Reliability and validity of the Persian version of Foot and Ankle Ability Measure (FAAM) to measure functional limitations in patients with foot and ankle disorders

The immediate effect of synergistic muscles kinesio taping on function and balance of volleyball players with functional ankle instability: A randomized controlled trial

OBJECTIVES

To determine the immediate effect of synergistic muscles Kinesio taping (KT) on the function and balance of volleyball players with functional ankle instability (FAI).

DESIGN

Parallel, superiority randomized controlled trial.

METHODS

Twenty-six semi-professional volleyball players with FAI were randomly assigned to either the intervention or control group. All participants received KT of fibularis longus, gastrocnemius, and gluteus maximus muscles for one session. The intervention group received KT with 35 % tension, while the control group received KT without tension. The function was assessed using the side hop and single hop distance tests. Dynamic balance was assessed with the Y Balance test. The outcomes were measured at baseline, 20 min after KT, and 24 h after KT. Statistical analyses were performed using Mixed-model repeated measures analysis of variance (ANOVA) and one-way ANOVA.

RESULTS

The interactions of time*group for the outcomes of function using the single hop test and stability in the anterior direction of the Y Balance test were significant (p < 0.05). Within-group comparisons showed after KT, both groups experienced significant improvements in all outcomes compared to the baseline. Results of between-group comparisons revealed that the application of KT with tension compared to no tension significantly improved function and balance in the anterior of the Y Balance test.

CONCLUSIONS

Kinesio taping can be an effective treatment option to improve function and balance in FAI. Additionally, Kinesio taping with tension compared to KT without tension had superiority.

Greek Cross-Cultural Adaptation, Reliability, and Validity of the Quick Foot and Ankle Ability Measure Questionnaire

CONTEXT

An easy-to-administer, function-based questionnaire to assess patients with various foot problems was required for a Greek-speaking population. This study aimed to translate and cross-culturally adapt the Quick Foot and Ankle Ability Measure (Quick-FAAM) into Greek and evaluate its reliability and validity.

DESIGN

Cross-sectional study.

METHODS

Established international guidelines for the cross-cultural adaptation of questionnaires were followed. The face and content validity of the Greek version of the Quick-FAAM (Quick-FAAM-GR), as well as the internal consistency and test-retest reliability upon repeated administration after 5 days, were examined. In addition, the construct validity of the scale was examined via exploratory factor analysis as well as by testing for associations with the Manchester Foot Pain and Disability Index, the 12-item Short-Form Survey (version 2), and a functional balance assessment test-the Y-Balance Test.

RESULTS

Sixty participants (18 women) with self-reported chronic ankle instability symptoms, with a median (interquartile range) age of 27 (7.7) years, participated in the study. Half of the participants were included in the test-retest reliability study. The Quick-FAAM-GR demonstrated face and content validity. Excellent internal consistency (Cronbach α = .961) and intrarater test-retest reliability (intraclass correlation coefficient ICC[2,1] = .93) were demonstrated, with a comparable error margin to the original version (standard error of the measurement = 2.1, 95% minimum detectable change = 5.9). Associations of the Quick-FAAM-GR scores to other questionnaires ranged from weak to strong (Spearman rho), all being statistically significant (Manchester Foot Pain and Disability Index from -.26, P = .04, to -.67, P < .001, and 12-item Short-Form Survey, version 2, between .41 and .72, P < .001), and to the Y-Balance Test between lower-limb differences (-.35 to -.58, P < .001). The exploratory factor analysis confirmed the single-factor structure of this scale. No floor/ceiling effects were observed.

CONCLUSIONS

The Greek Quick-FAAM has proven to be a valid and reliable tool for evaluating chronic ankle instability and can be used for clinical and research purposes in Greek-speaking individuals.

Comparing kinematic asymmetry and lateral step-down test scores in healthy, chronic ankle instability, and patellofemoral pain syndrome female basketball players: a cross-sectional study

We aimed to understand whether ankle dorsiflexion range of motion (ROM) and dynamic knee valgus (DKV) kinematic inter-limb asymmetries would be associated with the Lateral Step-Down Test (LSD) in basketball players with chronic ankle instability (CAI), patellofemoral pain (PFP) and healthy controls (HC). An observational cross-sectional study with a between-subject design was employed. Female basketball athletes with CAI (n = 20), PFP (n = 20) and HC (n = 20) were recruited. Ankle dorsiflexion-ROM, DKV angle during a single-limb squat, and LSD quality were measured bilaterally. The Asymmetry index (ASI) was calculated to identify between-limb percentage imbalances. The correlation matrix between the tasks was calculated. Ankle dorsiflexion-ROM was less in the CAI and PFP than in the HC group regardless of limb (p < 0.001). DKV angle was greater in the CAI and PFP than in the HC group bilaterally (p < 0.001). LSDs were similar between the PFP and CAI groups (p = 0.698) but worse than the HC group (p = 0.001). The ASI showed asymmetry across all tasks (p < 0.001), with the greatest asymmetry for the DKV angle. The correlation matrix between tasks on both limbs was significant (p < 0.05). Our findings suggest significant asymmetries in ankle dorsiflexion-ROM and frontal plane knee control are present in female basketball athletes with CAI and PFP, and thus, highlights need to evaluate and reduce limb asymmetries in these populations.

The effect of perturbation training with and without applying the dry needling on leg muscles in patients with chronic ankle sprain

INTRODUCTION

Ankle sprain is a common musculoskeletal injury that leads to recurrent instability. Repeated ankle sprain can be a mechanism for creating trigger point. Proper treatment of trigger points, in addition to preventing recurrence of sprains, may reduce pain and improve muscle function. This improvement can be the result of preserving the surrounding tissues from excessive pressure.

OBJECTIVE

Investigate the added value of dry needling into perturbation training protocol for chronic ankle sprain.

DESIGN

Randomized clinical trial; assessor-blind; before and after comparison.

SETTING

Treatment of patients referred to the institutional rehabilitation clinics.

MAIN OUTCOME MEASURE(S)

Functional assessment with FAAM questionnaire score, Pain with NPRS scale, ankle instability severity with Cumberland tool.

METHODS

Twenty-four patients with chronic ankle instability participated in this clinical trial and were randomly divided into two groups. Intervention was 12 sessions in which one group received only perturbation training and the other group received perturbation training along with dry needling. Repeated measures ANOVA was used to investigate the effect of treatment.

RESULTS

Data Analysis showed significant difference in NPRS and FAAM and Cumberland score before and after treatment in each group (P < 0.001). Comparison of the results between the groups did not show any significant difference (P > 0.05).

CONCLUSION

The findings showed that adding dry needling technique to the perturbation training does not have greater effects on the pain and function of patients with chronic ankle instability.

Cross-Culturally Adapted Versions of Patient Reported Outcome Measures for the Lower Extremity

Background

A large number of patient reported outcome measures (PROMs) have been developed in the English language for various lower extremity orthopaedic pathologies. Twenty different PROMs were recommended for 15 specific musculoskeletal lower extremity pathologies or surgeries. However, the availability of cross-culturally adapted versions of these recommended PROMs is unknown.

Purpose

The purpose of this study was to identify the cross-culturally adapted versions of recommended PROMs for individuals experiencing orthopedic lower extremity pathologies or undergoing surgeries, and to identify the psychometric evidence that supports their utilization.

Study design

Literature Review.

Methods

PubMed, Embase, Medline, Cochrane, CINAHL, SPORTDisucs and Scopus were searched for cross-culturally adapted translated studies through May 2022. The search strategy included the names of the 20 recommended PROMs from previous umbrella review along with the following terms: reliability, validity, responsiveness, psychometric properties and cross-cultural adaptation. Studies that presented a non-English language version of the PROM with evidence in at least one psychometric property to support its use were included. Two authors independently evaluated the studies for inclusion and independently extracted data.

Results

Nineteen PROMS had cross-culturally adapted and translated language versions. The KOOS, WOMAC, ACL-RSL, FAAM, ATRS, HOOS, OHS, MOXFQ and OKS were available in over 10 different language versions. Turkish, Dutch, German, Chinese and French were the most common languages, with each language having more than 10 PROMs with psychometric properties supporting their use. The WOMAC and KOOS were both available in 10 languages and had all three psychometric properties of reliability, validity, and responsiveness supporting their use.

Conclusion

Nineteen of the 20 recommended instruments were available in multiple languages. The PROM most frequently cross-culturally adapted and translated were the KOOS and WOMAC. PROMs were most frequently cross-culturally adapted and translated into Turkish. International researchers and clinicians may use this information to more consistently implement PROMs with the most appropriate psychometric evidence available to support their use.

Level of evidence

3a.

Empfehlung für Fragebögen zur Untersuchung der Fuß- und Sprunggelenkfunktion vom Research-Komitee der AGA

Das standardisierte Erheben von Behandlungsergebnissen findet immer mehr Einzug in die moderne Medizin. Hierbei ist vor allem das subjektive Ergebnis aus Patientensicht und die damit häufig einhergehende Zufriedenheit mit der medizinischen Behandlung in den Fokus gerückt. Dies hat in den letzten Jahren nicht nur in der akademischen Landschaft, sondern auch auf gesundheitspolitischer Ebene deutlich an Bedeutung gewonnen. Dies bedeutet, dass das Behandlungsergebnis immer mehr Einfluss auf die Vergütung der Leistungserbringer erhält, auch „value-based healthcare“ genannt. Insbesondere in der Orthopädie und Traumatologie gibt es dabei zahlreiche gelenkspezifische Messinstrumente (Fragebögen, Scores oder „patient-reported outcome measures“ [PROMs]), wobei in der Fuß- und Sprunggelenkchirurgie hierfür eine Vielzahl an Fragebögen verfügbar ist, die sich jedoch häufig sehr heterogen und selten pathologiespezifisch darstellen. In Anbetracht der derzeitigen Mannigfaltigkeit an PROMs in der aktuellen Literatur ist es deshalb von Interesse, die wissenschaftliche Qualität zu prüfen und gleichzeitig die Forschungskommunikation zu vereinheitlichen, indem etablierte und gemäß akademischen Gütekriterien ausgewählte Fragebögen zum Einsatz kommen. Ziel ist es, valide, verlässliche und möglichst repräsentative Daten zu gewinnen, um eine akkurate Darstellung der tatsächlichen Ergebnisse zu erreichen. Dies bedingt neben qualitativen Kriterien auch immer kompakte und leicht verständliche Fragenkataloge, um so eine möglichst hohe Rücklaufquote zu generieren. Schließlich sollte auch immer eine Einschätzung der klinischen Relevanz der erhaltenen Ergebnisse stattfinden. Hierfür hat sich der kleinste vom Patienten als klinische Veränderung wahrgenommene Wert des jeweiligen PROM („minimal clinically important difference“, MCID) durchgesetzt. Für den Fuß- und Sprunggelenkbereich werden dabei vom Research Komitee der AGA unter Berücksichtigung dieser Kriterien folgende Messinstrumente empfohlen: FAOS (Foot and Ankle Outcome Score) zur Beurteilung der allgemeinen Schmerzsymptomatik und Funktion sowie der EQ-5D-Fragebogen zur Beurteilung der Lebensqualität. Zwar kann aufgrund fehlender Datenlage keine pathologiespezifische Empfehlung abgegeben werden, jedoch ist der FAOS für eine Vielzahl von Fuß- und Sprunggelenkpathologien validiert und liegt zudem in deutscher Sprache vor.

Ultrasound-Guided Injection of Dextrose Versus Corticosteroid in Chronic Plantar Fasciitis Management: A Randomized, Double-Blind Clinical Trial

DESIGN

Chronic plantar fasciitis (PF) is a common cause of chronic heel pain, with different conventional treatment options. In this randomized clinical trial, the effect of ultrasound-guided injection of dextrose versus corticosteroid in chronic PF was evaluated and compared.

METHODS

A total of 44 patients suffering from chronic PF who visited the physical medicine and rehabilitation clinic were enrolled in the study. Two table-randomized groups were formed. They received an ultrasonography-guided, single injection of either 40 mg methylprednisolone or 20% dextrose. Numeric Rating Scale (NRS), Foot and Ankle Ability Measure questionnaire with 2 subscales, Activities of Daily Living (FAAM-A) and Sports (FAAM-S), along with ultrasonographic parameters were evaluated before and at 2 and 12 weeks after the injection. Results. A total of 40 participants completed the study. Both interventions significantly improved pain and function at 2 and 12 weeks postinjection. After 2 weeks, compared with the dextrose prolotherapy, the corticosteroid group had significantly lower daytime and morning NRS scores (2.55 vs 4.1, P = .012, and 2.75 vs 4.65, P = .004), higher FAAM-S (66.84 vs 54.19; P = .047), and lower plantar fascia thickness at insertion and 1 cm distal to the insertion zone (3.89 vs 4.29 mm, P = .004, and 3.13 vs 3.48 mm, P = .002), whereas FAAM-A was similar in both groups (P = .219). After 12 weeks, all study variables were statistically similar between corticosteroid and dextrose prolotherapy groups. No injection-related side effects were recorded in either group.

CONCLUSION

Both methods are effective. Compared with dextrose prolotherapy, our results show that corticosteroid injection may have superior therapeutic effects early after injection, accompanied by a similar outcome at 12 weeks postinjection.

LEVELS OF EVIDENCE

Level II.

Comparison of the Effect of Ultrasound-Guided Injection of Botulinum Toxin Type A and Corticosteroid in the Treatment of Chronic Plantar Fasciitis: A Randomized Controlled Trial

OBJECTIVE

The aim of the study was to compare the efficacy of ultrasound-guided injection of botulinum toxin type A with corticosteroid in patients with chronic plantar fasciitis (PF).

DESIGN

This randomized controlled trial was conducted on 35 patients with chronic plantar fasciitis. Participants were randomly allocated into two groups: one group received methylprednisolone in to the plantar fascia ( n = 18) and the other group received botulinum toxin type A injection into the flexor digitorum brevis and quadratus plantae ( n = 17). All injections were performed under ultrasound guidance. Patients were evaluated using the Visual Analog Scale, Foot and Ankle Ability Measures, and plantar fascia thickness before the intervention, 3 wks, 12 wks, and 6 mos after the treatment.

RESULTS

In both groups, patients' pain and function improved significantly up to 3 wks after injection. In the botulinum toxin type A group, morning Visual Analog Scale improved significantly at 12 wks after intervention and the improvement was sustained for another 3 mos. In the botulinum toxin type A group, Foot and Ankle Ability Measures-sports subscale improved in all evaluated points, whereas in the corticosteroid group, the improvement was significant only when comparing follow-ups values to baseline.

CONCLUSIONS

Both ultrasound-guided botulinum toxin type A and corticosteroid injection were effective in the treatment of plantar fasciitis. Our study showed that the effects of botulinum toxin type A injection last longer than those of steroid injection.

Validation of the Persian Version of the Engagement in Meaningful Activities Survey (EMAS) in an Iranian Stroke Population: Predictors of Participation in Meaningful Activities

IMPORTANCE

The inability to participate in meaningful activities is one of stroke survivors' main difficulties and has a negative effect on their satisfaction and quality of life.

OBJECTIVE

To assess the reliability and validity of the Persian version of the Engagement in Meaningful Activities Survey (EMAS-P) and predictors of participation in meaningful activity among chronic stroke survivors.

DESIGN

Cross-sectional.

SETTING

Medical and rehabilitation centers.

PARTICIPANTS

One hundred twenty-three people (75 men, 48 women) with chronic stroke.

OUTCOMES AND MEASURES

Participants were evaluated with the EMAS-P, Satisfaction With Life Scale (SWLS), Center for Epidemiologic Studies Depression Scale, Purpose in Life Test-Short Form (PIL-SF), 36-Item Short Form Health Survey (SF-36), and Life Satisfaction Index-Z (LSI-Z).

RESULTS

The EMAS-P showed good internal consistency (Cronbach's α = .95) and test-retest reliability (intraclass correlation coefficient = .87 for EMAS-P total score). Test-retest reliability for each EMAS-P item was moderate (κ = .40-.65). A significant correlation between the EMAS-P and PIL-SF (r = .86), SWLS (r = .83), LSI-Z (r = .75), and SF-36 subscales (rs = .52-.83) indicated the appropriate convergent validity. The EMAS-P's discriminative validity was also confirmed for age, depression level, and disability level among people with chronic stroke. Depression, disability level, gender, and fatigue were significant predictors of EMAS-P score.

CONCLUSIONS AND RELEVANCE

The results indicate that the EMAS-P has acceptable reliability and validity among Iranian people with chronic stroke. Moreover, the EMAS-P showed good discriminant validity for age, depression, and disability level among them. What This Article Adds: The EMAS-P is a reliable and valid scale for assessing the engagement of Iranian chronic stroke survivors in meaningful activities and thus should be helpful in both clinical research and practice.

Structural and Construct Validity of the Foot and Ankle Ability Measure (FAAM) With an Emphasis on Pain and Functionality After Foot Surgery: A Multicenter Study

The Foot and Ankle Ability Measure (FAAM) is a patient-reported outcome measure that is available in several languages. We aim to assess the structural and construct validity of the FAAM with an emphasis on pain and functionality after foot surgery. The activities of daily living (ADL) and Sports subscales of the Finnish version of the FAAM were completed by 182 patients who underwent operative treatment for disorders of the foot. Convergent validity was assessed by principal component analysis using Spearman's correlation coefficient between the FAAM subscales and the principal components (Function-PC and Pain-PC) derived from validated patient-reported outcome measures. Subscales were studied for floor and ceiling effects, internal consistency and unidimensionality. Internal consistency was examined with Cronbach's alpha and the subscale structure with exploratory factor analysis. FAAM-ADL had high correlation with the Function-PC (r = 0.87, 95% confidence interval [CI] 0.81-0.91) and the Pain-PC (r = 0.75, 95% CI 0.65-0.83). FAAM-Sports had moderate correlation (r = 0.64, 95% CI 0.50-0.74) with the Function-PC and high correlation (r = 0.74, 95% CI 0.64-0.82) with the Pain-PC. No floor or ceiling effects were observed. Cronbach's alpha was 0.97 (95% CI 0.96-0.98) for the ADL and 0.93 (95% CI 0.91-0.95) for the Sports subscales. The results supported the unidimensionality of the FAAM-Sports. Within the ADL subscale, 3 factors were identified, suggesting a 3-factor model for the FAAM overall. Results highlighted the inter-relationship of pain and physical function. Further research on longitudinal validity is needed.

Inter-limb asymmetry of kinetic and electromyographic during walking in patients with chronic ankle instability

After an initial ankle sprain, a relevant number of participants develop chronic ankle instability (CAI). Compensatory strategies in patients with CAI may change the inter-limb symmetry needed for absorbing movement-related forces. Accordingly, an increased risk of injury can occur. The present study aimed to compare the inter-limb asymmetry of kinetic and electromyography between individuals with CAI and without a history of an ankle sprain (Non-CAI) during walking. In this cross-sectional study, fifty-six athletes (28 CAI; 28 Non-CAI) participated. Participants walked at a comfortable pace over level ground while vertical ground reaction force (vGRF) and muscle activity of the tibialis anterior, peroneus longus, medial gastrocnemius, and gluteus medius were recorded. Inter-limb asymmetry during walking was calculated for each of the variables. Patients with CAI exhibited a greater inter-limb asymmetry of the first peak of vGRF, time to peak vGRF, and loading rate (P < 0.001), as well as presenting a greater inter-limb asymmetry of peroneus longus activity (contact phase) (P = 0.003) and gluteus medius activity (midstance/propulsion phase) (P = 0.010) compared to the Non-CAI group. No other differences in vGRF or muscles activity were observed between the groups. Our findings indicate that patients with CAI walk with greater inter-limb asymmetry in vGRF and muscle activity in different phases of the gait cycle compared to Non-CAI group. Our results could inform future studies on gait training aimed to reduce asymmetry during walking in patients with CAI.

Validation of Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) in individuals with chronic ankle instability: a cross-sectional observational study

Background

Ankle sprain is the most common lower limb injury in physically active individuals. Loss of function, decreased postural control (PC), strength deficit, and reduced range of motion (ROM) are common after acute lateral ankle sprains. Some patients experienced long lasting symptoms, with recurrent sprains, and episodes of giving-way: a condition known as chronic ankle instability (CAI). Evaluating the function in patients with CAI in the clinical environment is important to identify the severity of the condition, in addition to allowing to assess the effectiveness of a given treatment. The aim of this study was to investigate the validation of the Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) in terms of muscle strength, PC and ROM in adults with CAI.

Methods

This is a cross-sectional study. Individuals with CAI aged between 18 and 45 years were eligible. Individuals with CAI were identified using the Identification of Functional Ankle Instability (IdFAI). All patients filled in the FAAM and FAOS scores. Muscle strength was assessed by manual dynamometry, ROM by the Lunge test, PC by computerized posturography, modified Star Excursion Balance Test (mSEBT) and modified Balance Error Score System (mBESS).

Results

50 participants were enrolled in the present study. The mean age of the patients was 27.2 ± 6.3 years, and the mean body mass index was 26.4 ± 4.8 kg/m2. 58% (29 of 50) were men and 42% (21 of 50) women. 18 individuals had unilateral (36%) and 32 bilateral (64%) CAI. The results of FAAM were associated with MCT, mSEBT, invertor muscles strength, plantar flexor muscles strength, dorsiflexor muscles strength, and external hip rotator muscles strength (P < 0.05). The results of FAOS were associated with mSEBT, invertor muscles strength, plantar flexor muscles strength, dorsiflexor muscles strength, evertor muscles strength, and external hip rotator muscles strength, and mBEES (P < 0.05).

Conclusion

Both the FAAM and FAOS demonstrated validity to evaluate postural control and muscle strength in patients with CAI, while no association was found in relation to ankle dorsiflexion.

[Foot and ankle ability measure: Validation of a Spanish version with 29 items in rehabilitation setting]

OBJECTIVE

The Foot and Ankle Ability Measure (FAAM) is an internationally widely used outcome measure of foot and ankle disorders available in several languages. The purpose of this study was to develop and validate a FAAM Spanish-version with 29 items of Activities of Daily Living (ADL) and SPORT subscales in rehabilitation setting.

MATERIALS AND METHODS

A two-stage observational study was conducted. The FAAM was cross-culturally adapted to Spanish through a double-forward translation and a double-backward translation; the psychometric properties were then validated. The participants (n = 147), with various chronic foot and ankle disorders, completed the Spanish version of the Foot and Ankle Ability Measure ADL and SPORT, SF-36, and a pain intensity visual analogue scale (Pain VAS). The full sample was used to determine the factor structure, the internal consistency, and the convergent criterion validity, and a subgroup (n = 46) was used to determine the reliability at 48-72 h.

RESULTS

The factor structure of Spanish version of FAAM ADL and SPORT subscales were both one-dimensional, demonstrating high internal consistency (α = 0.97 and α = 0.93, respectively). The reliability values were ICC = 0.90 and ICC = 0.76, respectively. The convergent validity criterion of Spanish version of FAAM with the Pain VAS (r = 0.50) and Physical Function of SF-36 (r = 0.64) were moderately correlated.

CONCLUSIONS

The Spanish version of FAAM with 29 items are a valid foot and ankle disorder outcome measure with similar psychometric properties to the original version and versions in other languages.

Effect of Four Weeks of Home-Based Balance Training on the Performance in Individuals with Functional Ankle Instability: A Remote Online Study

The purpose of the current study is to evaluate the effect of 4 weeks of home-based balance training (HBBT) on the performance of individuals with functional ankle instability (FAI) in daily activities and sports. Thirty college students diagnosed with FAI and with a mean weight of 79.8 ± 3.4 kg, height of 182.5 ± 5.1 cm, age of 23.5 ± 1.2 years, and instability score of 20 ± 2.3 were selected to participate in this study and were randomly divided by computer-generated methods into two groups: the HBBT group and the control group (CG), each consisting of 15 subjects. The HBBT group performed the program at home for 4 weeks, while the CG was non-exercise. Before and after the 4 weeks of exercise program, a form containing the foot and ankle ability measure for daily activities and sports was completed by the individuals. For data analysis, intra- and inter-group comparisons were performed using paired and independent sample t-tests, respectively, at a significance level of p ≤ 0.05. The results showed that 4 weeks of progressive HBBT were sufficient to significantly improve the measurement of the ability of ankle and foot function in individuals with FAI, even with a total volume of only 60 min per week. Accordingly, it is suggested that individuals with FAI can benefit from short-term HBBT programs, which are simple yet powerful enough to promote improvements in daily activities.

Dextrose prolotherapy versus radial extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: A randomized, controlled clinical trial

In the recent years, prolotherapy is increasingly being used in the field of musculoskeletal medicine. However, few studies have investigated its effectiveness in plantar fasciitis (PF). The purpose of this study was to compare the effectiveness of ultrasound-guided dextrose prolotherapy with radial extracorporeal shock wave therapy (ESWT) in the treatment of chronic PF. This randomized controlled trial was conducted on 59 patients with chronic PF. Patients were randomly assigned into two groups receiving three sessions of radial ESWT (29 patients) vs. two sessions of ultrasound-guided intrafascial 2 cc dextrose 20% injection (30 patients). The following outcome measures were assessed before and then six weeks and 12 weeks after the treatments: pain intensity by visual analog scale (VAS), daily life and exercise activities by Foot and Ankle Ability Measure (FAAM), and the plantar fascia thickness by ultrasonographic imaging. The VAS and FAAM scales showed significant improvements of pain and function in both study groups 6 weeks and 12 weeks after the treatments. A significant reduction was noted for plantar fascia thickness at these intervals (all p < .05). The inter-group comparison revealed that except for the FAAM-sport subscale which favored ESWT, the interaction effects of group and time were not significant for other outcome measures. Dextrose prolotherapy has comparable efficacy to radial ESWT in reducing pain, daily-life functional limitation, and plantar fascia thickness in patients with PF. No serious adverse effects were observed in either group. LEVEL OF EVIDENCE: Level I, randomized controlled trial.

An Investigation of Knee Injury Profiles among Iranian Elite Karatekas: Observations from a Cross-Sectional Study

Karate training, despite the many positive health benefits, carries a risk of injury for participants. The current cross-sectional study aimed to investigate knee injury profiles among Iranian elite karatekas. Participants who attended the national team qualifiers, which included 390 male Kumite karatekas (age 24 ± 3 years old and weight 63 ± 12 kg), participated in this study. Information on knee injuries (injury history, type of injury mechanisms, and effects of knee symptoms on the ability to perform daily activities and recreational activities) were obtained using the Knee Outcome Survey (KOS). Using Pearson's correlation coefficient, the study examined the relationships between different variables, including KOS subscales and levels of self-reported knee joint function. Our findings indicated that 287 karatekas (73.6%) experienced knee injuries. The anterior cruciate ligament (ACL) rupture (6.9%), articular cartilage (5.4%), and meniscus damage (3.8%) were the main typology of injury. In addition, there were no differences in knee injuries between the non-dominant and dominant legs. Most injuries occurred during the preparatory period (n = 162, 50%), especially during training periods. The KOS subscales scores (Mean ± Sd) for activities of daily living (ADL) and sports activity (SAS) were, respectively, 89 ± 11 and 91 ± 9. The self-reported scores for both the ADL and SAS subscales were, respectively, 89 ± 11 and 90 ± 10. Pearson coefficients of ADL and SAS subscales with their self-reported score were r = 0.761 (p < 0.0001) and r = 0.782 and (p < 0.0001), respectively. The profile of knee injuries in the current investigation is similar to previous surveys that reported lower extremity injury patterns. The findings of this study could be adopted to inform practice aimed at planning interventions for the reduction and prevention of knee injuries among karatekas.

Diabetic foot disease: a systematic literature review of patient-reported outcome measures

PURPOSE

Diabetic foot disease is one of the most serious and expensive complications of diabetes. Patient-reported outcome measures (PROMs) analyse patients' perception of their disability, functionality and health. The goal of this work was to conduct a systematic review regarding the specific PROMs related to the evaluation of diabetic foot disease and to extract and analyse the values of their measurement properties.

METHODS

Electronic databases included were PubMed, CINAHL, Scopus, PEDro, Cochrane, SciELO and EMBASE. The search terms used were foot, diabet*, diabetic foot, questionnaire, patient-reported outcome, self-care, valid*, reliabil*. Studies whose did not satisfy the Critical Appraisals Skills Programme (CASP) Diagnostic Study Checklist were excluded. The measurement properties extracted were: Internal Consistency, Test-retest, Inter-rater and Intra-rater, Standard Error of Measurement, Minimum Detectable Measurement Difference, Content Validity, Construct Validity, Criterion Validity and Responsiveness.

RESULTS

The PROMs selected for this review were 12 questionnaires. The Diabetic foot self-care questionnaire (DFSQ-UMA) and the Questionnaire for Diabetes Related Foot Disease (Q-DFD) were the PROMs that showed the highest number of completed measurement properties.

CONCLUSION

According to the results, it is relevant to create specific questionnaires for the evaluation of diabetic foot disease. It seems appropriate to use both DFSQ-UMA and Q-DFD when assessing patients with diabetic foot disease.

The effect of the combination of whole body vibration and shoe with an unstable surface in chronic ankle instability treatment: a randomized clinical trial

Background

Chronic ankle instability (CAI) is a common condition following an ankle sprain. This study investigated the effects of whole body vibration (WBV) and shoe with an unstable surface training on balance, functional performance, strength, joint position sense in people with CAI.

Method

Thirty- four peoples with unilateral CAI were randomly assigned to three groups: WBV group, WBV with shoe with an unstable surface (WBV-S), and no treatment control group (CON). The WBV group received 4 weeks progressive WBV training and the WBV-S group received progressive WBV training with shoe with an unstable surface. Modified star excursion balance test (mSEBT)reach distance, Hop-Test, muscle strength, and joint position sense were measured at baseline and after the 4 weeks; Moreover, the mSEBT and Hop-Test were reassessed again 2 weeks post intervention.

Results

The result showed a significant group-by-time interaction for anterior and posterolateral directions of mSEBT. The reach distance of these directions at post-intervention and follow-up increased significantly compare to pre-intervention in the WBV and WBV-S groups but not significantly change in the CON group. The Hop test in the WBV-S group was significantly more at post-intervention and follow-up compared to pre-intervention. However, no significant changes were observed in WBV and CON groups. No significant changes were observed for mSEBT posteromedial direction, muscles strength, and joint position sense errors.

Conclusion

The 4 weeks WBV and WBV-S interventions could improve balance in peoples with CAI. Improvement in Hop test was only observed in the WBV-S group suggesting the added value of combining WBV and shoe with an unstable surface as an effective therapy compared to WBV training alone. The use of WBV and WBV-S were not associated with significant changes in strength and joint position sense variables over a four-week period.

Trial registration

This work registered in the Iranian Registry of Clinical Trials (IRCT20151118025105N4).

Applicability of cutoff scores of Chinese Cumberland Ankle Instability Tool and Foot and Ankle Ability Measure as inclusion criteria for study of chronic ankle instability in Chinese individuals

OBJECTIVE

To examine the applicability of Chinese Cumberland Ankle Instability Tool (CAIT-C) and Foot and Ankle Ability Measure (FAAM-C) as inclusion criteria recommended by the International Ankle Consortium (IAC) for study of chronic ankle instability in the Chinese individuals.

DESIGN

Cross-sectional comparative design with known groups.

SETTING

Research laboratory.

PARTICIPANTS

145 participants with chronic ankle instability (CAI) and 66 participants without injury.

MAIN OUTCOME MEASURES

CAIT-C and FAAM-C Activities of Daily Living (FAAM-C-ADL) and FAAM-C Sports (FAAM-C-Sports).

RESULTS

The CAIT-C scores (18.2 ± 5.6), FAAM-C-ADL scores (97.0 ± 4.3) and FAAM-C-Sports scores (92.2 ± 10.3) of the CAI group were all lower than the CAIT-C scores (27.4 ± 3.1), FAAM-ADL scores (99.0 ± 2.1) and FAAM-Sports scores (98.4 ± 3.1) (P < 0.01) of the uninjured group. The recommended cutoff score of CAIT-C<24 by the IAC for identifying CAI had a sensitivity of 80.7% and a specificity of 84.9%. If the recommended cutoff scores of FAAM-ADL<90，FAAM-Sports<80 by the IAC as inclusion criteria for the study of CAI were applied, 97% of participants with CAI in this sample would be excluded.

CONCLUSION

The results support the recommended cutoff score of CAIT-C<24 by the IAC to identify Chinese individuals with CAI for study. However, the recommended cutoff scores of FAAM-ADL<90 and FAAM-Sports<80 will exclude most Chinese individuals with CAI having only mild functional impairments.

Translation and Cross-cultural Adaptation of the Fremantle Back Awareness Questionnaire into Persian language and the assessment of reliability and validity in patients with chronic low back pain

Background:

Chronic low back pain (LBP) causes some neuroplastic changes in the brain, which result in body perception impairment. The Fremantle Back Awareness Questionnaire (FreBAQ) is a suggested tool for the diagnosis and evaluation of back perception in people with LBP. The aim of this study is to translate and cross culturally adapt the FreBAQ into Persian language and to assess its reliability and validity in patients with chronic LBP (CLBP).

Materials and Methods:

Fifty people with CLBP and fifty healthy people participated in this study. To evaluate the discriminant validity, we assessed the ability of the FreBAQ to discriminate between people with and without LBP. After an interval of 1 week, 25 patients with CLBP completed the questionnaire in the retest session. Data obtained from the first test administration were used for internal consistency and data obtained from repeated testing were used for test–retest reliability. Construct validity was assessed by investigating a correlation between the FreBAQ with the Roland–Morris Disability Questionnaire (RDQ), Visual Analog Scale, Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale, and Tampa Scale of Kinesiophobia. In addition, the construct validity of Persian FreBAQ was measured by factor analysis.

Results:

The test–retest reliability of the questionnaire was confirmed by intraclass correlation coefficient = 0.96. Cronbach's alpha was 0.74 for Persian FreBAQ. The standard error of measurement and minimal detectable change were 0.91 and 2.52, respectively. Construct validity was demonstrated by statistically significant relationship between the Persian FreBAQ and questionnaires of PCS (P < 0.001) and RDQ (P = 0.01).

Conclusion:

The Persian version of FreBAQ is a valid and reliable measurement tool for evaluating back perception changes in Persian-speaking patients with LBP.

Psychometric properties of Meaningful Activity Participation Assessment (MAPA) in chronic stroke survivors

BACKGROUND

Meaningful Activity Participation Assessment (MAPA) is an appropriate tool for assessing both objective and subjective aspects of participation.

OBJECTIVES

This study aimed to investigate the psychometric properties of MAPA in chronic stroke survivors.

METHODS

Translation of MAPA was done according to the standard protocol of forward-backward translation. One hundred and seven chronic stroke survivors participated in this study. In addition to the MAPA, they were assessed by Satisfaction With Life Scale (SWLS), Center for Epidemiologic Studies of Depression Scale (CES-D), Life Satisfaction Index-Z (LSI-Z), Purpose in Life Test-Short Form (PIL-SF), and 36-Item Short-Form Survey (SF-36). To investigate the test-retest reliability, 37 participants were reassessed by MAPA after two weeks. Reliability, construct and known-groups validity were evaluated for MAPA.

RESULTS

The results showed an acceptable internal consistency (Cronbach's α = 0.79) and good test-retest reliability (ICC = 0.92) of MAPA. A significant moderate to high correlation was found between the MAPA and PIL-SF, CES-D, LSI-Z, SWLS, and different subscales of SF-36 (r = 0.32-0.65). MAPA showed good ability to differentiate between young adults (age≤ 65 years) and older adults (age> 65 years) with chronic stroke (P = .005) as well as between chronic stroke survivors with different levels of disability (P < .001).

CONCLUSIONS

The MAPA has appropriate reliability and validity in chronic stroke survivors and is suggested to be used in research and clinical settings.

Validity and reliability: the Iranian version of Lawton IADL in elderly community dwellers

Purpose

Normal aging changes, acute and chronic illness, and the long stay in the hospital made the decline in elderly physical and mental abilities in non-instrumental and Instrumental Activities Daily Livings (IADL). This paper aims to determine the validity and reliability of Lawton IADL in the Iranian elderly community relevancy to physical, mental and cognitive measurements.

Design/methodology/approach

A cross-sectional study with 422 participants, age 60 years old and over selected by face-to-face interviewing from the geriatric clinic, Tehran medical university from January to June 2019.

Findings

Of 422 participants referring to outpatient clinics the majority were male (62.8%); with an average of 66.9 ± 5.95 years old. Reliability was significantly high (Cronbach’s alpha = 0.96, p < 0.001). There was a significant relationship between IADL with Short-Form Health Survey36-Mental Component Score (SF36-MCS), with p < 0.01. Reliability was significantly high (Cronbach’s alpha = 0.96, p < 0.001). In the factor analysis with eigenvalues more than one, two components were found; that the first factor named as observational daily activities, whereas the second factor named “advanced daily activities”.

Research limitations/implications

The limitation of this study was the low number of similar studies to compare the results and the stronger discussion.

Originality/value

Determining IADL's dependency in the community elderly is important to maintain their self-care manages. More studies are needed to manifest the relationship between mental health and IADL's independence. Therefore, validation in different settings is important in planning for the geriatrics team.

Cross-cultural adaptation, reliability and validity of the Persian version of the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A)

PURPOSE

Achilles tendinopathy is a prevalent overuse injury among athletes and in those with a sedentary lifestyle. Current evidence indicates that the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is a valid, reliable and disease-specific outcome measure for assessing the clinical symptoms in patients with Achilles tendinopathy. The objective of this study was to translate and cross-culturally adapt the VISA-A questionnaire into Persian (VISA-A-P) and evaluating its psychometric properties.

MATERIALS AND METHODS

Cultural adaptation of VISA-A-P was conducted according to Beaton's guideline. The final version of VISA-A-P was handed to 61 patients for analysis of psychometric properties. Test-retest reliability, internal consistency, concurrent validity, item-total correlation, and floor/ceiling effect were evaluated in patients with Achilles tendinopathy. To assess test-retest reliability, 35 patients refilled the VISA-A-P twice within 5-7 days. Known-group validity was evaluated using 50 healthy individuals.

RESULTS

VISA-A-P showed excellent test-retest reliability (ICC = 0.90), excellent internal consistency (Cronbach's alpha = 0.95), strong correlation with FAAM, and moderate to strong correlation with FAOS questionnaires. There was a significant difference between the average score of patients (34.55 ± 18.24) and the healthy group (73.1 ± 20.10). VISA-A-P showed neither ceiling nor floor effect.

CONCLUSIONS

The VISA-A-P is a reliable and valid instrument for measuring the symptoms in Persian speaking populations with Achilles tendinopathy.Implications for rehabilitationAchilles tendinopathy is a debilitating overuse injury that insidiously affects tendoAchilles.VISA-A-P revealed acceptable validity and reliability and it could be used by Persian speaking clinicians and researchers to assess pain and function in people with Achilles tendinopathy.

Effects of Kinesiotape vs Soft and Semirigid Ankle Orthoses on Balance in Patients With Chronic Ankle Instability: A Randomized Controlled Trial

BACKGROUND

Chronic ankle instability (CAI) is a frequent complication of ankle sprain that may be associated with long-term consequences. Although taping and bracing are common interventions that are widely used by clinicians and athletic trainers for patients with CAI, no studies have compared the effects of kinesiotaping and bracing on balance performance in these patients. The present study aimed to compare the effects of ankle kinesiotaping, a soft ankle orthosis, and a semirigid ankle orthosis on balance performance in patients with CAI.

METHODS

Sixty patients with CAI were randomly assigned to 4 groups that received kinesiotaping, a soft orthosis, a semirigid orthosis, or no treatment (control group). Dynamic and static balance were measured with the modified Star Excursion Balance Test, single leg hop test, and single leg stance test before and after a 4-week intervention period.

RESULTS

Significant between-group differences were seen in all evaluated outcomes (P ≤ .003). The lowest reach distances in all directions in the modified Star Excursion Balance Test were found in the control group, and these patients also had a significantly shorter measured distance in the single leg hop test, and more errors in the single leg stance test compared with the 3 intervention groups. No significant differences were found among the 3 intervention groups.

CONCLUSION

Use of kinesiotaping and a soft or a semirigid ankle brace for 4 weeks were all beneficial in improving static and dynamic balance in individuals with CAI. None of the interventions was superior to the other 2.

LEVEL OF EVIDENCE

Level I, randomized controlled trial.

Attentional Demands of Postural Control in Chronic Ankle Instability, Copers and Healthy Controls: A Controlled Cross-sectional Study

BACKGROUND

It has been shown that cognitive loading affects postural control in different populations. However, there is limited and conflicting information about dual task challenges on postural control in chronic ankle instability (CAI).

RESEARCH QUESTION

Does cognitive task performance change standing postural control in individuals with CAI, copers and healthy subjects?

METHODS

A descriptive, analytic, and controlled cross-sectional study was conducted on 75 individuals. They were assigned into three matched groups, including CAI, copers, and healthy controls. Postural control variables were collected during single leg standing on a force plate with and without vision and cognition. Parameters of center of pressure (COP), including mean COP area, range, sway index and velocity, were measured. Additionally, cognitive task performance by auditory stroop was assessed by calculating the reaction time and error ratio. Mixed model ANOVAs were used to determine the effects of group and testing conditions.

RESULTS

The CAI group demonstrated greater COP sway parameters compared to other groups under all testing conditions. The main significant effect of vision was observed for all COP parameters with greater COP sway during eyes closed compared to eyes open (P < 0.05). The main effect of a cognitive task was significant with reduced COP sway while performing the secondary cognitive compared to a single task in all three groups (P < 0.05). The cognitive task results revealed significantly longer reaction times in the CAI group compared to copers and healthy individuals (p < 0.05).

SIGNIFICANCE

Considering postural control deficits in CAI, especially in eye-closed condition and effects of cognitive loading, may guide us to improve postural control in those with CAI with neurocognitive training. Furthermore, no difference between coper and healthy groups may imply a successful compensatory postural control mechanism in copers.

Validity and Reliability of the World Health Organization Disability Assessment Schedule 2.0 36-Item Persian Version for Persons with Multiple Sclerosis

Background

No previous studies have assessed the psychometric properties of the 36-item version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in the Persian language of Iran. This study was designed and conducted to evaluate the validity and reliability of the Persian version using a sample of persons with multiple sclerosis in Ahvaz, Iran.

Methods

The methodological study was conducted in two stages: First, the 36 items of the original WHODAS 2.0 were translated to create a Persian version, after which the translation validity and psychometric properties were tested. The factor structure of the instrument was also tested using exploratory and confirmatory factor analyses.

Results

The intraclass correlation coefficients were very good to excellent, varying between 0.82 and 0.99 for the six domains, and all domains had Cronbach’s α reliability values of above 0.70. For construct validity, results showed negative and strong correlation between the total score of WHODAS 2.0 and the Multiple Sclerosis Quality of Life-54. Exploratory factor analysis divided the Persian version of WHODAS 2.0 into seven factors for multiple sclerosis patients.

Conclusion

The results of this study indicate that the Persian version of WHODAS 2.0 is a valid and reliable instrument to study the disabilities of people with multiple sclerosis.

Can fibular reposition taping improve balance performance in individuals with chronic ankle instability? A randomized controlled trial

BACKGROUND

Lateral ankle sprain results in positional faults in the fibula which are thought to limit accessory motion in the ankle, leading to hypomobility and negatively influencing sensorimotor function and postural control. Although it has been shown that fibular reposition taping (FRT) is effective in the prevention of recurrent lateral ankle sprain, its ability to produce significant changes in balance measures in patients with chronic ankle instability is inconclusive.

OBJECTIVE

This study aimed to determine whether a FRT intervention affects balance performance in patients with chronic ankle instability.

DESIGN

Randomized controlled trial.

METHODS

Sixty individuals with chronic ankle instability were randomly allocated to three groups: FRT, sham taping, or no intervention (control group). Kinesiotape was applied and then re-applied on 3 occasions per week for 2 weeks. Static and dynamic balance were measured with three functional tests before and 1 day after the last session of intervention with the tape removed: single-leg stance test, single-leg hop test for distance, and modified Star Excursion Balance Test (mSEBT).

RESULTS

The results of ANCOVA showed that there were no significant differences between the three groups except for mSEBT reach distance in the posterolateral direction, which was significantly greater in the FRT group than the control group (p = 0.03).

CONCLUSION

Applying FRT for 2 weeks did not significantly affect static or dynamic balance measures in individuals with chronic ankle instability, hence its clinical efficacy to influence balance remains uncertain in this population.

CLINICAL TRIAL REGISTRATION NUMBER

IRCT20171122037576N2.

Ultrasound-Guided Injection of High Molecular Weight Hyaluronic Acid versus Corticosteroid in Management of Plantar Fasciitis: A 24-Week Randomized Clinical Trial

BACKGROUND AND AIMS

Plantar fasciitis (PF) is the leading cause of heel pain in adults. This study was designed to evaluate the effect of hyaluronic acid (HA) injection in reducing the symptoms of PF, compared with corticosteroid (CS) injection as a conventional treatment.

METHODS

In this triple-blind, randomized, clinical trial, 75 patients who had the symptoms of PF for at least 3 months were randomly divided into two groups of 38 and 37 individuals. Then, each patient received either a single injection of high molecular weight (>2000 kDa) HA (1 mL HA 20 mg + 1 mL lidocaine 2%) or CS (1 mL methylprednisolone 40 mg + 1 mL lidocaine 2%) under the ultrasonography (US) guidance. Visual analog scale (VAS), foot ankle ability index (FAAI), pressure pain threshold (PPT), functional foot index (FFI), and plantar fascia thickness (PFT) were measured using US at baseline, 6 weeks and 24 weeks after the injection. Eventually, at the end of the treatment period, the patients' satisfaction was measured. Intention to treat analysis was used to assess the results.

RESULTS

After 24 weeks of follow-up, results from 60 subjects were fully obtained; however, results of 73 patients included into intention to treat analysis in the sixth-week follow-up. In both groups, VAS, PFT and FFI decreased, while FAAI and PPT increased significantly (P <0.001). At the baseline and at the 24th-week, no significant difference between the two groups was observed in any of the variables. However, a comparison between the baseline and the sixth-week results shows a prominent decrease in PPT and PFT in the CS group compared to the HA group (P = 0.004 and P = 0.011). Finally, there were no statistical differences between the two groups in treatment satisfaction (P = 0.618).

CONCLUSION

Both CS and HA were effective modalities for PF and can improve pain and function with no superiority in 24th-week follow-ups, although CS seems to have a faster trend of improvement in the short term.

Iranian Version of Barthel Index: Validity and Reliability in Outpatients' Elderly

Background:

Validation study of Barthel Index for elderly patients being attended in outpatient and rehabilitation clinics in Iran.

Methods:

Face-to-face interview with 395 out patients geriatric 60+ years was done in a cross-sectional study. The internal consistency Barthel-ADL was used to approve reliability. Criterion validity and factor analysis were used to verify validity.

Results:

Reliability the Iranian version BI was significant at 0.938. In criterion validity analysis, the high correlation tools included Functional Ambulation Category (FAC) and Foot and Ankle Ability Measure (FAAM-subscales ADL) at 0.947 and –0.945, respectively. In factor analyses, two domains obtained, the variance of 10 items achieved 69.79%; also, the Item Total Correlation (ITC) of each item was measured.

Conclusions:

The Barthel Index shows a good validity and reliability, and recommended to use in the Iranian geriatric outpatients in evaluating physical ability.

The Effect of Three Different Insoles on Ankle Movement Variability during Walking in Athletes with Functional Ankle Instability

Background

Increased ankle movement variability has been reported in people with functional ankle instability (FAI). The purpose of this study was to investigate the effect of textured insole, lateral wedge, and textured lateral wedge insole on ankle movement variability during walking in athletes with FAI.

Materials and Methods

Twenty-one athletes diagnosed with FAI participated in this before-after study. Kinematic data were collected during four conditions (5 repeated trials per condition): (1) flat ethylene-vinyl acetate (EVA) insole, (2) textured flat EVA insole, (3) prefabricated lateral heel and sole wedge insole, and (4) textured lateral heel and sole wedge. The analysis of ankle movement variability was conducted during stance phase and 200 ms before initial contact to 200 ms after initial contact. The coefficient of multiple correlations (CMC) was calculated to investigate pattern variability and intraclass correlation (ICC) was used to investigate variability at the points of interest.

Results

In terms of pattern variability, wearing textured lateral wedge increased CMC compared to other insoles. However, statistically significant differences were observed only in the frontal plane during stance phase (P < 0.05). In terms of variability at the points of interest, in the frontal plane and in all points of interest, wearing textured lateral wedge increased ICC compared to other insoles. The effects of other insoles on ankle movement variability were inconsistent.

Conclusions

The results of this study showed that textured insole has the potential to decrease variability and the use of texture with lateral wedge may more improve variability in athletes with FAI.

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

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.

Comparison of the Effect of the Combined Mechanism Ankle Support on Static and Dynamic Postural Control of Chronic Ankle Instability Patients

BACKGROUND

Chronic ankle instability (CAI) is associated with postural control impairment. Orthotic devices are routinely used to improve postural control of CAI patients and prevent recurrence of ankle sprain. This study aimed to evaluate and compare the effect of combined mechanism ankle support (CMAS) with soft ankle support (SAS) and custom-molded foot orthosis (CFO) on static and dynamic postural control in patients with CAI.

METHODS

Twenty-two patients with CAI and 22 matched healthy subjects were recruited. The participants were evaluated in four orthotic conditions (without orthosis and with the CMAS, SAS, and CFO). Static balance was investigated in single-limb stance on the force platform, and dynamic balance was assessed using the Star Excursion Balance Test (SEBT).

RESULTS

Statistically significant differences were found for the main effects of the groups in all center of pressure (COP) parameters and reach distances in medial (M), anteromedial (AM), and posteromedial (PM) directions of the SEBT ( P < .05). The main effect of the orthotics for all evaluated parameters, except reach distance in the PM direction, was statistically different. All COP parameters were significantly lower with the CMAS compared with other orthotic conditions in CAI patients. Also, the higher reach distances with the CMAS were obtained in the AM and M directions of the SEBT.

CONCLUSION

The CMAS improved impaired postural control in static and dynamic stability tests, but no similar effect was found for SAS and CFO. This result may have implications for the best bracing for CAI.

LEVEL OF EVIDENCE

Level II, comparative study.

Corrective Exercises Improve Movement Efficiency and Sensorimotor Function but Not Fatigue Sensitivity in Chronic Ankle Instability Patients: A Randomized Controlled Trial

OBJECTIVE

To investigate the effect of corrective exercises on functional movement patterns, sensorimotor function, self-reported function, and fatigue sensitivity in collegiate athletes with chronic ankle instability (CAI).

DESIGN

A randomized controlled trial.

SETTING

Laboratory of sports sciences.

PARTICIPANTS

Forty male volunteers were randomly assigned to the experimental group (age 21.2 ± 1.7 years, height 174.5 ± 6.1 cm, and weight 69.6 ± 6.9 kg) or the control group (age 20.9 ± 1.8 years, height 178.2 ± 6.6 cm, and weight 68.8 ± 8.1 kg).

INTERVENTION

Participants in the experimental group performed supervised corrective exercises 3 times per week for 8 weeks. Fatigue was induced with a progressive treadmill protocol before and after the 8-week intervention.

MAIN OUTCOME MEASURES

Outcomes included movement efficiency during 3 squat tasks, static and dynamic postural control, strength of the ankle musculature, joint position sense, and self-reported function with the Foot and Ankle Ability Measure subscales. These outcomes were assessed before and immediately after fatiguing treadmill running both before and after 8-weeks of corrective exercises.

RESULTS

Significant improvements in movement efficiency, sensorimotor function, and self-reported function were noted in the experimental group relative to the control group (P < 0.001), in a nonfatigued state. However, in a fatigued stated, the experimental intervention only improved static postural control (P = 0.016) relative to the control group.

CONCLUSIONS

These findings demonstrate that 8-weeks of corrective exercises were effective at enhancing movement efficiency, sensorimotor function, and self-reported function in collegiate athletes with CAI. However, this intervention program has limited abilities at reducing the effects of fatigue.

Does treatment duration of manual therapy influence functional outcomes for individuals with chronic ankle instability: A systematic review with meta-analysis?

QUESTION

Can manual therapy improve functional outcomes for individuals with chronic ankle instability?

DESIGN

Systematic review with meta-analysis of randomized controlled trials.

PARTICIPANTS

Individuals with chronic ankle instability.

INTERVENTION

Manual therapy is defined as an intervention that involves joint mobilization, and mobilization with movement.

OUTCOME MEASURE

The primary outcome is patient reported function (PRF) questionnaires scores, the secondary outcomes are ankle dorsiflexion range of motion (DFROM) and balance control.

RESULTS

Four studies were included (n = 208, mean age = 24.4) in the meta-analysis, with moderate to high quality on the PEDro scale (range 6-8). For patient reported function (PRF) questionnaires, two studies reported significant improvement after six-session manual therapy measured by foot and ankle ability measures sport subscale (FAAMS) and Cumberland ankle instability tool (CAIT), respectively. For DFROM, one session manual therapy had no significant effect on the weight-bearing lunge test (WBLT) (3 studies, n = 147, SMD = 1.24 (95%CI -0.87 to 3.36), I² = 96%) or non-weight-bearing inclinometer test (2 studies, n = 47, MD = 3.41° (95%CI -0.26 to 7.09),I² = 43%), while six-sessions manual therapy showed, a significantly positive effect on WBLT(2 studies, n = 80, SMD = 2.39, (95% CI 0.55, to 4.23), I² = 93%). For the SEBT, one-session manual therapy had no significant effect on overall star excursion balance test (SEBT) score (3 studies, n = 137,MD = 2.05,95%CI (-0.96,5.05), I² = 75%), while qualitative analysis of 2 included studies showed significant improvement both on the SEBT score and single limb balance test (SLBT).

CONCLUSIONS

Six sessions rather than one session of manual therapy improves ankle functional performance for individuals with CAI.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42017054715.

Patient-Reported Outcome Measures for Patients with Diabetes Mellitus Associated with Foot and Ankle Pathologies: A Systematic Review

Background: Diabetes mellitus (DM) is a chronic and complex disease, which is a major cause of morbidity and mortality and affects all age groups. It commonly produces secondary effects on the foot, often making daily activities impossible. Patient-reported outcome measures (PROMs) provide a standardised method of obtaining patients’ outlooks on their functional status and wellbeing. Although many instruments have been proposed for obtaining data on persons with DM whose feet are affected by the disease, in many cases the psychometric properties of the instrument have yet to be established. The principal objective of our review was to identify PROMs specific for patients with DM affecting the foot and ankle and to evaluate the psychometric properties and methodological quality of these instruments. Methods: In this systematic review, we investigate studies (published in English or Spanish) based on the use of one or more PROMs specific to foot and ankle pathologies for patients with DM (type I or II). To do so, the databases PubMed, Scopus, CINAHL, PEDro and Google Scholar were searched for studies that analysed psychometric or clinimetric properties in this respect. These were assessed according to Terwee or COSMIN criteria. Results: Of the 1016 studies identified in the initial search, only 11 were finally included in the qualitative review. Analysis according to Terwee and COSMIN criteria showed that the Foot Health Status Questionnaire (FHSQ) presented the greatest number of positive values. Conclusions: The FHSQ is the highest-quality PROM currently available for the foot and ankle, for patients with DM.

Reliability and Validity of the Turkish Version of Foot and Ankle Ability Measure for Patients With Chronic Ankle Disability

The Foot and Ankle Ability Measure is a valid, reliable, and widely used self-reported questionnaire for the foot. It has been adapted and validated for a Turkish-speaking population. The purpose of this study was to provide evidence for validity and reliability of the Turkish version of the Foot and Ankle Measure (FAAM-T) in patients with chronic ankle instability (CAI). A total of 316 patients with CAI were enrolled. The internal consistency and test-retest reliability were evaluated. Validity was examined using correlations with the Short Form Health Survey version 2.0 (SF-36v2) questionnaire. Cronbach's alpha scores were 0.94 and 0.96 for the the FAAM-T ADL (Activities of Daily Living) and FAAM-T Sports subscales, respectively, indicating high internal consistency. For the second administration, Cronbach's alpha was found to be 0.96 for both subscales of the FAAM-T. The test-retest reliability of the FAAM-T was very high for both subscales with an intraclass correlation coefficient of 0.97 and 0.94, respectively (p < .001). The standard error of the mean and minimal detectable change were determined to be 2.5 and 6.7 for the FAAM-T ADL and 6.9 and 18.5 for the FAAM-T Sport. The FAAM-T ADL and Sport subscales were strongly correlated with the SF-36v2 PF (physical functioning; r = 0.51, r = 0.40, respectively; p = .001) and SF-36v2 PCS (physical component scale; r = 0.64, r = 0.55, respectively; p = .001). The weakest associations between the FAAM-T ADL and Sport and the SF-36v2 were noted for the mental health subscale (r = 0.08 and r = 0.03) and the SF-36v2 MCS (mental component scale; r = .05 and r = .006, respectively). This study provides evidence for validity, internal consistency, and test-retest reliability for the FAAM-T to evaluate patients with CAI.

Translation, cross-cultural adaptation and factor analysis of the Persian version of ankle instability instrument

Background: Ankle Instability Instrument (AII) is a questionnaire for determination of ankle stability status. The aim of this study is to cross-culturally translate and investigate the reliability and validity of AII in a sample of Persian-speaking Iranians, suffering from ankle sprain.

Methods: One hundred twenty persons with a history of ankle sprain were recruited in the study. All participants completed the Persian version of Ankle Instability Instrument, Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM) and Foot and Ankle Outcome Score (FAOS) at the baseline. Out of them, 60 randomly selected subjects completed the questionnaires once more, one week later. Face validity, Test–retest reliability, internal consistency, standard error of measurement, minimal metric detectable change, spearman’s correlation coefficient and confirmatory factor analysis of AII measured. We used Lisrel v 8.80 software with significant level of p<0.05.

Results: Persian version of AII is clear and unambiguous and its qualitative face validity was confirmed in the pilot study on the 20 subjects with a lateral ankle sprain. The interclass correlation coefficient, Cronbach’s alpha, standard error of measurement and minimal metric detectable change were 0.93, 0.87, 0.81 and 2.25 (95% confidence interval, 0.85-0.96). The Spearman correlations coefficients between AII, and CAIT, FAAM and FAOS measures were 0.91, 0.71 and 0.69 respectively. The original three factor structure of AII was replicated based on the confirmatory factor analysis. Which showed an adequate fit of the model to the data and goodness-of-various fit indices.

Conclusion: The Ankle Instability Instrument Persian Version (AII-PV) is a reliable and valid measure for assessing the ankle stability status.

Measurement properties of the most commonly used Foot- and Ankle-Specific Questionnaires: the FFI, FAOS and FAAM. A systematic review

PURPOSE

In the foot and ankle literature, a wide range of patient-reported outcome measures (PROMs) is used, however, consensus as to which PROMs are preferred is lacking. Selection of a PROM is among other reasons, often based on measurement properties without considering the methodological quality of the studies that evaluate these measurement properties. The aim of current study was first to identify the most frequently used foot and ankle-specific PROMs in recent orthopaedic foot and ankle literature, and second to conduct a systematic review to synthesize and critically appraise the measurement properties of these PROMS.

METHODS

Six PubMed indexed journals focussing on foot and ankle research were screened to identify most commonly used foot and ankle-specific PROMs over a 2 year period (2015-2016). Subsequently, a systematic literature search was performed in PubMed, EMBASE, SPORTDiscus and Scopus to identify relevant studies on their measurement properties. Methodological quality assessment was performed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist, criteria for good measurement properties were applied, and a level of evidence was determined for the measurement properties of each domain of the questionnaires.

RESULTS

The three most frequently reported PROMs were the Foot Function Index (FFI), the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Activity Measure (FAAM). Among 2046 unique citations, 50 studies were included evaluating these PROMs. Evidence to support the measurement properties of the FFI was mainly lacking due to poor methodological quality. More evidence was available for the measurement properties of the FAOS and the FAAM, but overall evidence supporting all measurement properties is not yet sufficient.

CONCLUSION

The best available evidence retrieved in this review showed that the FAOS and the FAAM are promising outcome measures for evaluation of patients with foot and ankle conditions, but their shortcomings should be taken into account when interpreting results in clinical setting or trials.

LEVEL OF EVIDENCE

I.

Investigating the anticipatory postural adjustment phase of gait initiation in different directions in chronic ankle instability patients

OBJECTIVE

The main objective of the present study was to analyze how supra spinal motor control mechanisms are altered in different directions during anticipatory postural phase of gait initiation in chronic ankle instability patients. It seems that supra spinal pathways modulate anticipatory postural adjustment phase of gait initiation. Yet, there is a dearth of research on the effect of chronic ankle instability on the anticipatory postural adjustment phase of gait initiation in different directions.

METHOD

A total of 20 chronic ankle instability participants and 20 healthy individuals initiated gait on a force plate in forward, 30° lateral, and 30° medial directions.

RESULTS

According to the results of the present study, the peak lateral center of pressure shift decreased in forward direction compared to that in other directions in both groups. Also, it was found that the peak lateral center of pressure shift and the vertical center of mass velocity decreased significantly in chronic ankle instability patients, as compared with those of the healthy individuals.

CONCLUSION

According to the results of the present study, it seems that chronic ankle instability patients modulate the anticipatory postural adjustment phase of gait initiation, compared with healthy control group, in order to maintain postural stability. These changes were observed in different directions, too.

Epidemiology and history of knee injury and its impact on activity limitation among football premier league professional referees

BACKGROUND

The purpose of this study was to determine the epidemiology and history of knee injury and its impact on activity limitation among football premier league professional referees in Iran.

METHODS

This was a descriptive study. 59 Football Premier League professional referees participated in the study. The knee injury related information such as injury history and mechanism was recorded. Injury related symptoms and their impacts on the activity limitation, ability to perform activities of daily living as well participation in sports and recreational activities was obtained through the Knee Outcome Survey (KOS).

RESULTS

The results indicated that 31 out of 59 participants reported the history of knee injury. In addition, 18.6%, 22.4% and 81% of the referees reported that they had been injured during the last 6 months of the last year, and at some point in their refereeing careers, respectively. Results further indicated that 48.8% of the injuries occurred in the non-dominant leg and they occurred more frequently during training sessions (52%). Furthermore, the value of KOS was 85 ± 13 for Activities of Daily Living subscale and 90 ± 9 for Sports and Recreational Activities subscale of the KOS.

CONCLUSIONS

Knee injury was quite common among the Football Premier League professional referees. It was also indicated that the injuries occurred mainly due to insufficient physical fitness. Therefore, it is suggested that football referees undergo the proper warm-up program to avoid knee injury.

Cross-cultural adaptation and validation of Spanish version of The Foot and Ankle Ability Measures (FAAM-Sp)

BACKGROUND

The Foot and Ankle Ability Measure (FAAM) is a Patient Reported Outcome (PRO) commonly used to determine the effectiveness of therapeutic interventions for patients with foot and ankle pathologies and associated impairments of body function and structure, activity limitations, and participation restrictions. The aim of this study was to cross-culturally adapt the FAAM into Spanish.

METHODS

Cross-cultural adaptation was performed according to the international guidelines of the International Society for Pharmacoeconomics and Outcomes Research. Cronbach's alpha, test re-test reliability, and item-total and inter-item correlations were analyzed. Confirmatory factor analysis (CFA) was carried out to test construct validity. Pearson correlations were calculated to assess the convergent validity between FAAM and EuroQol-5.

RESULTS

Spanish data set comprised 194 patients, with a mean age of 38.45 (16.04) and 130 (67.1%) were female, seeing a podiatrist with a wide variety of foot and ankle related disorders. CFA was carried out to test structure matrix (which has three factors). The test-retest reliability was high with global ICC of 0.95 (95% CI: 0.93 to 0.98). A 15 items version of the FAAM-Sp Activities of Daily Living (ADL) obtained the best fit: relative chi-square (x²/df) of 2.46, GFI 0.90 CFI 0.95, NFI 0.93, and RMSEA 0.08 (90% CI 0.04 to 0.09). For exploratory factor analysis for the FAAM-Sp Sport, a one factor solution was obtained, which explained 76.70% of total variance. CFA corroborated this model with an excellent goodness of fit:: relative chi-square (x²/df) of 0.80, GFI 0.99 CFI 1.00, NFI 0.99, and RMSEA 0.00 (90% CI 0.00 to 0.75).

CONCLUSIONS

This study validated a new 15-item FAAM-Sp ADL and FAAM-Sp Sport subscales, which can be used as a self-reported outcome measure in clinical practice and research for patients resident in Spain whose main language is Spanish.

Translation, cross-cultural adaptation, reliability and validity of the Turkish version of the Olerud-Molander Ankle Score (OMAS)

Objective

The aim of this study was to translate and culturally adapt the Olerud-Molander Ankle Score (OMAS) into Turkish and to assess its reliability and validity.

Methods

The Turkish version of the OMAS (OMAS-Tr) was developed after the translation and back-translation, which included the stages recommended by Beaton. The OMAS-Tr was administered to one hundred patients (49 females, 51 males; average age: 42.3 ± 17.7; range 16–81 years) with malleolar fractures. The OMAS-Tr was completed twice by each participant at 7- to 10-days intervals to assess test-retest reliability based on the interrater correlation coefficient, whereas Cronbach's alpha evaluated internal consistency. The external validity was evaluated with correlations between the Turkish version of the Foot and Ankle Ability Measure (FAAM) and the Turkish version of the SF-12 questionnaire. The distribution of floor and ceiling effects was also analyzed.

Results

The internal consistency (Cronbach's α = 0.84) and the test-retest reliability (ICC = 0.98) were excellent. The mean interval between the two tests was 8.6 ± 1.4 days. The mean and standard deviation of the first and second assessments of the OMAS-Tr were 74.1 ± 23.7 and 75.7 ± 23.9, respectively. There was a strong correlation between the OMAS-Tr and the FAAM subscales on activities of daily living and sports (r = 0.86, r = 0.83; p < 0.001, respectively). The OMAS-Tr displayed very good to good correlation with the SF-12 physical component score and the SF-12 mental component score (r = 0.72, r = 0.60, p < 0.001, respectively).

Conclusion

OMAS-Tr was a valid and reliable tool to assess ankle fracture-related problems. Nonetheless, further studies are needed to assess its responsiveness.

Level of evidence

Level III, diagnostic study.

Foot and ankle ability measure to measure functional limitations in patients with foot and ankle disorders: a Chinese cross-cultural adaptation and validation

PURPOSE

To perform a cultural adaptation and validation study (internal and external) of the FAAM questionnaire to create the Chinese version of the questionnaire (FAAM-Ch).

MATERIALS AND METHODS

Two independent professional native translators performed a translation from English to Chinese and reverse translation. Psychometric properties analysis: Internal consistency of measure was analysed through the Cronbach's α coefficients. After extraction by maximum likelihood (EML), the structure factor and construct validity was analysed; to extract a factor, it was necessary to complete the following three requirements: ≥10% of variance, Eigenvalue >1.0 and scree plot inflection point. Standard error measurement (SEM) and minimal detectable change 90 (MDC90) were calculated. FFI-Taiwan version, SF12v2, and EuroQol5D were used for criterion validity analysis.

RESULTS

The internal consistency (Cronbach's α) for specific FAAM-Ch subscales was 0.879 (ADL) and 0.901 (Sport); test-retest analysis (interclass correlation) item ranging between 0.758 and 0.970 (ADL: 0758-0946; Sport: 0.911-0.970). Measures error: 3.449% (MDC90) and 1.478% (SEM). Chi-squared value =15228.74 and gl 406) (p < 0.001) and the Kaiser-Meyer-Oklin values (0.919). The correlation level with the FFI is strong, with SF12v2 is between poor and strong and with EuroQoL5d is between moderate and strong Conclusions: FAAM-Chinese version has satisfactory "transversal" psychometric properties, facilitating the inclusion of FAAM-Chinese into research and clinical practice. Implications for Rehabilitation Cross-cultural adaptation of the FAAM-Ch has been performed from the original version. The psychometric properties of the FAAM-Ch indicate satisfactory and consistent results (particularly in the internal consistence, reliability and criterion validity) with the original version. FAAM-Ch can be used by Chinese speaking clinicians and researches.

The effect of dual tasking on foot kinematics in people with functional ankle instability

BACKGROUND

Some cases of repeated inversion ankle sprains are thought to have a neurological basis and are termed functional ankle instability (FAI). In addition to factors local to the ankle, such as loss of proprioception, cognitive demands have the ability to influence motor control and may increase the risk of repetitive lateral sprains.

OBJECTIVE

The purpose of this study was to investigate the effect of cognitive demand on foot kinematics in physically active people with functional ankle instability.

METHODS

21 physically active participants with FAI and 19 matched healthy controls completed trials of normal walking (single task) and normal walking while performing a cognitive task (dual task). Foot motion relative to the shank was recorded. Cognitive performance, ankle kinematics and movement variability in single and dual task conditions was characterized.

RESULTS

During normal walking, the ankle joint was significantly more inverted in FAI compared to the control group pre and post initial contact. Under dual task conditions, there was a statistically significant increase in frontal plane foot movement variability during the period 200ms pre and post initial contact in people with FAI compared to the control group (p<0.05). Dual task also significantly increased plantar flexion and inversion during the period 200ms pre and post initial contact in the FAI group (p<0.05).

CONCLUSION

participants with FAI demonstrated different ankle movement patterns and increased movement variability during a dual task condition. Cognitive load may increase risk of ankle instability in these people.