Tag: Functional Tests

‌Low Ankle-GO Score While Returning to Sport After Lateral Ankle Sprain Leads to a 9-fold Increased Risk of Recurrence: A Two-year Prospective Cohort Study

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Blog Post Author Biography: Lauren Forsyth is a Research Associate in the department of Biomedical Engineering at the University of Strathclyde and a Strength and Conditioning Coach. Dr Forsyth’s research aims to develop objective functional assessment techniques and rehabilitation interventions for people with chronic ankle instability.

Citation: Picot B, François Fourchet, Lopes R, et al. Low Ankle-GO Score While Returning to Sport After Lateral Ankle Sprain Leads to a 9-fold Increased Risk of Recurrence: A Two-year Prospective Cohort Study. Sports Medicine – Open. 2024;10(1). doi: 10.1186/s40798-024-00693-w

Take-to-the-clinic message: The Ankle-GO score is an objective assessment of functional performance and self-reported function which can be used to guide return to sport (RTS) decisions after lateral ankle sprain (LAS) and inform clinical management. When patients scored low of the Ankle-GO their 2-year risk of ankle sprain recurrence was nine times higher. Women also tended to have a fourfold higher risk of reinjury within two years, despite an initial Ankle-GO score comparable to men. Clinicians should therefore be more cautious of lower scores for women.

Background: Lateral ankle sprain (LAS) reported as the most common sports-related injury, followed by high recurrence and development of CAI. Despite impairments and residual functional deficiencies, research shows that nearly 50% of patients return to sport (RTS) within three days after LAS, and 80% within a week. However, there is no published evidence-based criteria to guide a patient’s return to sport (RTS), which may explain the high recurrence. The Ankle-GO™ is a valid and reliable score which aims to score patients to facilitate a safe RTS, while minimising the risk of recurrent injuries.

Purpose: The aim of this study was to assess the efficacy of the Ankle-GO – a new functional score for LAS – to distinguish patients at risk of recurrent LAS within two years after the initial injury.

Methods: The study recruited 64 patients (36 Male/28 Female) from the same clinic from January-August 2021. All participants were recruited within one month of initial LAS, and, following consultation, each participant received personalised rehabilitation for 8 weeks.  Two months after LAS each participant completed the Ankle-GO score. The Ankle-GO score includes two self-reported questionnaires (The Foot and Ankle Ability Measure and the Ankle Ligament Reconstruction-Return to Sport after Injury) and four functional tests (single-leg stance test, modified star excursion balance test, side hop test, and figure-of-8 test). Each item is scored with a maximum total score of 25 points. A lower score indicates lower function. The rate of reinjury was recorded two years following the initial injury. Fifty-four participants (23 Male/31 Female) reported whether they had suffered a recurrent LAS (ie. a new LAS of the same location and type), and the mechanism of the reinjury (ie. contact or non-contact).

Results: Eighteen participants suffered a reinjury (33.3%) with non-contact mechanisms at the two-year follow up. The Ankle-GO score at two-months post-LAS was lower in patients with a recurrent LAS (by 3.7 points) and predicted the risk of reinjury. An Ankle-GO score of less than eight points indicated a 9-times higher risk of recurrent LAS. The same cut-off score (8 points) identified a return to preinjury level of sports four months after LAS. Women and men reported comparable Ankle-GO scores, however women tended to have a 4-times higher risk of recurrent LAS after two years.

Rolling the field forward: The Ankle-GO score offers a new objective criterion for RTS after LAS. This can aid clinical decision making to address the high recurrence rates of LAS. These recurring injuries are often explained by a lack of informed guidance to RTS.

Recently the PAASS framework was published to inform the RTS decision (PAASS: Pain, Ankle impairments, Athlete perception, Sensorimotor control, Sport/functional performance). The Ankle-GO is a step to establishing a specific objective criterion. It should be noted that the Ankle-GO does not include all items related to the PAASS framework. Thus, to gain a broader perspective during clinical assessment the Ankle-GO score may need to be used in conjunction with other clinical assessments.

Question for the researchers: The ANKLE-GO was conducted on participants two months following initial injury, and after a personalized rehabilitation plan had been administered. Do the researchers know how the personalized programme affected the Ankle-GO scores, and do they have a recommended time point for clinicians of when the Ankle-GO could be used? As a result, how may this affect the reinjury risk for patients?

Use of Functional Tests to Predict Ankle Instability Development

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Blog Post Author Biography: Luke Donovan is an Associate Professor at the University of North Carolina at Charlotte in the Department of Applied Physiology, Health, and Clinical Sciences and a certified athletic trainer. Dr. Donovan’s research aims to develop clinical measurement techniques for assessing gait and rehabilitation strategies among patients with chronic ankle instability.

Citation: Shein Lumbroso D, Gottlieb U, Zimmerman DR, Springer S. Functional tests as predictors of ankle instability six months after an acute lateral ankle sprain. J Sports Med Phys Fitness. 2023 Apr;63(4):570-579. doi: 10.23736/S0022-4707.22.14395-1.

Take-to-the-clinic message: Following an acute lateral ankle sprain, balance performance on foam in tandem stance, willingness to perform a single-limb drop landing task, and limb-dominance of the injured ankle were associated with the development of ankle instability 6-months after the initial injury. Clinicians can use these functional tasks and descriptive information to identify patients that may be at a greater risk of experiencing residual symptoms following a lateral ankle sprain. 

Background: Lateral ankle sprains (LAS) are one of the most common musculoskeletal injuries among individuals who are physically activity. It has been estimated that as high as 2 out of 3 individuals who experience a LAS develop a long-term condition characterized by repetitive ankle sprains and/or feelings of instability known as chronic ankle instability (CAI). Identifying individuals at risk of developing CAI as close to the initial injury as possible may help clinicians implement rehabilitative strategies to mitigate the development of the chronic condition. Given the sensorimotor disruption affiliated with CAI, the authors hypothesized that functional tasks that require attention and cognitive demand would be capable of discriminating between individuals who recover from the LAS (copers) vs individuals who do not (ankle instability).

Purpose: The purpose of this study was to prospectively determine whether performance on various functional tasks within 3-weeks of an acute LAS, as well as other demographic information could predict ankle instability outcomes 6-months after the initial injury. Specifically, the authors evaluated performance on the balance error scoring system (BESS) with a dual-cognitive task (Modified-BESS), a single-limb drop landing (SLDL) task and drop-vertical jump (DVJ) task.

Methods: The authors completed a prospective study of individuals who experienced a LAS within 3-weeks of data collection. To be included in the study, participants were required to be between the ages of 18 and 35. In addition, the LAS must have been associated with inflammatory symptoms and caused at least 1-day of interruption in their physical activity. 

Participants who enrolled in the study completed a one-hour data collection session. During this session, participants provided demographic information (age, gender, weight, height, injured leg, dominant leg, and physical activity). Next, participants completed the Modified-BESS, the SLDL, and the DVJ tasks. The Modified-BESS task reflected the previously reported BESS procedures (eyes closed balancing on firm/foam surfaces during double-limb, single-limb and tandem stance), but also included a dual-task component (Backward Digits Span Task). A 40-cm box was used for both the SLDL and DVJ tasks. After completing the data collection sessions, participants were contacted every month to determine whether they re-injured the involved ankle. After 6-months, participants completed the Cumberland Ankle Instability Tool (CAIT) to determine their status as either potential ankle instability or potential copers. Since a patient is not considered to be diagnosed with CAI until 12-months post-injury, the authors found the term ‘potential’ to be most appropriate.  Individuals who scored lower than a 24 on the CAIT and/or experienced any re-sprain during the follow-up period were classified as ‘potential ankle instability’. Participants who scored 24 or greater on the CAIT and did not experience any re-sprains were classified as ‘potential copers’. 

Results: Thirty-three individuals completed the study where 21 of the individuals met the potential ankle instability criteria 6-months following their initial injury. Specific to the main outcome measures, the authors found that for every 1-point increase observed on the Foam-Tandem stance task (part of the Modified BESS) increased the odds of developing ankle instability by 1.5. In addition, participants who were unwilling to complete the SLDL increased their odds of developing ankle instability by 10. Finally, individuals who sustained a LAS to their non-dominant limb had a 6 times greater odds of developing ankle instability when compared to individuals who sprained the ankle on the dominant limb. 

Rolling the field forward: The authors report that various functional tests, as well as demographic information may help clinicians prospectively identify individuals at a heightened risk of developing ankle instability 6-months after the initial injury. Clinicians can incorporate functional tasks as an evaluation tool to help guide the return to activity process.

Question for the researchers: The criteria required participants to be within 3-weeks of the LAS at the time of data collection; however, the time since injury was not reported. Did the authors observe differences in time since ankle sprain among participants? Do the authors have a recommendation as to when clinicians should incorporate these functional tasks as part of their evaluation?