1
|
Crowell MS, Thomasma E, Florkiewicz E, Brindle R, Roach M, Goss D, Pitt W. Validity and Responsiveness of a Modified Balance Error Scoring System Assessment Using a Mobile Device Application in Patients Recovering from Ankle Sprain. Int J Sports Phys Ther 2024; 19:440-450. [PMID: 38576835 PMCID: PMC10987306 DOI: 10.26603/001c.94608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/28/2024] [Indexed: 04/06/2024] Open
Abstract
Background Static balance is often impaired in patients after ankle sprains. The ability to identify static balance impairments is dependent on an effective balance assessment tool. The Sway Balance Mobile Application (SWAY App) (Sway Medical, Tulsa, OK) uses a smart phone or tablet to assess postural sway during a modified Balance Error Scoring System (mBESS) assessment and shows promise as an accessible method to quantify changes in static balance after injury. Purpose The primary purposes of this study were to determine the ability to differentiate between those with ankle sprain versus controls (construct validity) and ability to detect change over time (responsiveness) of a mBESS assessment using a mobile device application to evaluate static balance after an acute ankle sprain. Study Design Case-control study. Methods Twenty-two military academy Cadets with an acute ankle sprain and 20 healthy Cadets were enrolled in the study. All participants completed an assessment measuring self-reported function, ankle dorsiflexion range of motion (via the weightbearing lunge), dynamic balance, and static balance. Static balance measured with the mBESS using the SWAY App was validated against laboratory-based measures. Cadets with ankle sprains completed their assessment twice: once within two weeks of injury (baseline) and again after four weeks of rehabilitation that included balance training. Independent and paired t-tests were utilized to analyze differences over time and between groups. Effect sizes were calculated and relationships explored using Pearson's correlation coefficients. Results The mBESS scores measured by the SWAY App were lower in participants with acute ankle sprains than healthy Cadets (t = 3.15, p = 0.004). Injured participants improved their mBESS score measured by SWAY at four weeks following their initial assessments (t = 3.31, p = 0.004; Baseline: 74.2 +/- 16.1, 4-weeks: 82.7 +/- 9.5). The mBESS measured by the SWAY App demonstrated moderate to good correlation with a laboratory measure of static balance (r = -0.59, p \< 0.001). Conclusion The mBESS assessed with a mobile device application is a valid and responsive clinical tool for evaluating static balance. The tool demonstrated construct (known groups) validity detecting balance differences between a healthy and injured group, concurrent validity demonstrating moderate to good correlation with established laboratory measures, and responsiveness to changes in static balance in military Cadets during recovery from an acute ankle sprain. Level of Evidence Level 3.
Collapse
Affiliation(s)
- Michael S Crowell
- University of Scranton
- Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship
| | | | - Erin Florkiewicz
- Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship
| | | | - Megan Roach
- DoD-VA Extremity Trauma & Amputation Center of Excellence Womack Army Medical Center
| | | | - Will Pitt
- Army-Baylor Doctoral Program in Physical Therapy
| |
Collapse
|
2
|
Chandran A, Moffit RE, DeJong Lempke AF, Boltz AJ, Alexander AS, Robison HJ, Kerr ZY, Collins CL, Wikstrom EA. Epidemiology of Lateral Ligament Complex Tears of the Ankle in National Collegiate Athletic Association (NCAA) Sports: 2014-15 Through 2018-19. Am J Sports Med 2023; 51:169-178. [PMID: 36592020 DOI: 10.1177/03635465221138281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Epidemiological studies of lateral ankle sprains in NCAA sports are important in appraising the burden of this injury and informing prevention efforts. PURPOSE To describe the epidemiology of lateral ankle sprains in NCAA sports during the 2014-15 through 2018-19 seasons. STUDY DESIGN Descriptive epidemiology study. METHODS Injury and exposure information collected within the NCAA Injury Surveillance Program (ISP) were examined. Counts, rates, and proportions of lateral ankle sprains were used to describe injury incidence by sport, event type (practices, competitions), season segment (preseason, regular season, postseason), injury mechanism (player contact, noncontact, and surface contact, injury history (new, recurrent), and time loss (time loss [≥1 day], non-time loss). Injury rate ratios (IRRs) were used to examine differential injury rates, and injury proportion ratios (IPRs) were used to examine differential distributions. RESULTS A total of 3910 lateral ankle sprains were reported (4.61 per 10,000 athlete exposures) during the study period, and the overall rate was highest in men's basketball (11.82 per 10,000 athlete exposures). The competition-related injury rate was higher than the practice-related rate (IRR, 3.24; 95% CI, 3.04-3.45), and across season segments, the overall rate was highest in preseason (4.99 per 10,000 athlete exposures). Lateral ankle sprains were most often attributed to player-contact mechanisms in men's (43.2%) and women's sports (35.1%), although injuries were more prevalently attributed to player contact in men's than in women's sports (IPR, 1.23; 95% CI, 1.13-1.34). Overall, 49.7% of all lateral ankle sprains were time loss injuries. CONCLUSIONS The findings of this study are consistent with previous epidemiological investigations of lateral ankle sprains among NCAA athletes. Results offer additional context on differential injury mechanisms between men's and women's sports and on injury risk across the competitive season. Future research may examine the effectiveness of deploying injury prevention programs before the start of a season.
Collapse
Affiliation(s)
- Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Reagan E Moffit
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Alexandra F DeJong Lempke
- Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.,University of Michigan School of Kinesiology, Ann Arbor, Michigan, USA
| | - Adrian J Boltz
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA.,Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Hannah J Robison
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christy L Collins
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Erik A Wikstrom
- Motion Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
3
|
Muacevic A, Adler JR. Examination of Ankle Trauma in United States Military Members: A Scoping Review. Cureus 2022; 14:e32175. [PMID: 36605064 PMCID: PMC9809033 DOI: 10.7759/cureus.32175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/03/2022] [Indexed: 12/05/2022] Open
Abstract
Military members, along with their injuries and expectations to return to duty, vary significantly from the general population. The purpose of this scoping review is to examine current literature pertaining to ankle injuries in United States military members and identify the research gaps. A scoping review was carried out with the PRISMA-ScR guidelines. A systematic search was utilized on three databases: PubMed, AMED, and Cochrane Library. The papers included were those of ankle injuries in the military. Exclusionary criteria included papers that did not have quantitative data, no full paper availability and non-US military. One hundred and fifty articles were screened, with nine meeting the inclusion criteria. Almost all of these were cohort by design. The focus was on a variety of tests for returning to active duty and the risks associated with individual factors for each service member. The study identified a lack of randomized control trials, underrepresentation of vulnerable subgroups within the US military, and no single test for ankle mobility and strength to return to duty. Prioritizing these deficiencies may help to save time and money within the US military healthcare system.
Collapse
|
4
|
Dias S, Lewis TL, Alkhalfan Y, Ahluwalia R, Ray R. Current concepts in the surgical management of chronic ankle lateral ligament instability. J Orthop 2022; 33:87-94. [PMID: 35874042 PMCID: PMC9305620 DOI: 10.1016/j.jor.2022.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022] Open
Abstract
Background/aims Ankle sprains are common injuries which can lead to chronic lateral ankle ligament instability (CAI). Methods The aim of this review is to provide a comprehensive overview of the epidemiology, pathophysiology, investigation, surgical management and rehabilitation of CAI. Results Investigation of CAI is based on history, clinical examination, and imaging. Surgical management of CAI can be defined as anatomic reconstruction, anatomic and non anatomic repair of ATFL and/or CFL. Anatomic repair has been shown to have better functional outcomes and less secondary osteoarthritis when compared to non anatomic repair. Non-anatomic methods do not replicate the normal anatomical course of ATFL/CFL and may lead to stiffness. The most common surgical treatment for CAI is the open modified Broström repair augmented with the Gould modification. There are arthroscopic techniques being developed which have reported promising clinical results. However, there are considerable areas of further research which should be carried out to improve understanding and effectiveness of current treatment options. Standardised validated patient reported outcome measures and evidence-based protocols in the rehabilitation periods are crucial for positive and reproducible outcomes. Conclusion Surgical repair has proven to show excellent outcomes for patients suffering from CAI, however larger prospective studies should be carried out to evaluate the use of newer surgical techniques.
Collapse
Affiliation(s)
- Shiluka Dias
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Thomas L. Lewis
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Raju Ahluwalia
- King's College Hospital MTC, London; King's College Hospital Diabetic Foot Unit & King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Robbie Ray
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
5
|
Russell Esposito E, Farrokhi S, Shuman BR, Sessoms PH, Szymanek E, Hoppes CW, Bechard L, King D, Fraser JJ. Uneven treadmill training for rehabilitation of lateral ankle sprains and chronic ankle instability: a pragmatic randomized controlled trial (Preprint). JMIR Res Protoc 2022; 11:e38442. [PMID: 35731551 PMCID: PMC9260521 DOI: 10.2196/38442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 12/26/2022] Open
Abstract
Background Lateral ankle sprains (LASs) are common injuries among military service members. Approximately 40% of individuals with an LAS progress to develop chronic ankle instability (CAI), a condition that results in substantial mechanical and neurophysiological impairment and activity limitation. Since proprioceptive and balance training improve functional outcomes and prevent secondary injury following LAS, they are recommended in clinical practice. Uneven treadmills are an innovative modality that challenge the sensorimotor system while performing an ecologically valid task simulating environments frequently encountered by service members with LAS and CAI. Objective The aim of this study is to evaluate whether the inclusion of uneven treadmill training in standard rehabilitation can improve clinical, functional, biomechanical, and patient-reported outcomes compared with the standard of care alone in service members with LAS and CAI. The prophylactic effects of treatment on secondary injury and identification of any contributing or mediating factors that influence outcomes following treatment will also be evaluated. We hypothesize that service members receiving uneven treadmill training will demonstrate greater improvements in clinical and instrumented measures of impairment, patient-reported function, and lower risk of injury recurrence than the control group immediately post and 18 months following treatment. Methods A multisite, parallel randomized clinical trial will be performed among service members aged 18-49 years being treated for LAS and CAI in military treatment facilities in the United States. Participants randomly assigned and allocated to receive the experimental intervention will be provided up to 12 sessions of training on an uneven terrain treadmill over a 6-week treatment course to supplement standard rehabilitation care. Treatment intensity of the rehabilitation exercises and treadmill training will be progressed on the basis of patient-perceived intensity and treatment responses. Outcome measures will include patient-reported outcomes, functional assessments, performance measures, and biomechanical measures. Investigators collecting outcome measures will be blinded to treatment allocation. Reinjury rates and patient-reported outcomes of function will be tracked over 18 months following treatment. Results The project was funded in September 2020. Patient recruitment began in November 2021, with 3 participants enrolled as of February 2022. Dissemination of the main study findings is anticipated in 2024. Conclusions This study will assess the impact of an innovative uneven-terrain treadmill on treatment outcomes in the rehabilitation of service members with LAS and CAI. The results of this study will be used to inform rehabilitation practices and to potentially improve functional outcomes and secondary prevention in this patient population. Trial Registration ClinicalTrials.gov NCT04999904; https://clinicaltrials.gov/ct2/show/NCT04999904?term=NCT04999904 International Registered Report Identifier (IRRID) DERR1-10.2196/38442
Collapse
Affiliation(s)
- Elizabeth Russell Esposito
- Department of Defense -Veterans Affairs Extremity Trauma and Amputation Center of Excellence, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX, United States
- Center for Limb Loss and Mobility, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
- Department of Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, MD, United States
| | - Shawn Farrokhi
- Department of Defense -Veterans Affairs Extremity Trauma and Amputation Center of Excellence, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX, United States
- Department of Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, MD, United States
- Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, CA, United States
| | - Benjamin R Shuman
- Center for Limb Loss and Mobility, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
- Henry M Jackson Foundation, Bethesda, MD, United States
| | - Pinata H Sessoms
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, United States
| | - Eliza Szymanek
- Madigan Army Medical Center, Joint Base Lewis-McChord, WA, United States
- Doctoral Program in Physical Therapy, Army-Baylor University, U.S. Army Medical Center of Excellence, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX, United States
| | - Carrie W Hoppes
- Doctoral Program in Physical Therapy, Army-Baylor University, U.S. Army Medical Center of Excellence, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX, United States
- San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, United States
| | - Laura Bechard
- Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, CA, United States
- Henry M Jackson Foundation, Bethesda, MD, United States
| | - David King
- Henry M Jackson Foundation, Bethesda, MD, United States
| | - John J Fraser
- Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, CA, United States
- Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, United States
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, United States
| |
Collapse
|