Title | Response Shift After a 4-Week Multimodal Intervention for Chronic Ankle Instability. |
Publication Type | Journal Article |
Year of Publication | 2019 |
Authors | Powden CJ, Hoch MC, Jamali BE, Hoch JM |
Journal | J Athl Train |
Volume | 54 |
Issue | 4 |
Pagination | 397-402 |
Date Published | 2019 Apr |
ISSN | 1938-162X |
Keywords | Activities of Daily Living, Adult, Ankle Joint, Chronic Disease, Female, Follow-Up Studies, Humans, Joint Instability, Male, Patient Reported Outcome Measures, Physical Therapy Modalities, Range of Motion, Articular, Retrospective Studies, Time Factors, Young Adult |
Abstract | CONTEXT: The accurate evaluation of self-reported changes in function throughout the rehabilitation process is important for determining patient progression. Currently, how a response shift (RS) may affect the accuracy of self-reported functional assessment in a population with chronic ankle instability (CAI) is unknown. OBJECTIVE: To examine the RS in individuals with CAI after a 4-week multimodal rehabilitation program. DESIGN: Controlled laboratory study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty adults (5 men, 15 women; age = 24.35 ± 6.95 years, height = 169.29 ± 10.10 cm, mass = 70.58 ± 12.90 kg) with self-reported CAI participated. Inclusion criteria were at least 1 previous ankle sprain, at least 2 episodes of the ankle "giving way" in the 3 months before the study, and a score ≤24 on the Cumberland Ankle Instability Tool. INTERVENTION(S): Individuals participated in 12 intervention sessions over 4 weeks and daily home ankle strengthening and stretching. MAIN OUTCOME MEASURE(S): Patient-reported outcomes (PROs) were assessed at 4 times (baseline, preintervention, postintervention, and 2-week follow-up). At the postintervention and 2-week follow-up, participants completed then-test assessments to measure RS. Then-test assessments are retrospective evaluations of perceived baseline function completed after an intervention. The PROs consisted of the Foot and Ankle Ability Measure-Activities of Daily Living and Sport subscales, the modified Disablement in the Physically Active scale physical and mental summary components, and the Fear-Avoidance Beliefs Questionnaire Physical Activity and Work subscales. We used repeated-measures analyses of variance to compare preintervention with then-test measurements. Individual-level RSs were examined by determining the number of participants who experienced preintervention to then-test differences that exceeded the calculated minimal detectable change. RESULTS: We did not identify an RS for any PRO ( > 2.338, > .12), indicating no group-level differences between the preintervention and retrospective then-test assessments. Individual-level RS was most prominent in the Foot and Ankle Ability Measure-Sport subscale (n = 6, 30%) and the Fear-Avoidance Beliefs Questionnaire Physical Activity subscale (n = 9, 45%). CONCLUSIONS: No group-level RS was identified for any PRO after a 4-week multimodal rehabilitation program in individuals with CAI. This finding indicates that traditional assessment of self-reported function was accurate for evaluating the short-term effects of rehabilitation in those with CAI. Low levels of individual-level RS were identified. |
DOI | 10.4085/1062-6050-345-17 |
Alternate Journal | J Athl Train |
PubMed ID | 30848938 |
PubMed Central ID | PMC6522083 |