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Int J Sports Med 2016; 37(14): 1154-1158
DOI: 10.1055/s-0042-113464
Orthopedics & Biomechanics
© Georg Thieme Verlag KG Stuttgart · New York

A Multivariate Assessment of Clinical Contributions to the Severity of Perceived Dysfunction Measured by the Cumberland Ankle Instability Tool

A. Rosen
1   School of Health, Physical Education and Recreation, The University of Nebraska at Omaha, Omaha, NE, United States
,
J. Ko
2   Department of Physical Therapy & Athletic Training Norther Arizona University, Phoenix, AZ, USA
,
C. Brown
3   Department of Kinesiology, Oregon State University, Corvallis, OR, USA
› Author Affiliations
Further Information

Publication History



accepted after revision 11 July 2016

Publication Date:
05 October 2016 (online)

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Abstract

Chronic ankle instability is a common pathological consequence of ankle sprains. However, screening tools which assess self-reported dysfunction offer little insight into clinical factors which may be useful to improve deficits. The purpose of this study was to identify factors that contribute most to self-reported dysfunction. 93 individuals completed the Cumberland Ankle Instability Tool (CAIT), active range of motion, dynamic postural stability assessments, and an arthrometer inversion stress test to assess lateral ankle laxity and stiffness. Backwards selection linear-regression was used to identify the most parsimonious multifactorial model of the predictor variables’ ability to predict questionnaire score. Ankle sprain history, dorsiflexion in knee flexion, medial-lateral dynamic postural stability, and inversion laxity talar tilt had the highest relationships with the CAIT. When combined in the backwards-regression model index, these predictors explained approximately 57% of the variability (r=0.76, R 2=0.57, F=27.49, p<0.001) of the CAIT. Previous history, laxity, range of motion restrictions and balance together contributed to account for almost 60% of the variability in the CAIT. Clinical measures may have prognostic value assessing the severity of chronic ankle instability and allow clinicians to focus on specific deficiencies during rehabilitation programs.

Key words

range of motion - dynamic postural stability - mechanical laxity - sprain
 

  • References

  • 1 Anandacoomarasamy A, Barnsley L. Long term outcomes of inversion ankle injuries. Br J Sports Med 2005; 39: e14
    CrossrefPubMedGoogle Scholar
  • 2 Brown CN, Bowser B, Orellana A. Dynamic postural stability in females with chronic ankle instability. Med Sci Sports Exerc 2010; 42: 2258-2263
    CrossrefPubMedGoogle Scholar
  • 3 Brown CN, Ko J, Rosen AB, Hsieh K. Individuals with both perceived ankle instability and mechanical laxity demonstrate dynamic postural stability deficits. Clin Biomech 2015; 30: 1170-1174
    CrossrefPubMedGoogle Scholar
  • 4 Brown CN, Rosen AB, Ko J. Ankle ligament laxity and stiffness in chronic ankle instability. Foot Ankle Int 2015; 36: 565-572
    CrossrefPubMedGoogle Scholar
  • 5 Clarkson HM. Musculoskeletal Assessment: Joint Motion and Muscle Testing. Lippincott Williams & Wilkins; 2012
    Google Scholar
  • 6 Croy T, Koppenhaver S, Saliba S, Hertel J. Anterior talocrural joint laxity: diagnostic accuracy of the anterior drawer test of the ankle. J Orthop Sport Phys 2013; 43: 911-919
    CrossrefPubMedGoogle Scholar
  • 7 Cordova ML, Sefton JM, Hubbard TJ. Mechanical joint laxity associated with chronic ankle instability: a systematic review. Sports Health 2010; 2: 452-459
    CrossrefPubMedGoogle Scholar
  • 8 Cruz-Diaz D, Lomas Vega R, Osuna-Perez MC, Hita-Contreras F, Martinez-Amat A. Effects of joint mobilization on chronic ankle instability: a randomized controlled trial. Disabil Rehab 2015; 37: 601-610
    PubMedGoogle Scholar
  • 9 Delahunt E, Cusack K, Wilson L, Doherty C. Joint mobilization acutely improves landing kinematics in chronic ankle instability. Med Sci Sports Exerc 2013; 45: 514-519
    CrossrefPubMedGoogle Scholar
  • 10 Drewes LK, McKeon PO, Kerrigan DC, Hertel J. Dorsiflexion deficit during jogging with chronic ankle instability. J Sci Med Sport 2009; 12: 685-687
    CrossrefPubMedGoogle Scholar
  • 11 Field A. Discovering statistics using SPSS. 2nd ed. Thousand Oaks, CA US: Sage Publications, Inc; 2005
    Google Scholar
  • 12 Gabriner ML, Houston MN, Kirby JL, Hoch MC. Contributing factors to star excursion balance test performance in individuals with chronic ankle instability. Gait Posture 2015; 41: 912-916
    CrossrefPubMedGoogle Scholar
  • 13 Gribble PA, Delahunt E, Bleakley C, Caulfield B, Docherty CL, Fourchet F, Fong D, Hertel J, Hiller C, Kaminski TW, McKeon PO, Refshauge KM, van der Wees P, Vicenzino B, Wikstrom EA. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. J Orthop Sport Phys 2013; 43: 585-591
    CrossrefPubMedGoogle Scholar
  • 14 Harriss DJ, Atkinson G. Ethical standards in sport and exercise science research: 2016 update. Int J Sports Med 2015; 36: 1121-1124
    Google Scholar
  • 15 Harkey M, McLeod M, Van Scoit A, Tarada M, Tevald M, Gribble P, Pietrosimone B. The immediate effects of an anterior-to-posterior talar mobilization on neural excitability, dorsiflexion range of motion, and dynamic balance in patients with chronic ankle instability. J Sport Rehabil 2014; 23: 351-359
    PubMedGoogle Scholar
  • 16 Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train 2002; 37: 364-375
    PubMedGoogle Scholar
  • 17 Hiller CE, Refshauge KM, Bundy AC, Herbert RD, Kilbreath SL. The Cumberland ankle instability tool: a report of validity and reliability testing. Arch Phys Med Rehab 2006; 87: 1235-1241
    CrossrefPubMedGoogle Scholar
  • 18 Hoch MC, Farwell KE, Gaven SL, Weinhandl JT. Weight-bearing dorsiflexion range of motion and landing biomechanics in individuals with chronic ankle instability. J Athl Train 2015; 50: 833-839
    CrossrefPubMedGoogle Scholar
  • 19 Hoch MC, Staton GS, Medina McKeon JM, Mattacola CG, McKeon PO. Dorsiflexion and dynamic postural control deficits are present in those with chronic ankle instability. J Sci Med Sport 2012; 15: 574-579
    CrossrefPubMedGoogle Scholar
  • 20 Houston MN, Hoch JM, Gabriner ML, Kirby JL, Hoch MC. Clinical and laboratory measures associated with health-related quality of life in individuals with chronic ankle instability. Phys Ther Sport 2015; 16: 169-175
    CrossrefPubMedGoogle Scholar
  • 21 Houston MN, Hoch JM, Hoch MC. Patient-reported outcome measures in individuals with chronic ankle instability: a systematic review. J Athl Train 2015; 50: 1019-1033
    CrossrefPubMedGoogle Scholar
  • 22 Houston MN, Van Lunen BL, Hoch MC. Health-related quality of life in individuals with chronic ankle instability. J Athl Train 2014; 49: 758-763
    CrossrefPubMedGoogle Scholar
  • 23 Hubbard-Turner T. Relationship between mechanical ankle joint laxity and subjective function. Foot Ankle Int 2012; 33: 852-856
    CrossrefPubMedGoogle Scholar
  • 24 Hubbard TJ, Kramer LC, Denegar CR, Hertel J. Correlations among multiple measures of functional and mechanical instability in subjects with chronic ankle instability. J Athl Train 2007; 42: 361-366
    PubMedGoogle Scholar
  • 25 Hubbard TJ, Wikstrom EA. Ankle sprain: pathophysiology, predisposing factors, and management strategies. Open Access J Sports Med 2010; 1: 115-122
    PubMedGoogle Scholar
  • 26 Hubbard-Turner T, Turner MJ. Physical activity levels in college students with chronic ankle instability. J Athl Train 2015; 50: 742-747
    CrossrefPubMedGoogle Scholar
  • 27 Kim PJ, Peace R, Mieras J, Thoms T, Freeman D, Page J. Interrater and intrarater reliability in the measurement of ankle joint dorsiflexion is independent of examiner experience and technique used. J Am Podiatr Med Assoc 2011; 101: 407-414
    CrossrefPubMedGoogle Scholar
  • 28 Kucera KL, Marshall SW, Kirkendall DT, Marchak PM, Garrett Jr. WE. Injury history as a risk factor for incident injury in youth soccer. Br J Sports Med 2005; 39: 462
    CrossrefPubMedGoogle Scholar
  • 29 Ligmaster . Ligmaster™ User Manual. Ligmaster. Charlottesville, VA: Sport Tech, Inc; 2005
    Google Scholar
  • 30 Marron-Gomez D, Rodriguez-Fernandez AL, Martin-Urrialde JA. The effect of two mobilization techniques on dorsiflexion in people with chronic ankle instability. Phys Ther Sport 2015; 16: 10-15
    CrossrefPubMedGoogle Scholar
  • 31 Menadue C, Raymond J, Kilbreath SL, Refshauge KM, Adams R. Reliability of two goniometric methods of measuring active inversion and eversion range of motion at the ankle. BMC Musculoskelet Disord 2006; 7: 60
    CrossrefPubMedGoogle Scholar
  • 32 Nauck T, Lohrer H, Gollhofer A. Clinical evaluation of a new noninvasive ankle arthrometer. Phys Sportsmed 2010; 38: 55-61
    PubMedGoogle Scholar
  • 33 Pedhazur EJ. Multiple Regression in Behavioral Research: Explanation and Prediction. Harcourt Brace College Publishers; 1997
    Google Scholar
  • 34 Rosen AB, Ko J, Brown CN. Diagnostic accuracy of instrumented and manual talar tilt tests in chronic ankle instability populations. Scand J Med Sci Sports 2015; 25: e214-221
    CrossrefPubMedGoogle Scholar
  • 35 Sell TC. An examination, correlation, and comparison of static and dynamic measures of postural stability in healthy, physically active adults. Phys Ther Sport 2012; 13: 80-86
    CrossrefPubMedGoogle Scholar
  • 36 Terada M, Harkey MS, Wells AM, Pietrosimone BG, Gribble PA. The influence of ankle dorsiflexion and self-reported patient outcomes on dynamic postural control in participants with chronic ankle instability. Gait Posture 2014; 40: 193-197
    CrossrefPubMedGoogle Scholar
  • 37 Valderrabano V, Hintermann B, Horisberger M, Fung TS. Ligamentous posttraumatic ankle osteoarthritis. Am J Sports Med 2006; 34: 612-620
    CrossrefPubMedGoogle Scholar
  • 38 Wikstrom EA, Brown CN. Minimum reporting standards for copers in chronic ankle instability research. Sports Med 2014; 44: 251-268
    CrossrefPubMedGoogle Scholar
  • 39 Wikstrom EA, Fournier KA, McKeon PO. Postural control differs between those with and without chronic ankle instability. Gait Posture 2010; 32: 82-86
    CrossrefPubMedGoogle Scholar
  • 40 Wikstrom EA, Tillman MD, Smith AN, Borsa PA. A new force-plate technology measure of dynamic postural stability: the dynamic postural stability index. J Athl Train 2005; 40: 305-309
    PubMedGoogle Scholar
  • 41 Wright IC, Neptune RR, van den Bogert AJ, Nigg BM. The influence of foot positioning on ankle sprains. J Biomech 2000; 33: 513-519
    CrossrefPubMedGoogle Scholar
  • 42 Youdas JW, Bogard CL, Suman VJ. Reliability of goniometric measurements and visual estimates of ankle joint active range of motion obtained in a clinical setting. Arch Phys Med Rehab 1993; 74: 1113-1118
    CrossrefPubMedGoogle Scholar