Injury-Related Fear in Individuals With and Without Chronic Ankle Instability: A Systematic Review

2021 ◽  
pp. 1-10
Author(s):  
Ashley M.B. Suttmiller ◽  
Ryan S. McCann
Keyword(s):  
Systematic Review ◽  
Ankle Sprain ◽  
Methodological Quality ◽  
Ankle Instability ◽  
Evidence Synthesis ◽  
Chronic Ankle Instability ◽  
Fear Avoidance ◽  
Physically Active ◽  
Fear Avoidance Beliefs ◽  
Fear Avoidance Beliefs Questionnaire

Context: Injury-related fear has recently been recognized to exist in ankle sprain populations. It is unclear, however, if injury-related fear levels differ between those who develop chronic ankle instability (CAI) and those who do not and the best tools for assessing these differences. Objective: The purpose of this study was to conduct a comprehensive systematic review investigating differences in injury-related fear between individuals with and without CAI. Evidence Acquisition: Relevant studies from CINAHL Plus with full text, PubMed, and SPORTDiscus through November 2020 were included. All studies used the Tampa Scale of Kinesiophobia, Fear-Avoidance Beliefs Questionnaire, or Athlete Fear Avoidance Questionnaire as either a descriptor or a main outcome and provided comparison data between a CAI group and ankle sprain copers (COP) or controls (CON). The authors independently assessed methodological quality using the modified Downs and Black Quality Index. Studies were then grouped by between-group comparisons including CAI and CON, CAI and COP, and COP and CON. The authors calculated Hedge g effect sizes and 95% confidence intervals to examine group differences. Evidence Synthesis: A total of 11 studies were included in this review. In total, 8 studies provided data for the CAI and CON comparison, 7 for CAI and COP comparisons, and 4 for COP and CON comparisons. Methodological quality scores ranged from 60.0% to 86.7%, with 2 high-, and 9 moderate-quality studies. Overall, the evidence suggests that physically active individuals with CAI report higher levels of injury-related fear when compared with both COP and CON. Although limited, ankle sprain COP do not seem to differ from CON. Conclusion: Available evidence emphasizes the importance of injury-related fear in individuals who develop chronicity after ankle sprain injury. The Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia are useful for the identification of injury-related fear in individuals after sustaining an ankle sprain and should be used to inform rehabilitation strategies and to monitor efficacy in fear reduction.

scholarly journals Health-Related Quality of Life in Individuals With Chronic Ankle Instability

2014 ◽  
Vol 49 (6) ◽  
pp. 758-763 ◽  
Author(s):  
Megan N. Houston ◽  
Bonnie L. Van Lunen ◽  
Matthew C. Hoch
Keyword(s):  
Quality Of Life ◽  
Ankle Instability ◽  
Health Related Quality ◽  
Fear Avoidance ◽  
Physically Active ◽  
Fear Avoidance Beliefs ◽  
Related Quality ◽  
Health Related ◽  
Fear Avoidance Beliefs Questionnaire

Context: Individuals with chronic ankle instability (CAI) have reported decreased global and regional function. Despite the identification of functional deficits in those with CAI, more research is required to determine the extent to which CAI influences the multidimensional profile of health-related quality of life. Objective: To determine whether global, regional, and psychological health-related outcomes differ between individuals with and without CAI. Design: Case-control study. Setting: Laboratory. Patients or Other Participants: Twenty-five participants with CAI (age = 21.9 ± 2.5 years, height = 170.8 ± 8.6 cm, mass = 69.8.0 ± 11.7 kg) were sex- and limb-matched to 25 healthy participants (age = 22.0 ± 2.1 years, height = 167.4 ± 9.1 cm, mass = 64.8 ± 11.2 kg). Main Outcome Measure(s): Both groups completed the Disablement in the Physically Active Scale, the Foot and Ankle Ability Measure (FAAM), the FAAM-Sport, the Tampa Scale of Kinesiophobia-11, and the Fear-Avoidance Beliefs Questionnaire. Dependent variables were scores on these instruments, and the independent variable was group. Results: Compared with healthy individuals, those with CAI reported decreased function on the Disablement in the Physically Active Scale, FAAM, and FAAM-Sport (P < .001) and increased fear of reinjury on the Tampa Scale of Kinesiophobia-11 and Fear-Avoidance Beliefs Questionnaire (P < .001). In the CAI group, the FAAM and FAAM-Sport demonstrated a significant relationship (r = 0.774, P < .01). Conclusions: Individuals with CAI reported decreased function and increased fear of reinjury compared with healthy control participants. Also, within the CAI group, there was a strong relationship between FAAM and FAAM-Sport scores but not between any other instruments. These findings suggest that health-related quality of life should be examined during the rehabilitation process of individuals with CAI.

Predictors of chronic ankle instability after an index lateral ankle sprain: A systematic review

2014 ◽  
Vol 17 (6) ◽  
pp. 568-573 ◽  
Author(s):  
Fereshteh Pourkazemi ◽  
Claire E. Hiller ◽  
Jacqueline Raymond ◽  
Elizabeth J. Nightingale ◽  
Kathryn M. Refshauge
Keyword(s):  
Systematic Review ◽  
Ankle Sprain ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle

scholarly journals Abnormalities of foot and ankle alignment in individuals with chronic ankle instability: a systematic review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Takumi Kobayashi ◽  
Yuta Koshino ◽  
Takahiro Miki
Keyword(s):  
Systematic Review ◽  
Internal Rotation ◽  
Methodological Quality ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Foot And Ankle ◽  
Anterior Displacement ◽  
Foot Posture

Abstract Background To prevent recurrent ankle sprain, it is important to clarify the pathology of chronic ankle instability (CAI). An association has been reported between CAI and abnormalities of foot posture and ankle alignment. There is no consensus on the types of these abnormalities that occur in individuals with CAI. The objective of this systematic review is to clarify the relevance of abnormality of foot posture and ankle alignment for CAI. Methods A systematic computerized literature search was performed of the PubMed, CINAHL, SPORTDiscus, Web of Science, and the Cochrane Register of Clinical Trials databases. The selected studies either compared CAI patients with a control group or CAI ankles with contralateral healthy ankles and specifically reported foot posture and alignment of the ankle in the outcomes. They were written in English and published prior to June 2021. The methodological quality of the included studies was evaluated using a 16-question index. Data were extracted independently by two reviewers, and the certainty of evidence was assessed using GRADE approach. Results Sixteen studies including 872 patients of high to low methodological quality were included. These showed there was significant anterior displacement and internal rotation of the talus in CAI ankles (low evidence), but there was no consensus on fibular alignment or foot posture. Conclusions This review showed there was significant anterior displacement and internal rotation of the talus in CAI ankles but found no consensus on the characteristics of fibular and foot alignment. Further investigations are required to clarify the characteristic foot and ankle malalignment in CAI to facilitate the development of efficient interventions.

Isometric Hip Strength and Patient-Reported Outcomes of Individuals With and Without Chronic Ankle Instability

2021 ◽  
pp. 1-7
Author(s):  
Katherine A. Bain ◽  
Paige A. Clawson ◽  
Stacey A. Slone ◽  
Phillip A. Gribble ◽  
Johanna M. Hoch ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Peak Torque ◽  
Group Differences ◽  
Foot And Ankle ◽  
Fear Avoidance ◽  
Hip Strength ◽  
Fear Avoidance Beliefs ◽  
Patient Reported ◽  
Ability Measure ◽  
Fear Avoidance Beliefs Questionnaire

Context: Strength deficits and decreased scores on generic, dimension-specific, and region-specific health-related quality of life (HRQL) PRO measures are commonly documented among individuals with chronic ankle instability (CAI). However, it is unknown if there is a relationship between hip strength and self-reported patient-reported outcome (PRO) scores. Objective: To compare isometric peak torque for hip-extension (H-EXT) and hip-abduction (H-ABD), as well as PRO scores between CAI, lateral ankle sprain copers (LAS copers), and uninjured controls (UC). The secondary purpose was to examine the relationship between isometric hip peak torque and PROs in participants with CAI. Design: Cross-sectional. Setting: Laboratory. Participants: Sixty-three individuals, 45 women (23.02 [3.83] y, 165.91 [7.55] cm, 67.28 [11.95] kg) and 18 men (26.28 [5.43] y, 179.28 [9.01] cm, 83.87 [13.26] kg), grouped as uninjured control (n = 26), LAS coper (n = 15), or CAI (n = 22). Main Outcome Measures: The Foot and Ankle Ability Measure was used to assess region-specific HRQL. The Fear Avoidance Beliefs Questionnaire was used to assess injury-related fear. The Disablement in Physically Active was used to assess global HRQL. Isometric peak torque was measured with a handheld dynamometer for H-EXT and H-ABD. Results: No group differences were observed for H-ABD (P = .34) or H-EXT (P = .35). The CAI group had significantly worse scores on all PROs compared with LAS coper (P < .001) and HC (P < .001). Moderate–weak correlations were found between H-ABD and Foot and Ankle Ability Measure—activities of daily living (P = .047; ρ = .392) and Foot and Ankle Ability Measure-Sport (P = .013; ρ = .482) and H- EXT and Fear Avoidance Beliefs Questionnaire-Work (P = .007; ρ = −.517). Conclusions: Individuals with CAI displayed lower HRQL based on worse scores on generic, dimension-specific, and region-specific PROs compared with LAS copers and uninjured controls. There were no significant between-group differences for H-EXT and H-ABD isometric peak torque production, but there was a moderate positive relationship between isometric H-ABD and self-reported ankle disability in individuals with CAI.

Fear Avoidance Beliefs in College Athletes with a History of Ankle Sprain

2020 ◽  
Vol 41 (02) ◽  
pp. 128-133
Author(s):  
Mako Fukano ◽  
Shinshiro Mineta ◽  
Norikazu Hirose
Keyword(s):  
Ankle Joint ◽  
Ankle Sprain ◽  
Female Athletes ◽  
Ankle Instability ◽  
Joint Laxity ◽  
Ankle Sprains ◽  
Fear Avoidance ◽  
Functional Ankle Instability ◽  
Fear Avoidance Beliefs ◽  
Fear Of Movement

AbstractAnkle sprains are the most prevalent injuries, and elevated fear avoidance beliefs after ankle sprain episodes could inhibit athletic performance and contribute to residual symptoms, such as functional and/or mechanical instability. However, it remains unclear how fear avoidance beliefs differ according to conditions of posttraumatic sequelae. The purpose of this study was to determine whether fear of movement/reinjury differed between individuals with and without functional ankle instability (FI, NFI) and healthy controls (CON) and to examine the relationship between fear and ankle joint laxity by sex. Participants (115 male athletes, 105 female athletes) completed the Identification of Functional Ankle Instability, Athlete Fear Avoidance Questionnaire (AFAQ), Tampa Scale for Kinesiophobia (TSK), and ankle joint laxity test. Total 168 athletes (79 males, 89 females) data were eligible for analysis. The results demonstrated that fear of movement/reinjury was lower in individuals in the absence of functional ankle instability although they experienced ankle sprain (FI; TSK=38.6±4.5, AFAQ=27.4±6.2, NFI; TSK=35.7±5.6, AFAQ=24.5±6.6). The fear of movement/reinjury had correlation with ankle joint laxity only in female athletes (TSK; r=0.285, p=0.013, AFAQ; r 0=0.322, p=0.045).

scholarly journals A 4-Week Multimodal Intervention for Individuals With Chronic Ankle Instability: Examination of Disease-Oriented and Patient-Oriented Outcomes

2019 ◽  
Vol 54 (4) ◽  
pp. 384-396 ◽  
Author(s):  
Cameron J. Powden ◽  
Johanna M. Hoch ◽  
Beth E. Jamali ◽  
Matthew C. Hoch
Keyword(s):  
Effect Size ◽  
Size Range ◽  
Ankle Instability ◽  
Foot And Ankle ◽  
Fear Avoidance ◽  
Balance Test ◽  
Fear Avoidance Beliefs ◽  
Ability Measure ◽  
Fear Avoidance Beliefs Questionnaire

Context Individuals with chronic ankle instability (CAI) experience disease- and patient-oriented impairments that contribute to both immediate and long-term health detriments. Investigators have demonstrated the ability of targeted interventions to improve these impairments. However, the combined effects of a multimodal intervention on a multidimensional profile of health have not been evaluated. Objective To examine the effects of a 4-week rehabilitation program on disease- and patient-oriented impairments associated with CAI. Design Controlled laboratory study. Setting Laboratory. Patients or Other Participants Twenty adults (5 males, 15 females; age = 24.35 ± 6.95 years, height = 169.29 ± 10.10 cm, mass = 70.58 ± 12.90 kg) with self-reported CAI participated. Inclusion criteria were at least 1 previous ankle sprain, at least 2 episodes of “giving way” in the 3 months before the study, and a Cumberland Ankle Instability Tool score ≤24. Intervention(s) Individuals participated in 12 sessions over 4 weeks that consisted of ankle stretching and strengthening, balance training, and joint mobilizations. They also completed home ankle-strengthening and -stretching exercises daily. Main Outcome Measure(s) Dorsiflexion range of motion (weight-bearing–lunge test), isometric ankle strength (inversion, eversion, dorsiflexion, plantar flexion), isometric hip strength (abduction, adduction, flexion, extension), dynamic postural control (Y-Balance test), static postural control (eyes-open and -closed time to boundary in the anterior-posterior and medial-lateral directions), and patient-reported outcomes (Foot and Ankle Ability Measure–Activities of Daily Living and Foot and Ankle Ability Measure–Sport, modified Disablement in the Physically Active scale physical and mental summary components, and Fear-Avoidance Beliefs Questionnaire–Physical Activity and Fear-Avoidance Beliefs Questionnaire–Work) were assessed at 4 times (baseline, preintervention, postintervention, 2-week follow-up). Results Dorsiflexion range of motion, each direction of the Y-Balance test, 4-way ankle strength, hip-adduction and -extension strength, the Foot and Ankle Ability Measure–Activities of Daily Living score, the modified Disablement in the Physically Active scale–physical summary component score, and the Fear-Avoidance Beliefs Questionnaire–Physical Activity score were improved at postintervention (P &lt; .001; effect-size range = 0.72–1.73) and at the 2-week follow-up (P &lt; .001; effect-size range = 0.73–1.72) compared with preintervention. Hip-flexion strength was improved at postintervention compared with preintervention (P = .03; effect size = 0.61). Hip-abduction strength was improved at the 2-week follow-up compared with preintervention (P = .001; effect size = 0.96). Time to boundary in the anterior-posterior direction was increased at the 2-week follow-up compared with preintervention (P &lt; .04; effect-size range = 0.61–0.78) and postintervention (P &lt; .04) during the eyes-open condition. Conclusion A 4-week rehabilitation program improved a multidimensional profile of health in participants with CAI.

scholarly journals Response Shift After a 4-Week Multimodal Intervention for Chronic Ankle Instability

2019 ◽  
Vol 54 (4) ◽  
pp. 397-402 ◽  
Author(s):  
Cameron J. Powden ◽  
Matthew C. Hoch ◽  
Beth E. Jamali ◽  
Johanna M. Hoch
Keyword(s):  
Ankle Instability ◽  
Response Shift ◽  
Rehabilitation Program ◽  
Foot And Ankle ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Individual Level ◽  
Ability Measure ◽  
Fear Avoidance Beliefs Questionnaire

Context The accurate evaluation of self-reported changes in function throughout the rehabilitation process is important for determining patient progression. Currently, how a response shift (RS) may affect the accuracy of self-reported functional assessment in a population with chronic ankle instability (CAI) is unknown. Objective To examine the RS in individuals with CAI after a 4-week multimodal rehabilitation program. Design Controlled laboratory study. Setting Laboratory. Patients or Other Participants Twenty adults (5 men, 15 women; age = 24.35 ± 6.95 years, height = 169.29 ± 10.10 cm, mass = 70.58 ± 12.90 kg) with self-reported CAI participated. Inclusion criteria were at least 1 previous ankle sprain, at least 2 episodes of the ankle “giving way” in the 3 months before the study, and a score ≤24 on the Cumberland Ankle Instability Tool. Intervention(s) Individuals participated in 12 intervention sessions over 4 weeks and daily home ankle strengthening and stretching. Main Outcome Measure(s) Patient-reported outcomes (PROs) were assessed at 4 times (baseline, preintervention, postintervention, and 2-week follow-up). At the postintervention and 2-week follow-up, participants completed then-test assessments to measure RS. Then-test assessments are retrospective evaluations of perceived baseline function completed after an intervention. The PROs consisted of the Foot and Ankle Ability Measure-Activities of Daily Living and Sport subscales, the modified Disablement in the Physically Active scale physical and mental summary components, and the Fear-Avoidance Beliefs Questionnaire Physical Activity and Work subscales. We used repeated-measures analyses of variance to compare preintervention with then-test measurements. Individual-level RSs were examined by determining the number of participants who experienced preintervention to then-test differences that exceeded the calculated minimal detectable change. Results We did not identify an RS for any PRO (F &gt; 2.338, P &gt; .12), indicating no group-level differences between the preintervention and retrospective then-test assessments. Individual-level RS was most prominent in the Foot and Ankle Ability Measure-Sport subscale (n = 6, 30%) and the Fear-Avoidance Beliefs Questionnaire Physical Activity subscale (n = 9, 45%). Conclusions No group-level RS was identified for any PRO after a 4-week multimodal rehabilitation program in individuals with CAI. This finding indicates that traditional assessment of self-reported function was accurate for evaluating the short-term effects of rehabilitation in those with CAI. Low levels of individual-level RS were identified.

scholarly journals Prevalence of Chronic Ankle Instability in French Paratroopers

2019 ◽  
Vol 185 (3-4) ◽  
pp. 477-485
Author(s):  
Marion Schmitt ◽  
Joffrey Marchi ◽  
Arnaud Jouvion ◽  
Thomas Trappier ◽  
Lisa Reyes-Rivet ◽  
...  
Keyword(s):  
General Population ◽  
Ankle Sprain ◽  
Sports Injuries ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Military Population ◽  
Physically Active ◽  
Active Population ◽  
The Military ◽  
The Impact

Abstract Introduction Ankle sprain is the most common musculoskeletal injury in the physically active population (up to 50% of sports injuries) and is common in the general population with about one ankle sprain per 10 000 person-days worldwide. It is an even more frequent pathology in the military population with a prevalence of five to eight times higher than in the civilian population. In the general population, 20 to 74% of sprains are complicated by chronic ankle instability. No studies estimate this prevalence in a French military population. The main objective of our study was, therefore, to estimate the prevalence of chronic ankle instability in French paratroopers. Materials and Methods The study was carried out in a French parachute regiment over a period of 1 year during periodic medical examinations. To diagnose chronic ankle instability, we used the criteria defined by the International Ankle Consortium in 2013 and two questionnaires that this consortium recommended (FAAM and IdFAI). Results Chronic ankle instability has a prevalence of 43.1% after an ankle sprain with a total of 2.3% among paratroopers, which is comparable to data in the literature. After their first sprain, 23.1% of subjects did not consult a health professional and 47.6% of subjects did not receive physiotherapy. Conclusions Physiotherapy is the basis of care, both for prevention and treatment of chronic ankle instability. It is necessary to raise awareness of this injury among the military and to encourage their adherence to treatment in order to preserve the operational capabilities of combat units. Subsequently, further studies are needed to expand the study population to provide a more comprehensive view of the impact of this injury on the military. Studies concerning the management of chronic ankle instability adapted to the military population would also be relevant.

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