Neuromuscular Mechanosensitivity in Subjects with Chronic Ankle Sprain: A Cross-Sectional Study

Deficits in neurocognitive performance in patients with chronic ankle instability during a neurocognitive balance task - A retrospective case-control study

OBJECTIVES

To assess the neurocognitive performance while maintaining balance of patients experiencing CAI compared to healthy controls. In patients with CAI, the affected limb was also compared to the contralateral limb.

DESIGN

A retrospective case-control study.

SETTING

Laboratory study.

PARTICIPANTS

We included 27 patients with CAI and 21 healthy controls.

METHODS

The study consisted of two sessions, namely familiarisation and experimentation, which were scheduled with a gap of at least one week between them. During the experimental trial, both groups performed the Y-Balance Test and Reactive Balance Test once on each limb.

MAIN OUTCOME MEASURES

The main outcome measures are accuracy and visuomotor response time (VMRT) calculated via video-analysis and with the Fitlight™-hardware and software respectively during the Reactive Balance Test (RBT).

RESULTS

No data was excluded from the final analysis. Patients with CAI exhibited significantly lower accuracy than healthy controls, with a mean difference of 8.7% (±3.0)%. There were no differences for VMRT between groups. Additionally, no significant differences were observed between the affected and contralateral limb of the patient group for both accuracy and VMRT.

CONCLUSIONS

Patients with CAI showed lower accuracy, but similar VMRT compared to healthy controls during a neurocognitive balance task, indicating impaired neurocognitive function. Patients exhibit comparable speed to healthy individuals when completing neurocognitive balance tasks, yet they display a higher frequency of accuracy errors in accurately perceiving their environment and making decisions under time constraints. Future research should gain more insights in which other cognitive domains are affected in patients with CAI for a better grasp of this condition's underlying mechanism.

Test-retest, intra- and inter-rater reliability of the reactive balance test in patients with chronic ankle instability

Introduction

The Reactive Balance Test (RBT) could be a valuable addition to research on chronic ankle instability (CAI) and clinical practice, but before it can be used in clinical practice it needs to be reliable. It has already been proven reliable in healthy recreational athletes, but not yet in patients with CAI who have shown persistent deficits in dynamic balance. The study aimed to determine the test-retest, intra-, and inter-rater reliability of the RBT in patients with CAI, and the test-retest and inter-rater reliability of the newly developed RBT score sheet.

Methods

We used a repeated-measures, single-group design to administer the RBT to CAI patients on three occasions, scored by multiple raters. We included 27 participants with CAI. The study used multiple reliability measures, including Pearson r, intra-class correlations (ICC), standard error of measurement (SEM), standard error of prediction (SEP), minimal detectable change (MDC), and Bland-Altman plots, to evaluate the reliability of the RBT's outcome measures (visuomotor response time and accuracy). It also assessed the test-retest and inter-rater reliability of the RBT score sheet using the same measures.

Results

The ICC measures for test-retest reliability were similar for accuracy (0.609) and VMRT (0.594). Intra-rater reliability had high correlations and ICCs for accuracy (r = 0.816, ICC = 0.815) and VMRT (r = 0.802, ICC = 0.800). Inter-rater reliability had a higher ICC for VMRT (0.868) than for accuracy (0.690).

Conclusion

Test-retest reliability was moderate, intra-rater reliability was good, and inter-rater reliability showed moderate reliability for accuracy and good reliability for VMRT. Additionally, the RBT shows robust SEM and mean difference measures. The score sheet method also demonstrated moderate test-retest reliability, while inter-rater reliability was good to excellent. This suggests that the RBT can be a valuable tool in assessing and monitoring balance in patients with CAI.

Urdu translation and cross-cultural validation of Cumberland Ankle Instability Tool (CAIT)

Background

The Cumberland Ankle Instability Tool (CAIT) is a self-assessment tool for people with chronic ankle instability (CAI). This tool had been translated and validated in many languages but there is no Urdu version of CAIT available.

Objective

The aim was to translate the CAIT into the Urdu Language and determine its validity and reliability.

Methods

A standardized step-wise forward and backward translation process was followed. Content, construct, convergent validity, internal consistency, and test–retest reliability were determined. A pilot study was done on 10 patients with CAI. The final version was investigated in 120 patients (mean age 26.6 ± 4.8 yrs) with CAI for validity and test–retest reliability in which 105 participants filled the questionnaire in the second week. Internal consistency was calculated by Cronbach’s alpha. Intraclass correlation (ICC_2,1) was calculated to assess test–retest reliability between two weeks. Standard error of measurement (SEM) and smallest detectable change (SDC) were calculated. Convergent validity was determined by correlating Urdu CAIT with the Foot and Ankle Outcome Score (FAOS) using Spearman’s correlation co-efficient. Factor analysis describes the structure of underlying factors.

Results

Content validity index was > 0.80 of each question. Internal consistency was acceptable (Cronbach’s alpha > 0.75). Convergent validity with FAOS total score showed a moderate negative correlation (r = -0.68) with U-CAIT and negatively correlated with subscales of FAOS. Test–retest reliability was excellent ICC_2,1 > 0.80. Scree plot showed 3 factors > 1eigen value.

Conclusion

The Urdu version of CAIT is a valid and reliable assessment tool for patients with chronic ankle instability. It has good content validity, construct validity and reliability.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05408-4.

Intra-Rater and Inter-Rater Reliability of Pressure Pain Algometry of the Sural and Tibial Nerves in Asymptomatic Elite Youth Footballers

Ankle injuries are highly prevalent in elite youth footballers and increase the mechanosensitivity of the local neural tissue, which may predispose athletes to re-injury and prolong rehabilitation periods. Increased neural mechanosensitivity presents clinically as altered pain pressure thresholds (PPTs) which are measured with pressure algometry. The purpose of this study was to determine the intra-rater and inter-rater reliability of PPTs of the ankle neural tissue in asymptomatic elite youth football players. Three raters utilised a digital algometer to evaluate the PPTs of the Sural and Tibial nervous tissue at the ankle of elite youth male footballers. Intraclass correlation coefficients (ICCs) with 95% confidence intervals (CI) were calculated to assess intra-rater and inter-rater reliability and Bland-Altman figures were plotted to enable visual evaluation of measurement error with a significance level of p < 0.05. Thirty-four players (16-18 years old) were assessed. Excellent intra-rater (Tibial ICC 0.88 (0.76-0.94); Sural ICC 0.89 (0.79-0.95)) and good inter-rater reliability (Tibial ICC 0.66 (0.40-0.82); Sural 0.71 (0.50-0.85)) was demonstrated. Bland-Altman plots demonstrated low levels of measurement error. Pressure algometry can be utilised clinically to accurately evaluate the PPTs of the Tibial and Sural nervous tissue at the ankle in asymptomatic elite male youth footballers.

Tensiomyographic Neuromuscular Response of the Peroneus Longus and Tibialis Anterior with Chronic Ankle Instability

This study aimed to investigate the muscle contractile response of the peroneus longus (PL) and tibialis anterior (TA) in groups with and without chronic ankle instability (CAI) using tensiomyography. Twenty-three adults, 12 with CAI and 11 healthy participants, participated in this study. All subjects underwent a tensiomyographic assessment of the PL and TA to measure delay time, contraction time and maximal displacement. The ankle evertor and invertor normalized peak torques, maximum work done and muscle thickness of the PL and TA were calculated. The delay time and contraction time of the PL in the CAI side were significantly higher than those in the healthy group (p < 0.05); however, no significant difference could be detected in the TA between groups. Furthermore, there was no significant difference in the normalized peak torques, maximum work done and muscle thickness of the PL and TA between groups. The CAI side demonstrated a delayed muscle contractile response of the PL when compared with the healthy group although there was no difference in muscle strength and muscle size. Clinicians should consider the muscle contractile response of the PL for rehabilitation of the ankle evertor with CAI.

Predictive Factors of Recovery after an Acute Lateral Ankle Sprain: A Longitudinal Study

A prominent feature of ankle sprains is their variable clinical course. The difficulty of providing a reliable early prognosis may be responsible for the substantial rate of poor outcomes after an ankle sprain. The aim of the present study was to evaluate the prognostic value of objective clinical measures, pain, and functional scores for ankle sprain recovery. Fifty-two participants suffering from lateral ankle sprain were included. Sprain status was assessed four weeks following injury and included evaluations of ankle range of motion, strength, function, and pain. Seven months following injury, a second assessment classified the patients into recovered and non-recovered groups using ankle ability measures. Following a predictor pre-selection procedure, logistic regressions evaluated the association between the four-week predictors and the seven-month recovery status. Twenty-seven participants (52%) fully recovered and 25 did not (48%). The results of the logistic regressions showed that walking pain was negatively associated with the probability of recovering at seven months (odds ratio: 0.71, 95% CI: 0.53–0.95). Pain four weeks after ankle sprain had relevant predictive value for long-term recovery. Special attention should be paid to patients reporting persistent pain while walking four weeks following sprain to reduce the risk of chronicity.

Comparison of the Strength and Electromyography of the Evertor Muscles With and Without Toe Flexion in Patients With Chronic Ankle Instability

BACKGROUND

Weakness of evertor strength is controversial in chronic ankle instability (CAI). Ankle evertor muscles are attached to the toe joints as well as to the metatarsal bone. Therefore, it is necessary to consider toe joint position for the measurement of evertor strength. The purpose of this study was to compare ankle evertor strength and muscle activity during eversion with and without toe flexion (TF) in individuals with CAI and individuals in a healthy group.

METHODS

Fifteen subjects with CAI and 15 healthy subjects participated in this study. Isometric ankle evertor strength and muscle activity of the peroneus longus (PL), peroneus brevis (PB), and extensor digitorum longus (EDL) were measured during eversion with and without TF.

RESULTS

The results indicated a significant interaction effect in evertor strength (P = .03) and no significant interaction effect on EMG of the PL (P = .08), PB (P = .12), and EDL (P = .28). However, measurements of muscle activity of the PL and PB between eversion with and without TF revealed a significant difference in the CAI group (P < .01) and no significant difference in the healthy group (PL: P = .07; PB: P = .13).

CONCLUSION

The results indicated that subjects with CAI had increased EDL compensation and reduced selective activation of the PL and PB during eversion.

CLINICAL RELEVANCE

Our findings suggest that clinicians should consider the activation of EDL when training the evertor of patients with CAI.