• ankle
• consensus

Within a year of first-time acute lateral ankle sprain injury, as many as 40% of individuals develop long-term injury-associated symptoms and chronic ankle instability.1 Chronic ankle instability is founded in a combination of mechanical and sensorimotor impairments, which manifest after the injury.2

Before effective management protocols for lateral ankle sprain injuries can be developed and implemented, it is pertinent that a best practice, evidence-based approach to the clinical assessment of acute lateral ankle sprain injury is established. Second to diagnosis of the acute injury, clinical assessment should establish the presence or otherwise of mechanical and sensorimotor impairments that associate with chronic ankle instability. Developing structured, best practice, evidence-based recommendations for the clinical assessment of acute lateral ankle sprain injuries could be achieved by a systematic expert opinion approach.

To this end, we convened an international and multidisciplinary research group with different levels of clinical, academic and research experience to develop and conduct a modified Delphi process among members of the executive committee of the International Ankle Consortium.

Our modified Delphi process started with an anonymous online questionnaire specifically related to the clinical assessment of acute lateral ankle sprain injuries (see online supplementary appendix). The online questionnaire consisted of a number of distinct sections including (1) participant demographics; (2) subjective assessment and patient-reported outcome measures; (3) diagnostic imaging; (4) objective assessment (including assessment of bony integrity, ligamentous integrity, range of motion, arthrokinematics, strength, neurodynamics, postural balance); and (5) performance assessment. We sent an email to all members of the executive committee of the International Ankle Consortium requesting their participation in the online questionnaire. Participants were required to complete the online questionnaire within 4 weeks of receiving the invitation email. A reminder email was sent to all participants 2 weeks after the initial invitation email.

With reference to the online questionnaire, participants were requested to respond to questions related to the importance of different constructs of the clinical assessment of acute lateral ankle sprain injuries on a scale of 1–5 (1=strongly disagree; 2=disagree; 3=no opinion; 4=agree; 5=strongly agree). They also had the opportunity to elaborate further on how they would assess certain structures or functions by providing expanded answers to open-ended questions. To establish the level of agreement, the total percentage of ‘strongly agree’ (5 on the Likert scale) and ‘agree’ (4 on the Likert scale) responses was calculated. A cut-off score of ≥75% agreement was used for consensus agreement in this round (ie, round 1) of this modified Delphi method. The responses to the online questionnaire were collated, analysed (completed August 2017) and used as the foundation for a subsequent consensus meeting of the executive committee of the International Ankle Consortium (ie, international multidisciplinary expert group). (A detailed description of the study protocol is provided in the online supplementary appendix.)

This consensus meeting (held on 14 September 2017) represented round 2 of this modified Delphi method. Results from round 1 that reached partial agreement (50%–75%) were discussed further in round 2. During round 2, the international multidisciplinary expert group reached consensus on recommendations for the clinical assessment of acute lateral ankle sprain injuries (Delahunt E et al. Clinical assessment of acute lateral ankle sprain injuries: consensus statement and recommendations of the International Ankle Consortium. Br J Sports Med; in review).

Our modified Delphi process informed the development of consensus recommendations on the clinical assessment of acute lateral ankle sprain injuries. These consensus recommendations will help clinicians to identify anomalous mechanical and sensorimotor impairments that contribute to the development of chronic ankle instability.