A Randomized Controlled Trial Comparing Rehabilitation Efficacy in Chronic Ankle Instability
Wright CJ, Linens SW, Cain MS. Journal of Sport Rehabilitation. 2016 Aug 24:1-32.
Take Home Message: Patient- and clinician-oriented outcomes improved following a 4-week rehabilitation of either wobble board or resistance tubing protocols. Although both of the single exercise protocols were effective at improving outcomes, clinicians should use caution with applying these results to practice.
Chronic ankle instability (CAI) commonly results in decreased physical activity, quality of life, and self-reported symptoms. Due to the problems associated with CAI, effective rehabilitation is crucial; however, there is minimal research regarding the effectiveness of interventions used to reduce CAI symptoms. Therefore, the authors evaluated the effectiveness of 2 common, single exercise rehabilitation protocols for improving patient reported and clinician-oriented outcomes in individuals with CAI. Forty patients suffering with CAI (determined using Cumberland Ankle Instability Tool of 25 or greater) were randomized into either the wobble board balance training (20 patients) or the resistance tubing strength training protocol (20 patients). All participants completed baseline clinician-oriented tests including the foot lift test, time-in-balance, posterior medial direction of Star Excursion Balance Test, figure 8 hop test, and side hop test as well as 5 patient questionnaires including the Cumberland Ankle Instability Tool, Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL), FAAM Sport Scale, and Short-Form 36. Then participants completed a 4-week rehabilitation protocol, and then repeated baseline testing. Difficulty in rehabilitation exercises were gradually progressed over the course of 12 total sessions. The authors found both interventions were capable of improving the clinician- and patient-oriented outcomes. The wobble board balance group reported better scores on the FAAM-ADL, and those in the resistance tubing group remained the same. The authors did not find any other group differences.
This study is important because it demonstrates that there were significant improvements seen in both clinical and patient reported outcomes without the use of multi-exercise programs. This is helpful since single exercise rehabilitation programs can be implemented easily and efficiently. Both protocols demonstrated that it might be beneficial for clinicians in all settings to proactively implement these protocols in any patients with symptoms of CAI. However, a single exercise rehabilitation intervention for treatment of individuals with CAI should be used with caution. Clinicians should still use sound clinical judgement in determining deficits that need to be addressed and creating an appropriate rehabilitation plan. Additionally, treatments should be individualized based on the patient’s capability to properly perform the task and progressed at an appropriate rate.
Questions for Discussion: How should this information be used to for both clinicians in low resource settings and clinicians who have access to more resources? How do you think the results may have differed if the rehab protocols were more individualized so that the patient progressed at their own rate, not a predetermined rate?
Written by: Rachel Koldenhoven, MEd, ATC
Reviewed by: Jane McDevitt