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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