and understand the perspectives of people with ankle OA on their participation in the trial. Methods Thirty individuals aged 35 years or older with symptomatic radiographic ankle OA will be recruited from the community and randomised to receive either a combined education and exercise program or a general advice program, both of which will be delivered by a physiotherapist in a group setting. Primary outcomes of feasibility include responses to study advertisements, number of eligible participants, recruitment rate, adherence with the intervention, fidelity of the intervention, adverse events, drop-out rate, and credibility and expectancy of the intervention. Secondary participant-reported outcomes will include global rating of change, patient acceptable symptom state, severity of ankle pain and stiffness, self-reported function, quality of life, satisfaction with treatment, and use of co-interventions. Follow up will be at 8 weeks and 3 months. Physical measures of 40 m walking speed, timed stairs descent, heel raise endurance and ankle dorsiflexion range of motion will be collected at baseline and 8 weeks. Primary feasibility outcomes will be reported descriptively, and estimates of the variability of secondary participant-reported and physical outcomes will be calculated. Semi-structured interviews will be conducted with participants to understand perspectives about the intervention and participation in the trial, with data analyzed thematically. Discussion Study findings will establish the feasibility of running a full-scale RCT to investigate a combined education and exercise program compared to a general advice program for people with ankle OA. This study is a necessary first step to advance the international research agenda of evaluating the efficacy of exercise in the management of ankle OA. Trial registration ACTRN12623000017628. Registered 10 January 2023, https://www.anzctr.org.au/ACTRN12623000017628.aspx.

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“…Clinicians may want to assess falls risk factors in these patients to identify impairments that can be targeted in management. Exercise management may be considered to address risk factors such as impaired balance [10] and ankle muscle weakness [11], that are common in people with chronic ankle problems [12][13][14][15]. Implementation of cognitive-behavioural therapies to reduce concern about falling and improve self-efficacy has been shown to be effective in reducing falls in other populations [39].…”

Section: Chronic Ankle Symptoms Controls Effect Sizementioning

confidence: 99%

“…Many factors, such as impaired balance [ 10 ] and ankle muscle weakness [ 11 ], have been suggested to increase falls risk. Individuals with ankle osteoarthritis and chronic ankle symptoms have impaired balance [ 12 , 13 ], decreased muscle strength [ 14 , 15 ], reduced ankle joint motion [ 14 , 15 ] and decreased mobility [ 15 ]. In light of the relationship between these impairments and falls, individuals with ankle osteoarthritis and chronic ankle symptoms may be at an increased risk of falling.…”

Section: Introductionmentioning

confidence: 99%

Falls and falls‐related injuries in individuals with chronic ankle symptoms: a cross‐sectional study

Mahrouqi

Vicenzino

MacDonald

et al. 2023

Journal of Foot and Ankle Research

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Background Falls are a major public health concern globally. While falls are associated with osteoarthritis and persistent pain at the hip and knee, falls have not been investigated in people with chronic ankle symptoms. This study aimed to compare self-reported history of falls between adults with and without chronic ankle symptoms. Secondary aims were to compare concern about falling and balance confidence between groups, and to identify factors associated with falling. Methods A total of 226 participants (134 with chronic ankle pain and/or stiffness and 92 controls) participated in this cross-sectional case–control study. Participants completed an online questionnaire about falls in the past 12 months, injuries associated with falling, concern about falling, balance confidence, function, pain and multimorbidity. Results Eighty-six (64%) participants with chronic ankle symptoms and 24 (26%) controls reported at least one fall in the last 12 months (p < 0.001). Participants with chronic ankle symptoms reported more falls, more injurious falls, and more hospitalisations because of a fall than controls (p > 0.002). There was a small effect for lower balance confidence and higher concern about falling in symptomatic participants (standardised mean difference: 0.39–0.49; p > 0.017). Logistic regression analysis identified that falling was associated with the presence of ankle symptoms (3.08 (1.20, 7.92); p = 0.02) and concern about falling (odds ratio (95% confidence intervals): 1.13 (1.05, 1.23); p = 0.002). Conclusions Falls and falls-related injuries are a problem in individuals with chronic ankle symptoms. The high falls occurrence and concern about falling in individuals with chronic ankle symptoms suggest the need for clinicians to assess these factors in this population.

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Balance is impaired in symptomatic ankle osteoarthritis: A cross-sectional study

Cited by 7 publications

References 32 publications

Proprioception and Balance Control in Ankle Osteoarthritis and after Total Ankle Replacement: A Prospective Assessment

Proprioception and Balance Control in Ankle Osteoarthritis and after Total Ankle Replacement: A Prospective Assessment

Protocol for a randomised feasibility trial comparing a combined program of education and exercise versus general advice for ankle osteoarthritis

Falls and falls‐related injuries in individuals with chronic ankle symptoms: a cross‐sectional study

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