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P38 Evaluation of response shift in those with chronic ankle instability following a 4-week comprehensive intervention
  1. CP Powden1,
  2. JM Hoch2,
  3. BE Jamali2,
  4. MC Hoch2
  1. 1Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN, USA
  2. 2School of Physical Therapy and Athletic Training, Old Dominion University, Norfolk, VA, USA


Study Design Interrupted time-series.

Objective To examine if individuals with chronic ankle instability (CAI) experience a response shift (RS) in self-reported function following a 4 week rehabilitation program.

Background Evaluation of self-reported function is important during the rehabilitation process. RS may confound the assessment of self-reported function.

Methods and Measures Twenty adults (15 females; age=24.4±7.0 years; height=169.29±10.1 cm; weight=70.6±12.9 kg) with self-reported CAI participated. Inclusion criteria included ≥1 previous ankle sprain,≥2 episodes of giving way in the previous three months, and ≤24 on the Cumberland Ankle Instability Tool. Subjects participated in 12 intervention sessions that included balance training, ankle strengthening, and talocrural joint mobilizations over 4 weeks. Subjects also completed daily home ankle strengthening and gastroc-soleus complex stretching. Patient-reported outcomes (PRO) were assessed before the intervention (pre-intervention), 24–48 hours following intervention cessation (post-intervention), and 2 weeks following intervention cessation (follow-up). At post-intervention and follow-up, participants completed retrospective evaluations of their baseline function (then-test-post-intervention, then-test-follow-up) to assess RS. PROs included the Foot and Ankle Ability Measure (FAAM) ADL, FAAM-Sport, modified Disablement of the Physically Active scale (mDPA), and Fear-Avoidance Belief Questionnaire (FABQ). One-way ANOVAs evaluated the presence of RS (pre-intervention, then-test-post-intervention, then-test-follow-up). Two-way ANOVAs examined differences in RS adjusted change (then-test-post-intervention – post-intervention; then-test-follow-up – follow-up) and traditional change (pre-intervention – post-intervention; pre-intervention – follow-up). Alpha was set a-priori at p≤0.05.

Results RS was not identified for any PRO, p>0.124 (FAAM-ADL: pre-intervention=88.63%±8.07%, then-test-post-intervention=86.79%±9.66%, then-test-follow-up=86.37%±9.90%; FAAM-Sport: pre-intervention=80.16%±10.20%, then-test-post-intervention=77.97%±13.47%, then-test-follow-up=76.41%±12.88%; mDPA-Physical: pre-intervention=13.25±7.75, then-test-post-intervention=14.80±8.63, then-test-follow-up=16.45±8.44; FABQ-Physical: pre-intervention=12.6±4.22, then-test-post-intervention=11.5±5.22, then-test-follow-up=10.80±5.31). Greater RS adjusted change was only identified for the FAAM-ADL (p=0.032). A significant time main effect for the mDPA-Physical (p=0.032) indicated greater change at follow-up regardless of change type. No other significant results were identified (p>0.070).

Conclusion RS did not occur in individuals with CAI following conservative rehabilitation. Traditional assessment of self-reported function is accurate for evaluating the short-term effects of rehabilitation.

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