C. Simonin1, B. Berger2, S. Rogan1, P. Eichelberger1
1Bern University of Applied Sciences, Department of Health Professions, Physiotherapy, Bern, Switzerland, 2University of Salzburg, Department of Sport Science and Kinesiolgy, Salzburg, Austria
Background: Lateral ankle sprains (LASs) are very common injuries during sport and physical activity and up to 40% of individuals who experience a first-time LAS will possibly develop chronic ankle instability (CAI). During the COVID-19 pandemic swiss government regulations limited physical therapy with personal contact to emergency treatments. Telehealth provides the possibility to treat patients under such circumstances.
Purpose: The pilot study primarily aimed to evaluate the feasibility of a larger randomized controlled trial on exercise therapy administered by telehealth in people with CAI. Secondary, possible effects on telehealth-assessed postural control, subjective joint function, muscle force and joint mobility were evaluated.
Methods: Healthy subjects with CAI were recruited using the Identification of Functional Ankle Instability (IdFAI) questionnaire and randomly assigned to the intervention or control group. As primary outcomes, recruitment data and adherence rates were collected. Secondary outcomes included (1) postural sway during an eyes closed single limb balance test on instable surface using the Sway Balance Mobile App (SBMA), (2) weight-bearing lunge test (WBLT), (3) Foot and Ankle Ability Measure Sports and ADL subscales (FAAM-S, FAAM-ADL) and (4) standing heel rise test (SHRT). Testing was conducted via Physitrack video call by a blinded physical therapist. The intervention group completed 6 weeks of rehabilitation addressing strength, neuromuscular control, range of motion and postural control, instructed via Physitrack by a second physical therapist. After 6 weeks, all subjects were retested. Since the present work focused on the feasibility of the telehealth approach for assessment and exercise instruction, the evaluation was limited to the intervention group and was conducted descriptively.
Results: During the 14 days recruitment period, 194 persons entered the online survey. From the 80 completed surveys, 46 fulfilled the participation criteria. For economic reasons the study sample was limited to the first 21 eligible persons. The intervention group (n=11) showed a adherence rate of 92.9% and had improvements in postural control (+9.8%), muscle strength (+50.6%) and patient oriented outcomes (FAAM-S/ADL: +6.9%/+1.9%).
Conclusion(s): The study design can be chosen for further work with larger samples. Recommendations for small adjustments include monitoring the full dosage of exercise therapy and an adjusted timing of the telehealth appointments. Remote assessment of SBMA, WBLT and SHRT showed only few difficulties but validity compared to live assessment should be verified. Ceiling effects of SBMA and FAAM complicate evaluation of positive effects and should be diminished by adding a questionnaire of self-reported function to inclusion criteria. Nevertheless, the generic active training program showed positive tendencies on postural control, muscle strength and patient-oriented outcome. It is assumed that changes are partially clinically relevant. As an alternative, a study design with a findings-based treatment approach should be considered in order to respect the complexity and individuality of persons with CAI as well as physiotherapy practice.
Implications: Telehealth therapy is a possible supplement, but not a substitute to personal therapy.
For existing therapeutic relationships, telehealth may support physical therapists to provide treatment during extreme situations such as the COVID-19 pandemic.
Within research, telehealth could ease the recruitment of participants.
For existing therapeutic relationships, telehealth may support physical therapists to provide treatment during extreme situations such as the COVID-19 pandemic.
Within research, telehealth could ease the recruitment of participants.
Funding, acknowledgements: This study was supported by a grant from physiobern, the Physiotherapists Association of the Canton of Bern, Switzerland.
Keywords: chronic ankle instability, telehealth, exercise therapy
Topic: Innovative technology: information management, big data and artificial intelligence
Did this work require ethics approval? No
Institution: Gesundheits-, Sozial- und Integrationsdirektion des Kantons Bern
Committee: KEK-BE Req-2020-00248
Reason: According to the ethics committee, study did not fall under the Swiss Federal Act on Research involving Human Beings.
All authors, affiliations and abstracts have been published as submitted.
