THE EFECTIVENESS OF FOCUS OF ATTENTION IN STATIC BALANCE AND FUNCTIONAL ABILITY OF PATIENTS WITH CHRONIC ANKLE INSTABILITY

A. Christakou^1,2, A. Gkikopoulou², E. Iosif², G. Gioftsos²

¹University of Peloponnese, Physiotherapy, Sparta, Greece, ²University of West Attica, Physiotherapy, Athens, Greece

Background: Every ankle sprain, regardless of its degree, has up to 40% chance of resulting in Chronic Ankle Instability (CAI), a condition in which balance and functional ability may be decreased. Research shows that in various clinical and not populations the focus of patients’ attention during the physiotherapy program can affect the rehabilitation results.

Purpose: The purpose of the study was to examine the effectiveness of the focus of attention on static balance and functional ability in individuals with CAI.

Methods: Fourteen subjects with CAI, of both genders, aged from 19 to 25 years old, were randomly assigned to two groups: (a) external focus of attention group (n=7) (EFA) and (b) internal focus of attention group (n=7) (IFA). All participants signed a consent form andcompleted the Cumberland Ankle Instability Tool to confirm the existence of CAI. A series of static balance and functional ability tests (i.e., Foot Lift Test, Time in Balance Test, Side Hop test, 8-Figure test, SEBT) were performed as a pre-intervention evaluation. The participants practiced on a balance board 3 times per week for a period of 4 weeks. While on the board they followed instructions leading them either to use an EFA or an IFA, regarding their randomization. At the end of each week, they performed static balance and functional ability’s evaluation tests.

Results: The results of Repeated Measures ANOVA (Mixed ANOVA) and Friedman’s test showed a statistically significant improvement through the weeks of the intervention program in both groups of the study (a) in static balance (F (2.48, 29.85)=43.88 p<0.001 for the Foot Lift Test and F (2.57, 30.85) =11.18, p<0.001 for the Time in Balance Test) and (b) in functional ability (for the IFA group Χ²(4)=16.22, p<0.05, Χ²(4)=21.02, p<0.001 for the Side Hop test and 8-Figure test respectively; for the EFA group Χ²(4)=21.03, p<0.001, Χ²(4)=22.51 (p<0.001 for the Side Hop test and 8-Figure test, respectively, for the SEBT for the IFA group Χ²(4)=12.05, p<0.05, Χ²(4)=14.51, p<0.05, Χ²(4)=17.94, p<0.05 for the anteromedial, medial and posteromedial direction, respectively, for the EFA group Χ²(4)=16.57, p<0.05, Χ²(4)=23.65, p<0.001, Χ²(4)=10.17, p<0.05 for the anteromedial, medial and posteromedial direction, respectively). No significant differences were found on either static balance or on functional ability between the two groups of attention.

Conclusions: Even though there were no statistically significant differences between the two groups, both types of focus of attention contributed to the improvement of static balance and functional ability. That indicates an increase of motor control and neuromuscular ability of the participants with CAI. Further research should be conducted to investigate the insight psychophysiological processes of focus of attention during the rehabilitation of a musculoskeletal injury.

Implications: The findings suggest that incorporating commands that engage and direct the focus of attention during the rehabilitation program of patients with acute or chronic musculoskeletal injuries might help physiotherapists to achieve their rehabilitation goals easier and more quickly.

Funding acknowledgements: None

Keywords:
Ankle instability
Attentional focus
Balance

Topics:
Musculoskeletal: lower limb
Disability & rehabilitation
Orthopaedics

Did this work require ethics approval? Yes

Institution: University of West Attica Athens Greece

Committee: Human Research Ethics Committee

Ethics number: 44805/30-06-2020