Sports Medicine Research: In the Lab & In the Field: Quick Clinical Model to Identify Chronic Ankle Instability (Sports Med Res)
Wednesday, August 3, 2016

Quick Clinical Model to Identify Chronic Ankle Instability

Comparison Between Single and Combined Clinical Postural Stability Tests in Individuals With and Without Chronic Ankle Instability

Ko J, Rosen AB, Brown CN. Clin J Sport Med 2016;0:1–6

Take Home Message: Clinicians may be able to use the single-leg hop test and Star Excursion Balance Test to identify people with chronic ankle instability.

There has been immense interest in trying to prevent or treat chronic ankle instability, which is characterized by recurrent episodes of giving way and functional limitations. However, the only measures that have demonstrated high reliability of identifying chronic ankle instability are self-reported questionnaires, and it is difficult to determine functional limitations without objective measures. Therefore, the authors assessed if clinical tests independently and/or in combination could accurately differentiate individuals with and without chronic ankle instability to determine which tests could best match self-report perception of function. Participants completed an ankle injury history questionnaire and Cumberland Ankle Instability Tool (CAIT). The authors defined chronic ankle instability as a participant that scored < 25 on the CAIT, reported a history of moderate-severe ankle sprains that required at least 3 days of partial or non-weight bearing, and/or noted a history of “giving way” with activity (25 participants, 15 female). Participants who reported a score of > 29 on the CAIT with no history of ankle sprains or “giving way” were placed in the control group (33 participants, 17 female). Then, participants completed clinical tests to assess balance that included the Time in Balance Test (TIB), Foot Lift Test (FLT), Star Excursion BalanceTest (SEBT), and Single-Leg Hop Test (SLHT), in a randomized order. The authors found that 71% (41/58 participants) of participants were correctly assigned to their respective groups by the combination of all 4, 3 (TIB, SLHT, and SEBT), or 2 (SLHT and SEBT) clinical balance tests. The SEBT demonstrated the highest matched value as a single test after it correctly placed 38 out of 58 participants (~66% accuracy).

It is helpful for medical professionals to base clinical decisions on both patient-reported outcome measures and objective clinical measures. The authors of this study found that by conducting just the single-leg hop test and Star Excursion Balance Test clinicians could efficiently identify many people with or without chronic ankle instability. It was surprising to see that using all 4 was not necessary to improve recognition of chronic ankle instability. Ankle injuries are common, and with the concern about long-term joint health it is helpful to know that the single-leg hop test and Star Excursion Balance Test are quick clinical measures that can help identify those athletes suffering with chronic ankle instability. It will be interesting to see if these clinical tests can also help clinicians detect improvements during a rehabilitation program. With the addition of a patient-reported outcome measure these clinical tests could provide functional limitation information that are necessary for medical professionals to create an individualized treatment and rehabilitation plan for those with chronic ankle instability.

Questions for Discussion: How do you currently assess for chronic ankle instability? Would you incorporate SLHT and SEBT tests to identify chronic ankle instability?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

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Ko J, Rosen AB, & Brown CN (2016). Comparison Between Single and Combined Clinical Postural Stability Tests in Individuals With and Without Chronic Ankle Instability. Clinical Journal of Sport Medicine PMID: 27347871

2 comments:

boosh said...

Am I missing something? When talking about diagnostic accuracy, why isn't there sensitivity, specificity, LR, and PPV calculations?

Jane McDevitt said...

Boosh,
I agree, when we discuss diagnostic accuracy the best calculations are LR. The authors considered this the first step in the process of demonstrating the utilities of these clinical tests and point out the advantages of combining tests. However, as you noted, future studies will need to calculate diagnostic statistics. However, even still, they will need to be interpreted with great caution because there is not gold standard for diagnosing CAI.

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