Sports Medicine Research: In the Lab & In the Field: How Perceived Ankle Instability Affects a Population (Sports Med Res)
Wednesday, October 18, 2017

How Perceived Ankle Instability Affects a Population

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

Baldwin JN, McKay MJ, Hiller CE, Nightingale EJ, Moloney N, Burns J; 1000 Norms Project Consortium. Arch Phys Med Rehabil. 2017 Jan;98(1):72-79. doi: 10.1016/j.apmr.2016.08.474. Epub 2016 Sep 22.

Take Home Message: Almost 1 in 4 healthy individuals reported bilateral ankle instability. Several demographical and physical measures were associated with perceived ankle instability.

Clinician can use self-reported impairments following an ankle sprain to assess ankle instability and function. The International Ankle Consortium recommends using the Cumberland Ankle Instability Tool (CAIT) to classify and help to manage those suffering from ankle instability. While the CAIT is widely used when managing ankle instability, there is no reference data available for researchers and clinicians to utilize when using the CAIT. The authors of this article set out to provide reference data for the CAIT, as well as to examine the prevalence and factors related with perceived ankle instability in a large cohort of healthy individuals. The authors studied 900 participants from eight to 101 years old from the 1000 Norms Project in Sydney Australia. The 1000 Norms Project is an observational study researching self-reported health and physical function in 1000 healthy individuals aged three to 101 years. Participants were healthy if they did not have any health conditions that affected their physical function, and if they were able answer yes to both of the following questions; “Do you consider yourself healthy for your age?” and “Are you able to participate in normal daily activities with respect to your age?”. The investigators recorded physical measures (such as height, weight, body mass index, and waist circumference) along with sociodemographic information (such as sex, age, ethnicity). Self-reported measures of perceived ankle instability were recorded using the CAIT and the CAIT-Youth. The maximum score possible on the CAIT is a 30 and a cutoff score of ≤25 was used to detect perceived ankle instability. Of the 900 participants, the authors had CAIT reference data for 884 children and adults. From the 884 healthily deemed participants, 23% of participants reported bilateral ankle instability and 8% reported unilateral ankle instability. A female or participant with younger age, decreased dorsiflexion, or increased waist circumference was more likely to have bilateral perceived ankle instability than their peers.

The authors created reference data for the CAIT using a large number of healthy individuals. This reference data could be used as normative values that clinicians and researchers can use when assessing perceived ankle instability. This is important to have when encouraging the use of patient-reported impairments to drive impairment-based rehabilitation and management. The CAIT is recommended for categorizing people with or without chronic ankle instability (CAI). Hence in this study, 30% of healthy participants had CAI. This should call into question what is considered “healthy”. These findings may reveal an overwhelming perception that ankle sprains and their subsequent long-term consequences are innocuous, and pose no threat to one’s overall well-being and function. However, CAI has a negative impact on quality of life, and people with CAI report lower ankle function when compared to those without a history of ankle sprain. This study should remind us that overall measures of overall health often inadequately capture joint-specific measures of function or quality of life.  Clinicians should be aware that many “healthy” people may report ankle instability, which may indicate that they fail to perceive ankle instability as a big deal. Clinicians treating musculoskeletal pain should assess overall medical history and may benefit from using patient-reported outcomes to assess overall health and more specific measures of health based on prior injuries (such as CAIT for people with a history of ankle sprains). This could help to steer a holistic and impairment based treatment approach.

Questions for Discussion: How can the perception surrounding long-term effects of ankle sprains be adjusted to show the seriousness of the injury and its sequela? How important is reference data to have when using patient-reported outcome measures, as compared to having cut-off scores? How does perceived ankle instability play a role in how patients suffering from ankle sprains or CAI receive treatment? Can it assist with impairment based rehab?

Written by: Revay O. Corbett
Reviewed by: Jeffrey Driban

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