Blog Post Author Biography: Dr. Cameron Powden is an Associate Professor in the Department of Athletic Training at the University of Indianapolis. Dr. Powden’s interests include the investigation of clinically relevant interventions for ankle sprains and chronic ankle instability.

Citation: Powden CJ, Koldenhoven RM, Simon JE, et al. Participant-Level Analysis of the Effects of Interventions on Patient-Reported Outcomes in Patients With Chronic Ankle Instability. Journal of Sport Rehabilitation. 2023;32(2):124-132. DOI: 10.1123/jsr.2022-0053

Take-to-the-clinic message: This investigation matches previous literature indicating that the available chronic ankle instability (CAI) interventions are capable of improving self-reported ankle function, global well-being, and injury-related fear at the group level for patients with CAI. This study uniquely assessed individual level responses of patients with CAI to multimodal interventions. Between 13.8% and 53.3% of patients demonstrated improvements, for individual patient-reported outcomes (PROs), that exceeded the minimal detectable change (MDC) of the measure. These findings signify that individually, we may hope to only have about half of our patients have meaningful improvements following intervention.

Background: CAI intervention studies have often focused on improving physical impairments of the ankle complex. Recently, increased emphasis has been placed on the sensory-perceptual impairments associated with CAI. This has resulted in CAI investigations examining the health-related quality of life (HRQoL) through PROs of those with CAI, and the influence of intervention on such PROs. While most studies have assessed self-reported ankle function and through the lens of group level response, there is a need to investigate the impact of interventions on other aspects of HRQoL (such as global well-being and injury-related fears) and the individual level response to treatment within those with CAI.

Purpose: To evaluate improvements in multiple domains of HRQoL, self-reported ankle function, global well-being, and injury-related fear, following multimodal interventions in patients with CAI by using group- and participant-level responder analyses.

Methods: A secondary analysis was completed on a compiled data set of original, participant-level data from seven previously published investigations. Each of the investigations investigated self-reported function in patients with CAI. A total of 136 physically active individuals with self-reported CAI were included in the analysis. These individuals underwent a wide range of multimodal interventions that ranged from 1 to 6 weeks in length, 1 to 12 supervised sessions, and may have included a home intervention component. PROs included were the Foot and Ankle Ability Measure (FAAM) ADL and Sport, Tampa Scale of Kinesiophobia-11 (TSK-11), Fear Avoidance Belief Questionnaire (FABQ) and the Disablement in the modified Physically Active Scale (mDPA) physical summary component (PSC) and the mental summary component (MSC). The research team examined preintervention to postintervention changes in each PRO, as well as effect sizes (ES) and individual-level response rates through changes exceeding published MDCs.

Results: There was significant improvement in ankle-specific function following intervention that was associated with strong ESs and responder rates of 39.0% to 53.3%. There was a significant reduction in injury-related fear following intervention that was associated with moderate to strong effects and responder rates of 13.8% to 51.4%. Finally, there was a significant improvement in global well-being that was associated with strong effects and responder rates of 31.3%. 

Rolling the field forward: This investigation is part of the expanding evidence regarding interventions for those with CAI. It builds on previous multimodal intervention studies by combining various intervention protocols to allow for robust group and individual level analysis. The findings indicate that patients with CAI exhibit holistic HRQoL improvements following varied interventions. This investigation continues the exploration into individual-level responses within the CAI population. Further research is needed to better understand the clinical impact of this new form of analysis. Lastly, to enhance the ability to examine CAI interventions, at the group and individual level, there is a need to identify common clinician-, laboratory-, and patient-oriented outcome measures to allow for robust and comparative analysis.

Question for the researchers: What interventions would be beneficial for CAI patients to enhance aspects of HRQoL? How do researchers and clinicians work to develop common outcome measures to explore? Can the individual level responder analysis be used in clinical practice to examine patient progress?