Rehabilitation for Chronic Ankle Instability With or Without Destabilization Devices: A Randomized Controlled Trial

Abstract

Context: Individuals with chronic ankle instability (CAI) have deficits in neuromuscular control and altered movement patterns. Ankle-destabilization devices have been shown to increase lower extremity muscle activity during functional tasks and may be useful tools for improving common deficits and self-reported function.

Objective: To determine whether a 4-week rehabilitation program that includes destabilization devices has greater effects on self-reported function, range of motion (ROM), strength, and balance than rehabilitation without devices in patients with CAI.

Design: Randomized controlled clinical trial.

Setting: Laboratory.

Patients or other participants: A total of 26 patients with CAI (7 men, 19 women; age = 21.34 ± 3.06 years, height = 168.96 ± 8.77 cm, mass = 70.73 ± 13.86 kg).

Intervention(s): Patients completed baseline measures and were randomized into no-device and device groups. Both groups completed 4 weeks of supervised, impairment-based progressive rehabilitation with or without devices and then repeated baseline measures.

Main outcome measure(s): We assessed self-reported function using the Foot and Ankle Ability Measure. Ankle ROM was measured with an inclinometer. Ankle strength was assessed using a handheld dynamometer during maximal voluntary isometric contractions. Balance was measured using a composite score of 3 reach directions from the Star Excursion Balance Test and a force plate to calculate center of pressure during eyes-open and eyes-closed single-limb balance. We compared each dependent variable using a 2 × 2 (group × time) analysis of variance and post hoc tests as appropriate and set an a priori α level at .05. The Hedges g effect sizes and associated 95% confidence intervals were calculated.

Results: We observed no differences between the no-device and device groups for any measure. However, both groups had large improvements in self-reported function and ankle strength.

Conclusions: Incorporating destabilization devices into rehabilitation did not improve ankle function more effectively than traditional rehabilitation tools because both interventions resulted in similar improvements. Impairment-based progressive rehabilitation improved clinical outcomes associated with CAI.

Keywords: ankle sprain; impairment-based progressive rehabilitation; postural control; strength.

Figure 1.

A, Myolux Athletik (Cevres Santé, Le Bourget-du-Lac, France) and B, Myolux II (Cevres Santé) destabilization devices.

Figure 2.

Modification to the rehabilitation paradigm to include self-reported function. Donovan L, Hertel J. A new paradigm for rehabilitation of patients with chronic ankle instability. Phys Sportsmed. 2012;40(4):41–51. Reprinted by permission of the publisher Taylor & Francis Ltd, www.tandfonline.com.

Figure 3.

CONSORT flowchart that outlines the methods used for this study.