Predicting manual therapy treatment success in patients with chronic ankle instability: Improving self-reported function

Abstract

Context: Therapeutic modalities that stimulate sensory receptors around the foot-Ankle complex improve chronic ankle instability (CAI)-Associated impairments. However, not all patients have equal responses to these modalities. Identifying predictors of treatment success could improve clinician efficiency when treating patients with CAI. Objective: To conduct a response analysis on existing data to identify predictors of improved self-reported function in patients with CAI. Design: Secondary analysis of a randomized controlled clinical trial. Setting: Sports medicine research laboratories. Patients or Other Participants: Fifty-nine patients with CAI, which was defined in accordance with the International Ankle Consortium recommendations. Intervention(s): Participants were randomized into 3 treatment groups (plantar massage [PM], ankle-joint mobilization [AJM], or calf stretching [CS]) that received six 5-minute treatments over 2 weeks. Main Outcome Measure(s): Treatment success, defined as a patient exceeding the minimally clinically important difference of the Foot and Ankle Ability Measure-Sport (FAAM-S). Results: Patients with 5 recurrent sprains and 82.73% on the Foot and Ankle Ability Measure had a 98% probability of having a meaningful FAAM-S improvement after AJM. As well, 5 balance errors demonstrated 98% probability of meaningful FAAM-S improvements from AJM. Patients ,22 years old and with 9.9 cm of dorsiflexion had a 99% probability of a meaningful FAAM-S improvement after PM. Also, those who made 2 single-limb-stance errors had a 98% probability of a meaningful FAAM-S improvement from PM. Patients with 53.1% on the FAAM-S had an 83% probability of a meaningful FAAM-S improvement after CS. Conclusions: Each sensory-Targeted ankle-rehabilitation strategy resulted in a unique combination of predictors of success for patients with CAI. Specific indicators of success with AJM were deficits in self-reported function, single-limb balance, and ,5 previous sprains. Age, weight-bearing-dorsiflexion restrictions, and single-limb balance deficits identified patients with CAI who will respond well to PM. Assessing self-reported sport-related function can identify CAI patients who will respond positively to CS.