Comparison Between Single and Combined Clinical Postural
Stability Tests in Individuals With and Without Chronic Ankle Instability
Stability Tests in Individuals With and Without Chronic Ankle Instability
Ko
J, Rosen AB, Brown CN. Clin J Sport Med 2016;0:1–6
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.
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).
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.
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?
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
by: Jane McDevitt, PhD
Reviewed
by: Jeff Driban
by: Jeff Driban
Related
Posts:
Posts:
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
Am I missing something? When talking about diagnostic accuracy, why isn't there sensitivity, specificity, LR, and PPV calculations?
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.