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Although altered biomechanics has been well documented as an impairment associated with chronic ankle instability (CAI), effective interventions targeting biomechanics with long-term outcomes measuring patient-reported outcomes (PROs) are absent. Evidence suggests that external focus of attention (ExFOCUS), internal focus of attention (InFOCUS) feedback, and auditory feedback during movement training can alter biomechanics in other patient populations, with ExFOCUS and auditory enhancing retention of learned biomechanics. Therefore, this randomized controlled trial will determine if a 4-week (12 session) impairment-based rehabilitation program that includes feedback (ExFOCUS or InFOCUS or Auditory) can (1) decrease ankle inversion kinematics and lateral plantar pressure during walking and (2) improve self-reported function.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ExFOCUS Visual | Experimental | Participants will complete 12 sessions over 4-weeks of impairment-based rehabilitation that incorporates ankle range of motion, ankle strength, balance, and functional activity exercises. For the balance and functional activity exercises, participants will use traditional instability tools and will receive external focus of attention visual feedback. |
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| ExFOCUS Auditory | Experimental | Participants will complete 12 sessions over 4-weeks of impairment-based rehabilitation that incorporates ankle range of motion, ankle strength, balance, and functional activity exercises. For the balance and functional activity exercises, participants will use traditional instability tools and will receive auditory feedback. |
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| InFOCUS Visual | Experimental | Participants will complete 12 sessions over 4-weeks of impairment-based rehabilitation that incorporates ankle range of motion, ankle strength, balance, and functional activity exercises. For the balance and functional activity exercises, participants will use traditional instability tools and will receive internal focus of attention visual feedback via video. |
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| NoFeedback | Active Comparator | Participants will complete 12 sessions over 4-weeks of impairment-based rehabilitation that incorporates ankle range of motion, ankle strength, balance, and functional activity exercises. For the balance and functional activity exercises, participants will use traditional instability tools and receive no feedback. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| External focus of attention visual feedback | Other | Patients will receive external focus of attention visual feedback during the impairment-based rehabilitation program. |
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| Measure | Description | Time Frame |
|---|---|---|
| Changes from baseline in lower extremity kinematics and kinetics during walking | Ankle, knee, and hip motion and moments during walking measured by a 3D motion capture system and in shoe plantar pressure system | Immediate post-intervention, 1-month post-intervention, 3-months post-intervention |
| Changes from baseline in self-reported ankle function | Changes from baseline in self-reported function as measured by the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living and Sport questionnaire. Scores range from 100% (no decrease in function) to 0% (complete loss of function). | Immediate post-intervention, 1-month post-intervention, 3-months post-intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Changes from baseline in ankle range of motion measured in degrees | Four different ankle ranges of motion will be measured | Immediate post-intervention, 1-month post-intervention, 3-months post-intervention |
| Changes from baseline in ankle maximum voluntary isometric strength |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| UNC Charlotte | Charlotte | North Carolina | 28223 | United States |
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| External focus of attention auditory feedback | Other | Patients will receive external focus of attention auditory feedback during the impairment-based rehabilitation program. |
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| Internal focus of attention video feedback | Other | Patients will receive internal focus of attention visual feedback during the impairment-based rehabilitation program. |
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| No feedback | Other | Patients will receive no feedback during the impairment-based rehabilitation program. |
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Ankle maximum voluntary isometric strength will be measured during four different ankle positions using a hand-held dynamometer. |
| Immediate post-intervention, 1-month post-intervention, 3-months post-intervention |
| Changes from baseline in static and dynamic balance | Static balance will be measured via a force plate and dynamic balance will be measured using the Star Excursion Balance Test | Immediate post-intervention, 1-month post-intervention, 3-months post-intervention |
| ID | Term |
|---|---|
| D016512 | Ankle Injuries |
| ID | Term |
|---|---|
| D007869 | Leg Injuries |
| D014947 | Wounds and Injuries |
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