Elizabeth J. Nightingale

Characteristics of people with recurrent ankle sprains: a systematic review with meta-analysis

Objective To examine whether people with recurrent ankle sprain, have specific physical and sensorimotor deficits. Design A systematic review of journal articles in English using electronic databases to September 2009. Included articles compared physical or sensorimotor measures in people with recurrent (≥2) ankle sprains and uninjured controls. Main outcome groups Outcome measures were grouped into: physical characteristics, strength, postural stability, proprioception, response to perturbation, biomechanics and functional tests. A meta-analysis was undertaken where comparable results within an outcome group were inconsistent. Results Fifty-five articles met the inclusion criteria. Compared with healthy controls, people with recurrent sprains demonstrated radiographic changes in the talus, changes in foot position during gait and prolonged time to stabilisation after a jump. There were no differences in ankle range of motion or functional test performance. Pooled results showed greater postural sway when standing with eyes closed (SMD=0.9, 95% CI 0.4 to 1.4) or on unstable surfaces (0.5, 0.1 to 1.0) and decreased concentric inversion strength (1.1, 0.2 to 2.1) but no difference in evertor strength, inversion joint position sense or peroneal latency in response to a perturbation. Conclusion There are specific impairments in people with recurrent ankle sprain but not necessarily in areas commonly investigated.

Benefits of FES gait in a spinal cord injured population.

Study design:Review.Objectives:This review article investigated the objective evidence of benefits derived from functional electrical stimulation (FES)-assisted gait for people with spinal cord injury (SCI). Both FES and gait have been proposed to promote not only augmented health and fitness, but specific ambulatory outcomes for individuals with neurological disabilities. However, due to small sample sizes and the lack of functionality of the intervention, it has not been widely used in clinical practice. This review assessed whether there is sufficient evidence to encourage a more widespread deployment of FES gait within the rehabilitation community.Methods:Hand searches and online data collection were performed in Medline and Science Direct. Specific search terms used included SCI/paralysis/paraplegia and tetraplegia with electrical stimulation/FES, gait and walking.Results:The searches generated 532 papers. Of these papers, 496 were excluded and 36 papers were included in the review. Many reported benefits were not carefully investigated, and small sample sizes or different methodologies resulted in insufficient evidence to draw definitive conclusions.Conclusions:FES gait can enhance gait, muscle strength and cardiorespiratory fitness for people with SCI. However, these benefits are dependent on the nature of the injury and further research is required to generalize these results to the widespread population of SCI individuals. Proof of the functionality and further evidence of the benefits of FES gait will assist in FES gait gaining clinical acceptance.

Prevalence and impact of chronic musculoskeletal ankle disorders in the community.

OBJECTIVE To determine the point prevalence of chronic musculoskeletal ankle disorders in the community. DESIGN Cross-sectional stratified (metropolitan vs regional) random sample. SETTING General community. PARTICIPANTS Population-based computer-aided telephone survey of people (N=2078) aged 18 to 65 years in New South Wales, Australia. Of those contacted, 751 participants provided data. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Point prevalence for no history of ankle injury or chronic ankle problems (no ankle problems), history of ankle injury without residual problems, and chronic ankle disorders. Chronic musculoskeletal ankle disorders due to ankle sprain, fracture, arthritis, or other disorder compared by chi-square test for the presence of pain, weakness, giving way, swelling and instability, activity limitation, and health care use in the past year. RESULTS There were 231 (30.8%) participants with no ankle problems, 342 (45.5%) with a history of ankle injury but no chronic problems, and 178 (23.7%) with chronic ankle disorders. The major component of chronic ankle disorders was musculoskeletal disorders (n=147, 19.6% of the total sample), most of which were due to ankle injury (n=117, 15.6% of the total). There was no difference among the arthritis, fracture, sprain, and other groups in the prevalence of the specific complaints, or health care use. Significantly more participants with arthritis had to limit activity than in the sprain group (Chi-square test, P=.035). CONCLUSIONS Chronic musculoskeletal ankle disorders affected almost 20% of the Australian community. The majority were due to a previous ankle injury, and most people had to limit or change their physical activity because of the ankle disorder.

Do exercises used in injury prevention programmes modify cutting task biomechanics? A systematic review with meta-analysis

Objective Some injury prevention programmes aim to reduce the risk of ACL rupture. Although the most common athletic task leading to ACL rupture is cutting, there is currently no consensus on how injury prevention programmes influence cutting task biomechanics. To systematically review and synthesise the scientific literature regarding the influence of injury prevention programme exercises on cutting task biomechanics. Design The three largest databases (Medline, EMBASE and CINAHL) were searched for studies that investigated the effect of injury prevention programmes on cutting task biomechanics. When possible meta-analyses were performed. Results Seven studies met the inclusion criteria. Across all studies, a total of 100 participants received exercises that are part of ACL injury prevention programmes and 76 participants served in control groups. Most studies evaluated variables associated with the quadriceps dominance theory. The meta-analysis revealed decreased lateral hamstrings electromyography activity (p≤0.05) while single studies revealed decreased quadriceps and increased medial hamstrings activity and decreased peak knee flexion moment. Findings from single studies reported that ACL injury prevention exercises reduce neuromuscular deficits (knee valgus moment, lateral trunk leaning) associated with the ligament and trunk dominance theories, respectively. The programmes we analysed appear most effective when they emphasise individualised biomechanical technique correction and target postpubertal women. Conclusions The exercises used in injury prevention programmes have the potential to improve cutting task biomechanics by ameliorating neuromuscular deficits linked to ACL rupture, especially when they emphasise individualised biomechanical technique correction and target postpubertal female athletes.

Reliability and Validity of a Smartphone App to Measure Joint Range

ABSTRACT In clinical and research settings, objective range of motion measurement is an essential component of lower limb assessment and treatment evaluation. One reliable tool is the digital inclinometer; however, availability and cost preclude its widespread use. Smartphone apps are now widely available, allowing smartphones to be used as an inclinometer. Reliability and validity studies of new technologies are scarce. Intrarater and interrater reliability of the iHandy Level app installed on a smartphone and an inclinometer were assessed in 20 participants for ankle dorsiflexion using a weight-bearing lunge test. Criterion validity was assessed between a Fastrak and the app, and construct validity was assessed between the inclinometer and the app. Intraclass correlation coefficients2,1 demonstrated excellent intrarater and interrater reliability (intraclass correlation coefficient, 0.97 and 0.76, respectively). Tests of validity demonstrated excellent correlation between all three methods (r2 > 0.99). The smartphone app is both reliable and valid, provides a low-cost method of measuring range of motion, and can be easily incorporated into clinical practice.

Predictors of chronic ankle instability after an index lateral ankle sprain: A systematic review

OBJECTIVES To identify the predictors of chronic ankle instability after an index lateral ankle sprain. DESIGN Systematic review. METHODS The databases of MEDLINE, CINAHL, AMED, Scopus, SPORTDiscus, Embase, Web of Science, PubMed, PEDro, and Cochrane Register of Clinical Trials were searched from the earliest record until May 2013. Prospective studies investigating any potential intrinsic predictors of chronic ankle instability after an index ankle sprain were included. Eligible studies had a prospective design (follow-up of at least three months), participants of any age with an index ankle sprain, and had assessed ongoing impairments associated with chronic ankle instability. Eligible studies were screened and data extracted by two independent reviewers. RESULTS Four studies were included. Three potential predictors of chronic ankle instability, i.e., postural control, perceived instability, and severity of the index sprain, were investigated. Decreased postural control measured by number of foot lifts during single-leg stance with eyes closed and perceived instability measured by Cumberland Ankle Instability Tool were not predictors of chronic ankle instability. While the results of one study showed that the severity of the initial sprain was a predictor of re-sprain, another study did not. CONCLUSIONS Of the three investigated potential predictors of chronic ankle instability after an index ankle sprain, only severity of initial sprain (grade II) predicted re-sprain. However, concerns about validity of the grading system suggest that these findings should be interpreted with caution.

Systematic review of timed stair tests

Functional testing is particularly useful in the clinic and for making research translatable; however, finding measures relevant across ages and different conditions can be difficult. A systematic review was conducted to investigate timed stair tests as an objective measure of functional abilities and musculoskeletal integrity. Data were analyzed for their ability to differentiate between controls and patient groups and between different patient groups. Literature was reviewed using the Medline, CINAHL, and PubMed databases until February 2012. Data were grouped according to methodology, ages, and medical conditions. Time per step was calculated to allow comparison between studies. Eighty-eight studies were included in this review. Methodologies varied considerably with stair ascent, stair descent, or a combination of the two being used across a wide range of ages and medical conditions. Times increased with age for ascent, descent, and combined and for a variety of medical problems. Timed stair tests appear to be sensitive to medical conditions but further data are required to obtain normative values for this test. We suggest that timed stair tests should follow a more standardized methodology using a combination of ascent and descent and asking participants to complete the stairs as quickly and safely as possible.

Passive dorsiflexion flexibility after cast immobilization for ankle fracture.

Ankle fracture is frequently managed with cast immobilization, but immobilization may produce ankle contracture (loss of flexibility). We aimed to quantify recovery of ankle dorsiflexion flexibility in people treated with cast immobilization after ankle fracture, and to determine if initial orthopaedic management was associated with recovery. Ankle flexibility was measured in 150 people with plantarflexion contracture who had been referred for outpatient physical therapy following cast immobilization for ankle fracture. We obtained measurements using an instrumented footplate within 5 days of cast removal and then 4 weeks and 3 months later. Data were compared with published normative data. Both stiffness and the torque corresponding to the peak dorsiflexion angle at baseline decreased during the 3 month recovery period, but recovery was still incomplete 3 months after cast removal. Surgical fixation was associated with higher stiffness, preload and torque values. Passive ankle flexibility does not return to normal values within 3 months of cast removal after ankle fracture. Recovery of normal ankle dorsiflexion flexibility typically takes longer than the initial period of immobilization.Level of Evidence: Level I, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Impaired weight transfer persists at least four months after hip fracture and rehabilitation

Objective: To determine whether choice stepping reaction time performance is impaired in people after hip fracture and whether different aspects of choice stepping performance improve with rehabilitation. Design: This study includes a secondary analysis of data obtained from participants in a randomized controlled trial of exercise after hip fracture. Setting: Data were either collected in a hospital rehabilitation unit, research institute or participant homes. Subjects: The hip fracture group (n = 91) were recruited from three rehabilitation hospitals in metropolitan Sydney. The control group (n = 77) were healthy age-, gender- and dwelling-matched controls, participating in unrelated studies of fall risk factors. Main measures: Response time, movement time and total time components of the choice stepping reaction time test. Results: Improvements in choice stepping reaction time were seen in people after hip fracture, during a 16-week rehabilitation period, however performance remained impaired (1808 ± 663 ms), compared with matched controls (1029 ± 255 ms, P<0.001). Further, choice stepping performance was significantly slower when transferring weight onto the affected leg (1271 ± 615 ms), compared with the unaffected leg (1119 ± 499 ms, P<0.001). Conclusions: Movement deficits are evident for an extended time frame following rehabilitation for hip fracture. The slower response time following the rehabilitation period highlights ongoing difficulties with weight transfer onto the affected leg.

Using Balance Tests to Discriminate Between Participants With a Recent Index Lateral Ankle Sprain and Healthy Control Participants: A Cross-Sectional Study.

CONTEXT The first step to identifying factors that increase the risk of recurrent ankle sprains is to identify impairments after a first sprain and compare performance with individuals who have never sustained a sprain. Few researchers have restricted recruitment to a homogeneous group of patients with first sprains, thereby introducing the potential for confounding. OBJECTIVE To identify impairments that differ in participants with a recent index lateral ankle sprain versus participants with no history of ankle sprain. DESIGN Cross-sectional study. PATIENTS OR OTHER PARTICIPANTS We recruited a sample of convenience from May 2010 to April 2013 that included 70 volunteers (age = 27.4 ± 8.3 years, height = 168.7 ± 9.5 cm, mass = 65.0 ± 12.5 kg) serving as controls and 30 volunteers (age = 31.1 ± 13.3 years, height = 168.3 ± 9.1 cm, mass = 67.3 ± 13.7 kg) with index ankle sprains. MAIN OUTCOME MEASURE(S) We collected demographic and physical performance variables, including ankle-joint range of motion, balance (time to balance after perturbation, Star Excursion Balance Test, foot lifts during single-legged stance, demi-pointe balance test), proprioception, motor planning, inversion-eversion peak power, and timed stair tests. Discriminant analysis was conducted to determine the relationship between explanatory variables and sprain status. Sequential discriminant analysis was performed to identify the most relevant variables that explained the greatest variance. RESULTS The average time since the sprain was 3.5 ± 1.5 months. The model, including all variables, correctly predicted a sprain status of 77% (n = 23) of the sprain group and 80% (n = 56) of the control group and explained 40% of the variance between groups ([Formula: see text] = 42.16, P = .03). Backward stepwise discriminant analysis revealed associations between sprain status and only 2 tests: Star Excursion Balance Test in the anterior direction and foot lifts during single-legged stance ([Formula: see text] = 15.2, P = .001). These 2 tests explained 15% of the between-groups variance and correctly predicted group membership of 63% (n = 19) of the sprain group and 69% (n = 48) of the control group. CONCLUSIONS Balance impairments were associated with a recent first ankle sprain, but proprioception, motor control, power, and function were not.