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J. Takatalo1,2, H. Kylmä3, T. Somervuori4, J. Turunen5, M. Kytömäki6,7
1Loisto Terveys, Oulu, Finland, 2Medical Research Center Oulu, Oulu, Finland, 3Coronaria FysioJärvenpää, Järvenpää, Finland, 4Coronaria Kotkan OMT-Fysio, Kotka, Finland, 5Fysioterapia-OMT Porvoo, Porvoo, Finland, 6Terveystalo, Helsinki, Finland, 7Mehiläinen, Helsinki, Finland
Background: Inversion injury of the ankle (i.e. ankle sprain) is one of the most common musculoskeletal injury. Typically, inversion injury recovers within a week, however, more than one third of the patients will develop chronic ankle instability. Therefore, the physical assessment of the ankle may be important in patients with ankle pain after two weeks after the ankle sprain.
Purpose: The aim of this study is to determine the reliability of the tests used in physical examination in chronic ankle instability.
Methods: Two physical therapists (A and B) performed seven physical examination tests to evaluate ankle function in one session in the same day. The physical therapist A performed the same physical examination 6 to 14 days later. Questionnaires (Foot and Ankle Ability Measure, FAAM, Patient Specific Functional Scale, PSFS and Numeric Rating Scale, NRS) on function and symptoms of ankle were used to evaluate how ankle symptoms affects subjects’ activities of daily living. The physical therapists were blinded for each other and subjects’ symptoms. The physical examinations were performed for both ankles and the order of the tests were randomized for each subject being same in consecutive examinations. The physical examination included tests for ankle mobility and muscle function. Intra-class correlation coefficiency and Cohen’s Kappa were used to analyze the reliability.
Results: Twenty-one (12 women and 9 men) subjects participated in the study. They were 42 years old (SD 14.3) and reported NRS 1, 3.2 and 2 in rest, during loading and 1–2 hours after loading, respectively. The most reliable tests were the ankle mobility tests such as weight bearing lunge test (ICC 0.94–0.99; 95 % confidence interval, CI 0.79–1.00) depending whether the test was performed with inclinometer or tape measure. Similarly, the small knee bend, evaluating the length of gastrocnemius and soleus muscles, was found to be reliable test and useful in clinical practice (Kappa 0.88-1.00 and 0.74 for inter- and intra-rater reliability, respectively). Physical examinations based on observation did not reach for high reliability, as suspected prior the study.
Conclusion(s): Physical examination in patients with chronic ankle instability is reliably in tests which uses tape measure and inclinometer. Observation-based tests may be useful for detecting the differences between ankles, but cannot used for evaluate the changes over time.
Implications: Weight bearing lunge can be used reliably in physical therapy to measure the effects of the rehabilitation of chronic ankle instability.
Funding, acknowledgements: No funding was received for this study.
Keywords: Ankle, Sprain, Reliability
Topic: Musculoskeletal: lower limb
Did this work require ethics approval? Yes
Institution: University of Helsinki
Committee: Research Ethics Committee of the Faculty of Medicine
Ethics number: 377/2019
All authors, affiliations and abstracts have been published as submitted.
