Role of Dynamic Postural Control Using Functional Movement Assessments in Individuals with Chronic Ankle Instability: Systematic Review and Matched Case-control Study
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Context: Worldwide, more than 700,000 individuals sprain their ankle each day, with instability and recurrent ankle sprains reported in 40% to 70% of patients. Chronic ankle instability (CAI) is a term that describes the structural changes at the ankle joint due to recurrent ankle sprains and presence of residual symptoms such as pain, swelling, “giving way”, and loss of motion occurring long after an initial lateral ankle sprain. Previous studies have identified kinematic and kinetic changes in walking and running gait among individuals with CAI. The Functional Movement ScreenTM (FMS) is a tool used to assess the quality of human movement, and there are limited research investigations that have examined the relationship between postural stability control and the FMS scores. Additionally, no previous systematic review of literature has evaluated the evidence that exists related to biomechanical changes in gait among individuals with CAI while wearing ankle support devices. Objective: For the systematic review, our objective was to evaluate the effects of ankle support devices on kinematic and kinetic characteristics during walking and running in people with CAI. For the case-control study, the primary purpose was to identify differences among measures of active range of motion (AROM), dynamic postural stability, and FMS-lower extremity scores in physically-active persons with and without CAI. A secondary purpose was to identify risk factors that predispose individuals to CAI. Design: Systematic review and case-control study. Setting: Laboratory based study. Participants: Prior to a university-mandated moratorium on face-to-face human data collection due to the COVID-19 pandemic, we recruited 23 participants (age, 22.3 + 2.1 yrs) who completed all aspects of the study. From these participants’ data we were able to create 7 triads (N = 21) using a 2:1 ratio of persons without a previous history of ankle injury (n = 14) to those with CAI (n = 7) and triple matched them on sex, age (+ 5 yrs), and BMI category, e.g., underweight, normal, overweight. Interventions: We searched electronic databases from January 2000 to March 2020 for relevant studies related to the purpose of our systematic review. During a one-time visit to the laboratory, we obtained both disease-oriented and patient-oriented measures of lower extremity function and postural control. Main Outcome Measures: In the case-control study we obtained talocrural dorsiflexion and plantar flexion active range of motion (AROM), subtalar inversion and eversion AROM, FMS composite score (FMS-CS), FMS lower extremity subscore (FMS-LE), the Athlete Single Leg Stability Test (ASLST), and the Foot and Ankle Disability Index-Sport (FADISport) measures. Statistical Analyses: In the case-control study we calculated a Pearson product moment intercorrelation matrix from our 10 outcome measures to identify the presence of multicollinearity (r > 0.80) and eliminated one redundant variable from further analysis. We employed both 1-way and 2-way ANOVAs to identify differences between the CAI and control groups, and the involved and uninvolved limbs of the CAI group (a < 0.05). We used an unconditional binary logistic regression approach to calculate odds ratios to determine the extent to which postulated risk factors increased the risk of developing CAI. Results: A total of 77 articles were identified in our database search for the systematic review, and eight articles qualified for inclusion. Moderate evidence exists that semi-rigid ankle braces, closed-basketweave, KinesioTape™ and high-dye ankle taping have positive effects on correcting walking and running gait biomechanics in a CAI population. In the case-control study, 1-way ANOVA results indicated the case group scored significantly lower on the FADI-Sport (26.7 + 4.1 points) than the control group (31.0 + 2.7 points) [F = 9.30, p = 0.006, η2 = 0.529]. The case group had significantly worse (higher) ASLST level 4 scores (1.58 + 0.35 deg, F = 4.14, p = 0.045, η2 = 0.172) compared to their matched controls (1.05 + 0.35 deg). The unconditional logistic regression analysis indicated that for every 1 point decrease in FADI-Sport score, the odds of being diagnosed with CAI increased by a factor of 1.5 (p = 0.042). Conversely, for every 1 point increase in OSI-CAI Level 4 scores from the ASLST, the odds of being diagnosed with CAI increased by a factor of 0.03 (p = 0.045). Conclusions: The collective evidence contained in the systematic review indicated that semi-rigid ankle braces, closed-basketweave, KinesioTape™ and high-dye ankle taping had positive effects on correcting walking and running gait biomechanics in a CAI population. Our case-control study results indicated that a lower FADI-Sport and a higher ASLST level 4 score can classify individuals as being more at risk for developing CAI.