Fereshteh Pourkazemi

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.

Systematic review of chronic ankle instability in children.

BackgroundChronic ankle instability (CAI) is a disabling condition often encountered after ankle injury. Three main components of CAI exist; perceived instability; mechanical instability (increased ankle ligament laxity); and recurrent sprain. Literature evaluating CAI has been heavily focused on adults, with little attention to CAI in children. Hence, the objective of this study was to systematically review the prevalence of CAI in children.MethodsStudies were retrieved from major databases from earliest records to March 2013. References from identified articles were also examined. Studies involving participants with CAI, classified by authors as children, were considered for inclusion. Papers investigating traumatic instability or instability arising from fractures were excluded. Two independent examiners undertook all stages of screening, data extraction and methodological quality assessments. Screening discrepancies were resolved by reaching consensus.ResultsFollowing the removal of duplicates, 14,263 papers were screened for eligibility against inclusion and exclusion criteria. Nine full papers were included in the review. Symptoms of CAI evaluated included perceived and mechanical ankle instability along with recurrent ankle sprain. In children with a history of ankle sprain, perceived instability was reported in 23-71% whilst mechanical instability was found in 18-47% of children. A history of recurrent ankle sprain was found in 22% of children.ConclusionDue to the long-lasting impacts of CAI, future research into the measurement and incidence of ankle instability in children is recommended.

Difference in knee joint position sense in athletes with and without patellofemoral pain syndrome.

PurposeThe purpose of this study was to evaluate knee joint position sense (JPS) in athletes with patellofemoral pain syndrome (PFPS) and compare it with healthy participants under non-weight bearing (sitting) and weight bearing (standing) conditions.MethodsTwenty patients and 20 healthy athletes participated in this study. JPS was evaluated by active replication of knee angles with visual cues eliminated. Two target angles in sitting and one in standing were tested. Each test and replication was repeated three times. By subtracting the test angle from the replicated angle, the absolute error was calculated as a dependent variable.ResultsNo significant difference in knee JPS was found between groups either in the sitting or in the standing tests.ConclusionIt seems that PFPS does not affect the knee JPS in athletes. The lack of deficiency in patients could possibly be attributed to their severity of knee pathology, pain intensity and their physical activity level.Level of evidenceCase–control study, Level III.

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.

Predictors of recurrent sprains after an index lateral ankle sprain: a longitudinal study

OBJECTIVE To explore and identify the predictors of ankle sprain after an index (first) lateral ankle sprain. DESIGN Prospective cohort study, Level of evidence II. SETTING Musculoskeletal research laboratory at the University of Sydney. PARTICIPANTS A sample of convenience (70 controls, 30 with an index sprain) was recruited. METHODS Potential predictors of ankle sprain were measured including: demographic measures, perceived ankle instability, ankle joint ligamentous laxity, passive range of ankle motion, balance, proprioception, motor planning and control, and inversion/eversion peak power. Participants were followed up monthly and the number of ankle sprains was recorded over 12 months. RESULTS Ninety-six participants completed the study; 10 participants sustained an ankle sprain. A combination of 10 predictors including: a recent index sprain, younger age, greater height and weight, perceived instability, increased laxity, impaired balance, and greater inversion/eversion peak power explained 27 to 56% of the variance in occurrence of ankle sprain (χ211,95=30.67, p=0.001). The regression model correctly classified 90% of cases. The strongest independent predictors were history of an index sprain (odds ratio (OR)=8.23, 95% confidence interval (CI)=1.66 to 40.72) and younger age (OR=8.41, 95%CI=1.48 to 47.96). CONCLUSION A recent index ankle sprain and younger age were the only independent predictors of ankle sprain. The combination of greater height or weight, feeling of instability, peak power and impaired balance predicted the occurrence of ankle sprain in almost 90% of participants. These findings could form the basis for intervention targeted at reducing recurrence of sprain after an index sprain.

Perceived ankle instability is not related to ankle joint position sense, movement detection and inversion/eversion peak power: an observational study

Background It is not known why continuing instability exists after ankle sprain. The most common hypotheses include impairments in proprioception, muscle power or postural control [1] but a relationship has not been established. Therefore, the aim of this study was to investigate the relationship between functional instability and invertor/evertor peak power, accuracy of movement detection and threshold for position sense in the ankle. Materials and methods Sixty three participants with history of either no ankle sprain or only one ankle sprain were recruited. Functional ankle instability was measured using the Cumberland Ankle Instability Tool (CAIT), a highly reliable measure of functional ankle instability [2]. Invertor/evertor power testing was performed using a Biodex isokinetic dynamometer at speeds of 30, 60 and 120°/sec and the scores were normalised using participants’ BMI. Joint position sense was measured by actively matching the 3 test angles in inversion and eversion with the contra lateral ankle. Movement detection sense was tested at three velocities, 0.1, 0.5, and 2.5°/sec, in a random order. The relationship between perceived ankle instability and proprioception or inversion/eversion peak power was investigated using Pearson product-moment correlation coefficient. Preliminary analyses were performed to ensure the assumptions of normality, linearity and homoscedasticity were not violated. Results No correlation was found between the CAIT scores and the three measured variables. The strongest correlation was between CAIT score and inversion peak power at 30°/s (r=0.220, p= 0.083). Conclusion

Correlates of Perceived Ankle Instability in Healthy Individuals Aged 8 to 101 Years

OBJECTIVES To provide reference data for the Cumberland Ankle Instability Tool (CAIT) and to investigate the prevalence and correlates of perceived ankle instability in a large healthy population. DESIGN Cross-sectional observational study. SETTING University laboratory. PARTICIPANTS Self-reported healthy individuals (N=900; age range, 8-101y, stratified by age and sex) from the 1000 Norms Project. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants completed the CAIT (age range, 18-101y) or CAIT-Youth (age range, 8-17y). Sociodemographic factors, anthropometric measures, hypermobility, foot alignment, toes strength, lower limb alignment, and ankle strength and range of motion were analyzed. RESULTS Of the 900 individuals aged 8 to 101 years, 203 (23%) had bilateral and 73 (8%) had unilateral perceived ankle instability. The odds of bilateral ankle instability were 2.6 (95% confidence interval [CI], 1.7-3.8; P<.001) times higher for female individuals, decreased by 2% (95% CI, 1%-3%; P=.001) for each year of increasing age, increased by 3% (95% CI, 0%-6%; P=.041) for each degree of ankle dorsiflexion tightness, and increased by 4% (95% CI, 2%-6%, P<.001) for each centimeter of increased waist circumference. CONCLUSIONS Perceived ankle instability was common, with almost a quarter of the sample reporting bilateral instability. Female sex, younger age, increased abdominal adiposity, and decreased ankle dorsiflexion range of motion were independently associated with perceived ankle instability.