The Effect of a 4-Week Comprehensive Rehabilitation Program on Postural Control and Lower Extremity Function in Individuals With Chronic Ankle Instability

Sheri A. Hale, Jay Hertel, Lauren C. Olmsted-Kramer
STUDY DESIGN: Prospective, randomized controlled trial. OBJECTIVE: To examine the effects of a 4-week rehabilitation program for chronic ankle instability (CAI) on postural control and lower extremity function. BACKGROUND: CAI is associated with residual symptoms, performance deficits, and reinjury. Managing CAI is challenging and more evidence is needed to guide effective treatment. METHODS AND MEASURES: Subjects with unilateral CAI were randomly assigned to the rehabilitation (CAI-rehab, n=16) or control (CAI-control, n=13) group. Subjects without CAI were assigned to a healthy group (n=19). Baseline testing included the (1) center of pressure velocity (COPV), 2) star excursion balance test (SEBT), and 3) Foot and Ankle Disability Index (FADI) and FADI-Sports Subscale (FADI-Sport). The CAI-rehab group completed 4 weeks of rehabilitation that addressed range of motion, strength, neuromuscular control, and functional tasks. After 4 weeks, all subjects were retested. Nonparametric analyses for group differences and between-group comparisons were performed. RESULTS: Subjects with CAI demonstrated deficits in postural control and SEBT reach tasks in the involved limb compared to the uninvolved limb and reported functional deficits on the involved limb compared to healthy subjects. Following rehabilitation, the CAI-rehab group had greater SEBT reach improvements on the involved limb than the other groups and greater improvements in FADI and FADI-Sport scores. CONCLUSIONS: These results demonstrate postural control and functional limitations exist in individuals with CAI. In addition, rehabilitation appears to improve these functional limitations. Finally, there is evidence to suggest the SEBT may be a good functional measure to monitor change after rehabilitation for CAI.

J Orthop Sports Phys Ther. 2007;37(6):303-311, Epub 16 April 2007. doi:10.2519/jospt.2007.2322

KEY WORDS: ankle sprain, balance, Foot and Ankle Disability Index, star excursion balance test

Simplifying the Star Excursion Balance Test: Analyses of Subjects With and Without Chronic Ankle Instability

Jay Hertel, Rebecca A. Braham, Sheri A. Hale, Lauren C. Olmsted-Kramer

Study Design: Case control study. Objectives: The objectives of this study are: (1) to perform factor analyses on data from the 8 components of the star excursion balance test (SEBT) in subjects with and without chronic ankle instability (CAI) in an effort to reduce the number of components of the SEBT, (2) to assess the relationships between performance of the different reach directions using correlation analyses, and (3) to determine which components of the SEBT are most affected by CAI. Background: The SEBT is a series of 8 lower-extremity–reaching tasks purported to be useful in identifying lower extremity functional deficits. Methods and Measures: Forty-eight young adults with unilateral CAI (22 males, 26 females; mean ± SD age, 20.9 ± 3.2 years; mean ± SD height, 173.6 ± 11.1 cm; mean ± SD mass, 80.1 ± 22.1 kg) and 39 controls (23 males, 16 females; mean ± SD age, 20.7 ± 2.4 years; mean ± SD height, 174.1 ± 12.9 cm; mean ± SD mass, 75.1 ± 18.6 kg) performed 3 trials of the 8 tasks with each of their limbs. Separate exploratory factor analyses were performed on data for involved limbs of the CAI group, uninvolved limbs of the CAI and control groups, and both limbs of the CAI and control groups. Pearson product moment correlations were calculated to identify the relationships between the different reach directions. A series of eight 2 × 2 analyses of variance were calculated to determine the influence of group (CAI, control) and side (involved, uninvolved) on performance of the 8 tasks. Results: For all 3 factor analyses, only 1 factor in each analysis produced an eigenvalue greater than 1 and the posteromedial reach score was the most strongly correlated task with the computed factor (α>.90), although all 8 tasks produced alpha scores greater than .67. Bivariate correlations between specific reach directions ranged from .40 to .91. Subjects with CAI reached significantly less on the anteromedial, medial, and posteromedial directions when balancing on their involved limbs compared to their uninvolved limbs and the side-matched limbs of controls. Conclusions: The posteromedial component of the SEBT is highly representative of the performance of all 8 components of the test in limbs with and without CAI. There is considerable redundancy in the 8 tasks. The anteromedial, medial, and posteromedial reach tasks may be used clinically to test for functional deficits related to CAI in lieu of testing all 8 tasks. There is a need for a hypothesis-driven study to confirm the results of this exploratory study.

J Orthop Sports Phys Ther. 2006;36(3):131-137. doi:10.2519/jospt.2006.2103

Key Words: dynamic postural control, functional testing, lower extremity

Journal of Orthopaedic & Sports Physical Therapy - Lauren C. Olmsted-Kramer, PhD, ATC

The Effect of a 4-Week Comprehensive Rehabilitation Program on Postural Control and Lower Extremity Function in Individuals With Chronic Ankle Instability

Simplifying the Star Excursion Balance Test: Analyses of Subjects With and Without Chronic Ankle Instability