Health-related quality of life is decreased in middle-aged adults with chronic ankle instability
Simon JE, Docherty CL. J Sci Med Sport. Epub ahead of print 24 May 2018.
Take Home Message: Middle-aged adults with chronic ankle instability (CAI) report impaired regional and global function compared to healthy controls. Healthcare providers can use questionnaires to identify patients with perceived functional deficits and lower quality of life.
Healthcare providers increasingly rely on patient-reported outcomes to assess a patient’s perception of their recovery and quality of life after an injury. While it is well documented among young adults that chronic ankle instability (CAI) relates to a lower quality of life, it is unclear how CAI may relate to quality of life among middle-aged adults (> 40 years old). Therefore, the researchers assessed if health-related quality of life differed between middle-aged adults with and without CAI. The authors recruited 200 participants and separated them into CAI or healthy based on the Identification of Functional Ankle Instability (IdFAI). The CAI group had a history of an ankle sprain and an IdFAI score ≥11 (75 participants, ~52 years old). The healthy group had no history of ankle sprains and an IdFAI score of 0 (125 participants, ~53 years old). The participants also completed a questionnaire on foot and ankle function and (American Academy of Orthopaedic Surgeons Lower Limb Questionnaire), and another on generic physical and mental health-related quality of life (Short Form-36). On average, a person with CAI reported worse physical health and ankle function than a person without CAI. In terms of overall physical and mental health, the healthy group had scores consistent (if not slightly better) than the general population. In contrast, the adults with CAI had lower physical health than the general population.
This study is important because it highlights that middle-aged adults report impaired ankle function and overall physical health when they have CAI. Perception is reality for those who believe that they have increased functional deficits that they associate with their CAI. Unfortunately, it is unclear why these adults with CAI report impaired function and physical health and how it impacts their life. The study raises concerns that a person who develops CAI in high school or college may have decades of impaired function and quality of life. We need to do more to identify people who have these poor outcomes. Hence, as healthcare providers, we should use patient-reported outcomes that are specific to the ankle but also those that capture mental and physical health, which will help us understand how an injury affects the whole patient.
Question for Discussion: Do your patients think about how their injury and recovery will affect them later in life or do they focus on immediate recovery? How do you address patient concerns for future limitations, both perceived and real?