Advertisement

Ankle inversion proprioception measured during landing in individuals with and without chronic ankle instability

Published:February 16, 2021DOI:https://doi.org/10.1016/j.jsams.2021.02.004

      Abstract

      Background

      Research evidence has suggested that a more sensitive ankle proprioceptive testing method with higher ecological validity is needed for assessing proprioceptive deficits in individuals with chronic ankle instability (CAI).

      Objectives

      (1) To determine the test–retest reliability of a novel ankle proprioception assessment tool, the Ankle Inversion Discrimination Apparatus for Landing (AIDAL); (2) To assess whether AIDAL scores were sufficiently sensitive to detect proprioceptive deficits in chronic ankle instability (CAI); and (3) To examine whether AIDAL scores correlated with Cumberland Ankle Instability Tool (CAIT) scores.

      Design

      Cross-sectional study.

      Methods

      The AIDAL was purpose-built to assess ankle discrimination in four positions of ankle inversion (10°, 12°, 14° and 16°) upon landing from a 10 cm drop. Area Under the Receiver Operating Curve (AUC) was employed as the ankle proprioceptive discrimination score. Seven-day test–retest reliability was evaluated with 23 university students (12 CAI and 11 non-CAI), and another 36 university students (18 CAI and 18 non-CAI) were in the comparison study.

      Results

      The test–retest reliability ICC score for the whole group was 0.763 (95% CI = 0.519–0.892), which showed an excellent reliability level. ICC (3,1) was 0.701 for the non-CAI group (95%CI = 0.210–0.910) and 0.804 for the CAI group (95%CI = 0.451–0.939). The CAI group performed at a significantly lower level on the AIDAL assessment than the non-CAI group (0.777 ± 0.05 vs. 0.815 ± 0.05, F = 5.107, p = 0.03). The discriminative AUC value for the AIDAL test was 0.756 with a cut point of 0.819 (sensitivity = 0.733, specificity = 0.800). The MDC90 scores for CAI and non-CAI groups were both 0.04. Spearman's correlation showed that the CAIT scores were significantly correlated with the ankle proprioceptive discrimination scores (rho = 0.401, p = 0.015).

      Conclusion

      The AIDAL showed good test–retest reliability for both non-CAI and CAI groups. Measuring ankle inversion proprioception during landing may be important for assessing the outcomes of CAI rehabilitation, as proprioceptive performance obtained from the AIDAL was significantly correlated with severity of functional ankle instability CAIT scores.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Science and Medicine in Sport
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hertel J.
        Sensorimotor deficits with ankle sprains and chronic ankle instability.
        Clin Sports Med. 2008; 27 (vii): 353-370
        • Shi X.
        • Han J.
        • Witchalls J.
        • et al.
        Does treatment duration of manual therapy influence functional outcomes for individuals with chronic ankle instability: a systematic review with meta-analysis?.
        Musculoskelet Sci Pract. 2019; 40: 87-95
        • Han J.
        • Anson J.
        • Waddington G.
        • et al.
        The role of ankle proprioception for balance control in relation to sports performance and injury.
        Biomed Res Int. 2015; 2015: 842804
        • Hiller C.E.
        • Nightingale E.J.
        • Lin C.W.
        • et al.
        Characteristics of people with recurrent ankle sprains: a systematic review with meta-analysis.
        Br J Sports Med. 2011; 45: 660-672
        • Thompson C.
        • Schabrun S.
        • Romero R.
        • et al.
        Factors contributing to chronic ankle instability: a systematic review and meta-analysis of systematic reviews.
        Sports Med. 2018; 48: 189-205
        • Han J.
        • Waddington G.
        • Adams R.
        • et al.
        Assessing proprioception: what do you really want to know? – Response to Krewer et al.
        J Sport Health Sci. 2016; 5: 93-94
        • Han J.
        • Waddington G.
        • Adams R.
        • et al.
        Assessing proprioception: a critical review of methods.
        J Sport Health Sci. 2016; 5: 80-90
        • Gibson J.J.
        The Senses Considered as Perceptual Systems.
        Allen & Unwin, 1968
        • Steinberg N.
        • Adams R.
        • Ayalon M.
        • et al.
        Recent ankle injury, sport participation level, and tests of proprioception.
        J Sport Rehabil. 2019; : 1-7
        • Steinberg N.
        • Adams R.
        • Tirosh O.
        • et al.
        Effects of textured balance board training in adolescent ballet dancers with ankle pathology.
        J Sport Rehabil. 2019; 28: 584-592
        • Han J.
        • Waddington G.
        • Anson J.
        • et al.
        Level of competitive success achieved by elite athletes and multi-joint proprioceptive ability.
        J Sci Med Sport. 2015; 18: 77-81
        • Han J.
        • Anson J.
        • Waddington G.
        • et al.
        Proprioceptive performance of bilateral upper and lower limb joints: side-general and site-specific effects.
        Exp Brain Res. 2013; 226: 313-323
        • Yang N.
        • Waddington G.
        • Adams R.
        • et al.
        Age-related changes in proprioception of the ankle complex across the lifespan.
        J Sport Health Sci. 2019; 8: 548-554
        • Wang Y.
        • Wang Z.
        • Zhuang J.
        • et al.
        Ankle proprioception and postural sway in people with Parkinson's disease.
        J Sci Med Sport. 2018; 21: S67
        • Witchalls J.B.
        • Waddington G.
        • Adams R.
        • et al.
        Chronic ankle instability affects learning rate during repeated proprioception testing.
        Phys Ther Sport. 2014; 15: 106-111
        • Witchalls J.B.
        • Newman P.
        • Waddington G.
        • et al.
        Functional performance deficits associated with ligamentous instability at the ankle.
        J Sci Med Sport. 2013; 16: 89-93
        • Hiller C.E.
        • Refshauge K.M.
        • Bundy A.C.
        • et al.
        The Cumberland ankle instability tool: a report of validity and reliability testing.
        Arch Phys Med Rehabil. 2006; 87: 1235-1241
        • Gribble P.A.
        • Delahunt E.
        • Bleakley C.
        • et al.
        Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium.
        Br J Sports Med. 2014; 48: 1014
        • Komi P.V.
        • Gollhofer A.
        • Schmidtbleicher D.
        • et al.
        Interaction between man and shoe in running: considerations for a more comprehensive measurement approach.
        Int J Sports Med. 1987; 8: 196-202
        • Zou K.H.
        • O’Malley A.J.
        • Mauri L.
        Receiver-operating characteristic analysis for evaluating diagnostic tests and predictive models.
        Circulation. 2007; 115: 654-657
        • McDowell I.
        • Newell C.
        Measuring Health: A Guide to Rating Scales and Questionnaires.
        2nd ed. Oxford University Press, 1996
        • Deshpande N.
        • Connelly D.M.
        • Culham E.G.
        • et al.
        Reliability and validity of ankle proprioceptive measures.
        Arch Phys Med Rehabil. 2003; 84: 883-889
        • Yang N.
        • Waddington G.
        • Adams R.
        • et al.
        Joint position reproduction and joint position discrimination at the ankle are not related.
        Somatosens Mot Res. 2020; 37: 97-105
        • Han J.
        • Anson J.
        • Waddington G.
        • et al.
        Sport attainment and proprioception.
        Int J Sports Sci Coach. 2014; 9: 159-170
        • Hass C.J.
        • Bishop M.D.
        • Doidge D.
        • et al.
        Chronic ankle instability alters central organization of movement.
        Am J Sports Med. 2010; 38: 829-834
        • Kiers H.
        • Brumagne S.
        • van Dieën J.
        • et al.
        Ankle proprioception is not targeted by exercises on an unstable surface.
        Eur J Appl Physiol. 2012; 112: 1577-1585
        • de Noronha M.
        • Refshauge K.M.
        • Kilbreath S.L.
        • et al.
        Loss of proprioception or motor control is not related to functional ankle instability: an observational study.
        Aust J Physiother. 2007; 53: 193-198