Smith M1, Al Mahrouqi M1, MacDonald D1,2, Vicenzino B1
1The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia, 2Griffith University, School of Allied Health Sciences, Gold Coast, Australia
Background: Ankle sprains and fractures are among the most common injuries sustained in sporting populations, and one significant consequence of these injuries is ankle osteoarthritis. There is suggestion that quality of life (QoL) is impaired in ankle osteoarthritis, but research is limited to individuals with end-stage disease. Recent meta-analyses revealed impaired ankle muscle strength and range of motion (ROM), and altered ankle joint alignment in ankle osteoarthritis. Although the correlation between radiographic evidence of osteoarthritis and symptoms/impairments is generally poor in many joints in the body, this has not been investigated at the ankle.
Purpose: This cross-sectional study compared physical measures and patient-reported outcomes between individuals with symptomatic radiographic ankle osteoarthritis and asymptomatic individuals. Secondary aims were to compare these outcomes in asymptomatic individuals with and without radiographic evidence of ankle osteoarthritis, and to identify associations between outcomes and health-related QoL.
Methods: Thirty-one symptomatic individuals with persistent pain, stiffness and radiographic ankle osteoarthritis and 65 asymptomatic individuals (41 with radiographic ankle osteoarthritis and 24 with no radiographic ankle osteoarthritis) participated in this study (n=96). Participants completed timed walking, stair ascent/ descent, ankle muscle strength, heel raise endurance, dorsiflexion ROM, ankle arthrokinematics, foot posture and mobility testing. An online survey of QoL, function, pain, disability, kinesiophobia, ankle instability and physical activity was also completed.
Results: There were moderate to very large effects for lower ankle muscle strength and heel raise endurance, and less dorsiflexion ROM in individuals with symptomatic ankle osteoarthritis compared to asymptomatic individuals. Walking speed and stairs ascent/decent were slower in individuals with symptomatic ankle osteoarthritis than individuals without symptoms. Symptomatic individuals with ankle osteoarthritis reported greater disability, pain, instability and kinesiophobia, and lower patient reported function and QoL than asymptomatic individuals (all moderate to large effects). There were no differences in physical outcomes between asymptomatic individuals with and without radiographic ankle osteoarthritis, except for less anterior displacement on arthrometry in the asymptomatic ankle osteoarthritis group. Overall QoL, function, pain, disability, kinesiophobia, ankle instability and physical activity were similar between asymptomatic groups. Ankle joint symptoms (ankle pain and/or stiffness) and stair ascent/descent times were significantly associated with health-related QoL.
Conclusion(s): Symptomatic ankle osteoarthritis has a significant negative impact on QoL, function and disability. Persistent ankle symptoms (pain and stiffness), but not the presence of radiographic ankle osteoarthritis, is associated with physical impairments and poor patient-reported outcomes. QoL is related to timed stair ascent/descent ability and symptoms of pain and stiffness.
Implications: Deficits in physical and patient-reported outcomes in individuals with symptomatic ankle osteoarthritis identified in this study may inform patient management. The relationship between stair function, ankle symptoms and impaired QoL suggests that stair function should be included in the assessment of this population. Our data indicate that evidence of radiographic joint degeneration is not related to two common targets for management in ankle osteoarthritis; QoL and physical impairments.
Keywords: Ankle pain, Ankle stiffness, Radiographs
Funding acknowledgements: This trial was part funded by a National Health and Medical Research Council (NHMRC) programme grant (#631717).
Purpose: This cross-sectional study compared physical measures and patient-reported outcomes between individuals with symptomatic radiographic ankle osteoarthritis and asymptomatic individuals. Secondary aims were to compare these outcomes in asymptomatic individuals with and without radiographic evidence of ankle osteoarthritis, and to identify associations between outcomes and health-related QoL.
Methods: Thirty-one symptomatic individuals with persistent pain, stiffness and radiographic ankle osteoarthritis and 65 asymptomatic individuals (41 with radiographic ankle osteoarthritis and 24 with no radiographic ankle osteoarthritis) participated in this study (n=96). Participants completed timed walking, stair ascent/ descent, ankle muscle strength, heel raise endurance, dorsiflexion ROM, ankle arthrokinematics, foot posture and mobility testing. An online survey of QoL, function, pain, disability, kinesiophobia, ankle instability and physical activity was also completed.
Results: There were moderate to very large effects for lower ankle muscle strength and heel raise endurance, and less dorsiflexion ROM in individuals with symptomatic ankle osteoarthritis compared to asymptomatic individuals. Walking speed and stairs ascent/decent were slower in individuals with symptomatic ankle osteoarthritis than individuals without symptoms. Symptomatic individuals with ankle osteoarthritis reported greater disability, pain, instability and kinesiophobia, and lower patient reported function and QoL than asymptomatic individuals (all moderate to large effects). There were no differences in physical outcomes between asymptomatic individuals with and without radiographic ankle osteoarthritis, except for less anterior displacement on arthrometry in the asymptomatic ankle osteoarthritis group. Overall QoL, function, pain, disability, kinesiophobia, ankle instability and physical activity were similar between asymptomatic groups. Ankle joint symptoms (ankle pain and/or stiffness) and stair ascent/descent times were significantly associated with health-related QoL.
Conclusion(s): Symptomatic ankle osteoarthritis has a significant negative impact on QoL, function and disability. Persistent ankle symptoms (pain and stiffness), but not the presence of radiographic ankle osteoarthritis, is associated with physical impairments and poor patient-reported outcomes. QoL is related to timed stair ascent/descent ability and symptoms of pain and stiffness.
Implications: Deficits in physical and patient-reported outcomes in individuals with symptomatic ankle osteoarthritis identified in this study may inform patient management. The relationship between stair function, ankle symptoms and impaired QoL suggests that stair function should be included in the assessment of this population. Our data indicate that evidence of radiographic joint degeneration is not related to two common targets for management in ankle osteoarthritis; QoL and physical impairments.
Keywords: Ankle pain, Ankle stiffness, Radiographs
Funding acknowledgements: This trial was part funded by a National Health and Medical Research Council (NHMRC) programme grant (#631717).
Topic: Musculoskeletal: lower limb; Rheumatology
Ethics approval required: Yes
Institution: The University of Queensland
Ethics committee: The University of Queensland Human Research Ethics Committee
Ethics number: 2014001194
All authors, affiliations and abstracts have been published as submitted.
