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

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.

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Molecular mechanisms of Zika virus teratogenesis from animal studies: a systematic review protocol

Systematic Reviews ◽

10.1186/s13643-021-01713-6 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Gabriela Elis Wachholz ◽

Julia do Amaral Gomes ◽

Juliano André Boquett ◽

Fernanda Sales Luiz Vianna ◽

Lavínia Schuler-Faccini ◽

...

Keyword(s):

Systematic Review ◽

Animal Models ◽

Zika Virus ◽

Methodological Quality ◽

Molecular Mechanisms ◽

Grey Literature ◽

Standard Form ◽

Teratogenic Effect ◽

Control Group

Abstract Background Due to the diversity of studies in animal models reporting that molecular mechanisms are involved in the teratogenic effect of the Zika virus (ZIKV), the objective of the present study is to evaluate the methodological quality of these studies, as well as to demonstrate which genes and which molecular pathways are affected by ZIKV in different animal models. Methods This search will be performed in four databases: PubMed/MEDLINE, EMBASE, Web of Science, and Scopus, as well as in the grey literature. The studies selection process will be reported through the PRISMA Statement diagram model. All studies describing the molecular mechanisms possibly involved in the development of malformations caused by embryonic/fetal ZIKV exposure in animal models with an appropriate control group and methodology will be included (including, for instance, randomized and non-randomized studies). All animals used as experimental models for ZIKV teratogenesis may be included as long as exposure to the virus occurred during the embryonic/fetal period. From the selected studies, data will be extracted using a previously prepared standard form. Bias risk evaluation will be conducted following the SYRCLE’s Risk of Bias tool. All data obtained will be tabulated and organized by outcomes (morphological and molecular). Discussion With the proposed systematic review, we expect to present results about the methodological quality of the published studies with animal models that investigated the molecular mechanisms involved in the teratogenic effect of ZIKV, as well as to show the studies with greater reliability. Systematic review registration PROSPERO CRD42019157316

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

Journal of Sport Rehabilitation ◽

10.1123/jsr.2021-0015 ◽

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.

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Systematic review of the psychometric properties of patient-reported outcome measures for rheumatoid arthritis in the foot and ankle

Clinical Rehabilitation ◽

10.1177/0269215519862328 ◽

2019 ◽

Vol 33 (11) ◽

pp. 1788-1799 ◽

Cited By ~ 2

Author(s):

Ana Belen Ortega-Avila ◽

Laura Ramos-Petersen ◽

Pablo Cervera-Garvi ◽

Christopher J Nester ◽

José Miguel Morales-Asencio ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Systematic Review ◽

Psychometric Properties ◽

Outcome Measures ◽

Methodological Quality ◽

Measurement Properties ◽

Foot And Ankle ◽

Inclusion Criteria ◽

Patient Reported

Objective: To identify self-reported outcome measures specific to the foot and ankle in patients with rheumatoid arthritis and to investigate the methodological quality and psychometric properties of these measures. Method: A systematic review focusing on patients with rheumatoid arthritis. Setting: The search was conducted in the PubMed, SCOPUS, CINAHL, PEDro and Google Scholar databases, based on the following inclusion criteria: population (with rheumatoid arthritis) > 18 years; psychometric or clinimetric validation studies of patient-reported outcomes specific to the foot and ankle, in different languages, with no time limit. Two of the present authors independently assessed the quality of the studies located and extracted the relevant data. Terwee’s criteria and the COSMIN checklist were employed to ensure adequate methodological quality. Results: Of the initial 431 studies considered, 14 met the inclusion criteria, representing 7,793 patients (56.8 years). These instruments were grouped into three dimensions (pain, perceived health status and quality of life and disability). The time to complete any of the PROMs varies around 15 minutes. PROMs criterias with the worst scores by COSMIN, 92.85% and 85.71% were criterion validity, measurement error, internal consistency and responsiveness. 28.57% of PROMs were compared with the measurement properties. Conclusion: the Self-Reported Foot and Ankle Score achieved the highest number of positive criteria (according to Terwee and COSMIN), and is currently the most appropriate for patients with Rheumatoid arthritis.

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DANCE AND MOVEMENT THERAPY: A MIXED-METHODS SYSTEMATIC REVIEW

SOCIETY INTEGRATION EDUCATION Proceedings of the International Scientific Conference ◽

10.17770/sie2020vol7.5076 ◽

2020 ◽

Vol 7 ◽

pp. 215

Author(s):

Marta Zande ◽

Sanita Šuriņa

Keyword(s):

Systematic Review ◽

Mixed Methods ◽

Social Interactions ◽

Methodological Quality ◽

Meta Analysis ◽

Movement Therapy ◽

Control Group ◽

Emotional Component ◽

Therapy Sessions

Changes caused by aging manifest themselves in physical, cognitive, emotional and social areas. Dance and movement therapy ensures that it is possible to work with a client in all four areas – promote physical activity, stimulate cognitive functions, activate emotional component and encourage social interactions. The aim of this research was to create a mixed methods systematic review on dance and movement therapy (DMT) for seniors, to assess the methodological quality of included studies, analyse structural and content indicators of applied DMT interventions, their effect and experience of seniors gained during dance and movement therapy sessions. Findings suggest that the methodological quality of studies varies from high to low. Data acquired by meta-analysis indicates a statistically significant reduction of depression scores for research (DMT) group in comparison to control group (95% CI: -3.74 to -2.52, total effect Z = 10.05 (P < 0.00001)). Qualitative data shows changes in all four areas as well as provides dance and movement therapists with a framework for different client groups such as individuals with depression, Parkinson’s disease, etc. Further research on seniors’ experiences is needed.

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Exercise Interventions for Improving Flexibility in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis

Medicina ◽

10.3390/medicina55110726 ◽

2019 ◽

Vol 55 (11) ◽

pp. 726

Author(s):

Torres-Pareja ◽

Sánchez-Lastra ◽

Iglesias ◽

Suárez-Iglesias ◽

Mendoza ◽

...

Keyword(s):

Multiple Sclerosis ◽

Systematic Review ◽

Range Of Motion ◽

Methodological Quality ◽

Assessment Tool ◽

Meta Analysis ◽

Preliminary Evidence ◽

Control Group ◽

Exercise Interventions

Background and objectives: People with multiple sclerosis (MS) often experience limitations in joint range of motion, which is linked to spasticity and continued inactivity. Low flexibility levels in this population have been linked to postural problems and muscular pain. Therefore, the purpose of this study was to conduct a systematic review and a meta-analysis aimed at identifying the characteristics and methodological quality of investigations studying the effects of exercise interventions on the flexibility levels of people with MS. Materials and Methods: Three electronic databases (MEDLINE/PubMed, SPORTDiscus and Scopus) were systematically searched up to May 2019 for intervention studies focused on the effects of exercise on the flexibility levels of people with MS. A meta-analysis, including randomized controlled trials (RCT), which reported information regarding the effects of exercise on flexibility, was also conducted. The methodological quality of included studies was assessed using the Physiotherapy Evidence Database, and the Quality Assessment Tool for Before–After Studies, with no control group. The quality of the information reported, regarding the programs conducted, was assessed by means of the Consensus on Exercise Reporting Template (CERT) scale. Results: Seven studies, four RCTs and three uncontrolled investigations were finally selected. The methodological quality of the RCTs was considered “poor” in one study, and “good” and “excellent” in two studies and one investigation, respectively. The three uncontrolled studies showed a methodological quality between “fair” and “poor”. Following the CERT scale, four studies were graded as “high” and three as “low”. Findings from the meta-analysis indicated no significant effects on hamstring flexibility, or the range of motion in the hips, knees or ankles. Conclusions: There is preliminary evidence from individual studies which indicates that people with MS can improve their lower limb flexibility following participation in physical exercise programs, but the meta-analysis did not confirm these findings.

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Effects of balance training on functionality, ankle instability, and dynamic balance outcomes in people with chronic ankle instability: Systematic review and meta-analysis

Clinical Rehabilitation ◽

10.1177/02692155211022009 ◽

2021 ◽

pp. 026921552110220

Author(s):

Sara Mollà-Casanova ◽

Marta Inglés ◽

Pilar Serra-Añó

Keyword(s):

Systematic Review ◽

Strength Training ◽

Randomized Controlled Trials ◽

Ankle Instability ◽

Dynamic Balance ◽

Balance Training ◽

Chronic Ankle Instability ◽

Control Group ◽

Controlled Trials ◽

Randomized Controlled

Aim: To identify the effects of balance and strength training on function, ankle instability and dynamic balance in people with chronic ankle instability. Method: The search was conducted on randomized controlled trials that investigated the effects of balance training or strength training in people with chronic ankle instability compared to a control group. Therefore, a systematic electronic search was performed until April 2021 in Pubmed/MEDLINE, Cochrane, and Embase databases. Moreover, an additional search was further performed checking the reference lists of the selected articles. The main outcomes were ankle instability, functionality, and dynamic balance. Finally, a qualitative and quantitative synthesis was performed. Results: Fifteen randomized controlled trials with 457 volunteers were included. Compared to regular exercise, balance training demonstrated to be more effective in terms of improving functionality (0.81 (0.48, 1.14)), ankle instability (0.77 (0.27, 1.26)), and dynamic balance (0.83 (0.57, 1.10)) outcomes. However, when compared to strength training, the effectiveness of balance training was only greater in terms of the functionality outcome (0.49 (0.06, 0.92)), since no differences were found for instability (0.43 (0.00, 0.85)) and dynamic balance (0.21 (−0.15, 0.58)). Conclusions: Based on fair-to-high quality evidence, balance training significantly improves functionality, instability, and dynamic balance outcomes in people with chronic ankle instability Moreover, results of the comparison between balance training versus strength training suggest that the former achieves greater benefits for functionality, but not for instability and dynamic balance. Systematic review registration number: CRD42021224179.

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Changes in Dorsiflexion and Dynamic Postural Control After Mobilizations in Individuals With Chronic Ankle Instability: A Systematic Review and Meta-Analysis

Journal of Athletic Training ◽

10.4085/1062-6050-380-17 ◽

2019 ◽

Vol 54 (4) ◽

pp. 403-417 ◽

Cited By ~ 1

Author(s):

Robert A. Vallandingham ◽

Stacey L. Gaven ◽

Cameron J. Powden

Keyword(s):

Systematic Review ◽

Postural Control ◽

Ankle Instability ◽

Meta Analysis ◽

Intervention Group ◽

Chronic Ankle Instability ◽

Control Group ◽

Quality Level ◽

Methodologic Quality ◽

Evidence Database

Objective To conduct a systematic review with meta-analysis assessing the effectiveness of joint mobilizations for improving dorsiflexion range of motion (DFROM) and dynamic postural control in individuals with chronic ankle instability. Data Sources Electronic databases (PubMed, MEDLINE, CINAHL, and SPORTDiscus) were searched from inception to January 2017. Study Selection Included studies examined the isolated effects of joint mobilizations to enhance DFROM and dynamic postural control in individuals with chronic ankle instability and provided adequate data to calculate effect sizes (ESs) and 95% confidence intervals (CIs). Data Extraction Two investigators independently assessed the methodologic quality, level of evidence, and strength of recommendation using the Physiotherapy Evidence Database scale and the Strength of Recommendation Taxonomy. We extracted the sample sizes, means, and standard deviations for DFROM and dynamic postural control and filtered the data based on control-to-intervention and preintervention-to-postintervention (pre-post) comparisons. Data Synthesis We included 7 level 1 and 3 level 2 studies that had a median Physiotherapy Evidence Database score of 60% (range = 40%–80%). The magnitudes of control-to-intervention and pre-post differences were examined using bias-corrected Hedges g ESs. Random-effects meta-analyses were conducted for each outcome measure and comparison. Positive ESs indicated better outcome scores in the intervention group than in the control group and at postintervention than at preintervention. The α level was set at .05. Meta-analysis revealed weak and moderate ESs for overall control-to-intervention (ES = 0.41; 95% CI = 0.14, 0.68; P = .003) and pre-post (ES = 0.34; 95% CI = 0.20, 0.48; P < .001) DFROM analyses. Overall, dynamic postural control meta-analysis revealed moderate control-to-intervention (ES = 0.42; 95% CI = −0.14, 0.98; P = .14) and weak and moderate ESs for pre-post (ES = 0.37; 95% CI = −0.12, 0.87; P = .14) analyses. Conclusions We observed grade A evidence that joint mobilizations can mildly improve DFROM among individuals with chronic ankle instability compared with controls and preintervention. We observed grade B evidence that indicated conflicting effects of joint mobilizations on dynamic postural control compared with controls and preintervention.

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Changes in Spinal and Corticospinal Excitability in Patients with Chronic Ankle Instability: A Systematic Review with Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm8071037 ◽

2019 ◽

Vol 8 (7) ◽

pp. 1037 ◽

Cited By ~ 2

Author(s):

Kyung-Min Kim ◽

Joo-Sung Kim ◽

David Cruz-Díaz ◽

Seungho Ryu ◽

Minsoo Kang ◽

...

Keyword(s):

Systematic Review ◽

Ankle Instability ◽

Meta Analysis ◽

Chronic Ankle Instability ◽

H Reflex ◽

Corticospinal Excitability ◽

Spinal Reflex ◽

Control Group ◽

Neural Excitability ◽

Ankle Muscles

The objective of this systematic review with meta-analysis was to determine alterations in spinal and corticospinal excitability of ankle muscles in patients with chronic ankle instability (CAI) compared to uninjured controls. Independent researchers performed comprehensive literature searches of electronic databases and included studies that compared groups with and without CAI and investigated neural excitability with Hoffmann reflex (H-reflex) and/or transcranial magnetic stimulation (TMS). A fixed-effect meta-analysis was conducted to determine group differences for (1) soleus and fibularis maximal H-reflex (Hmax)/maximal M-wave (Mmax)-ratios, and (2) soleus and fibularis longus cortical motor thresholds (CMTs). Seventeen studies were included in the current meta-analysis. They showed that the Hmax/Mmax-ratios of the soleus and the fibularis longus in the CAI group were significantly lower than those in the uninjured control group (soleus: d = −0.41, p < 0.001; fibularis longus: d = −0.27, p = 0.04). There was no evidence for changes in the CMT. This systematic review is the first to demonstrate evidence that patients with CAI present decreased spinal reflex excitability in the soleus and fibularis longus. However, there is no evidence of changes in supraspinal excitability when considering only the CMT. The latter result needs to be interpreted with caution as all except one study demonstrate some changes at the supraspinal level with CAI.

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How Does Mindfulness Affect Cognition? A Reflection on Confounding Issues Surrounding Mindfulness-based Intervention Research Targeting Cognitive Outcomes

10.31231/osf.io/86hrv ◽

2018 ◽

Author(s):

David R Vago ◽

Resh Gupta ◽

Sara Lazar

Keyword(s):

Systematic Review ◽

Health Outcomes ◽

Cognitive Functioning ◽

Cognitive Processes ◽

Methodological Quality ◽

Cognitive Outcomes ◽

Controlled Trials ◽

Randomized Controlled ◽

Existing Data

One potential pathway by which mindfulness-based meditation improves health outcomes is through changes in cognitive functioning. A systematic review of randomized controlled trials of mindfulness-based interventions (MBIs) was conducted with a focus on assessing the state of the evidence for effects on cognitive processes and associated assays. Here, we comment on confounding issues surrounding the reporting of these and related findings, including 1) criteria that appropriately define an MBI; 2) limitations of assays used to measure cognition; and 3) methodological quality of MBI trials and reporting of findings. Because these issues contribute to potentially distorted interpretations of existing data, we offer constructive means for interpretation and recommendations for moving the field of mindfulness research forward regarding the effects on cognition.

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