Balance- and strength-training protocols to improve chronic ankle instability deficits, part II: Assessing patient-reported outcome measures

Abstract

Context: Assessing global, regional, and fear-of-reinjury outcomes in individuals with chronic ankle instability (CAI) is critical to understanding the effectiveness of clinical interventions. Objective: To determine the improvement of patient-reported outcomes after balance- and strength-training and control protocols among participants with CAI. Design: Randomized controlled clinical trial. Setting: Athletic training research laboratory. Patients or Other Participants: Thirty-nine volunteers with CAI who scored 11 or greater on the Identification of Functional Ankle Instability questionnaire were randomly assigned to 1 of 3 groups: balance-training protocol (7 males, 6 females; age ¼ 23.5 6 6.5 years, height ¼ 175.0 6 8.5 cm, mass ¼ 72.8 6 10.9 kg), strength-training protocol (8 males, 5 females; age ¼ 24.6 6 7.7 years, height ¼ 173.2 6 9.0 cm, mass ¼ 76.0 6 16.2 kg), or control (6 males, 7 females; age ¼ 24.8 6 9.0 years, height ¼ 175.5 6 8.4 cm, mass ¼ 79.1 6 16.8 kg). Intervention(s): Each group met for 20 minutes, 3 times each week, for 6 weeks. The control group completed a mild to moderately strenuous bicycle workout. Main Outcome Measure(s): Global patient-reported outcomes, regional ankle function, and perceived instability were measured using the Disablement in the Physically Active Scale, the Fear-Avoidance Beliefs Questionnaire, the Foot and Ankle Ability Measure, and a visual analog scale for perceived instability. Participants completed the questionnaires at pretest and 6 weeks posttest. A multivariate repeated-measures analysis of variance with follow-up univariate analysis was conducted. The a level was set a priori at .05. Results: No time-by-group interaction was found (P ¼ .78, g2 ¼ 0.09). However, we observed a main effect for time (P ¼ .001, g2 ¼ 0.49). Follow-up univariate analyses revealed differences between the pretest and posttest for the Disablement in the Physically Active Scale (P ¼ .02, g2 ¼ 0.15), Fear-Avoidance Beliefs Questionnaire (P ¼ .001, g2 ¼ 0.27), Foot and Ankle Ability Measure–Activities of Daily Living subscale (P ¼ .003, g2 ¼ 0.22), Foot and Ankle Ability Measure–Sport subscale (P ¼ .001, g2 ¼ 0.36), and visual analog scale (P ¼ .008, g2 ¼ 0.18). Conclusions: Statistically, after the 6-week intervention, all groups improved in global and regional health-related quality of life. Clinicians should compare patient-reported outcomes with clinical measures to have a better understanding of progression during rehabilitation.