Original research
Clinical Tests Have Limited Predictive Value for Chronic Ankle Instability When Conducted in the Acute Phase of a First-Time Lateral Ankle Sprain Injury

https://doi.org/10.1016/j.apmr.2017.11.008Get rights and content

Abstract

Objective

To evaluate whether a battery of clinical assessments for acute lateral ankle sprain (LAS) can be used to predict long-term recovery.

Setting

University biomechanics laboratory.

Participants

Individuals (N=82) were assessed using a clinical test battery within 2 weeks of incurring a first-time LAS.

Interventions

Not applicable.

Main Outcome Measures

The clinical test battery included scores on the talar glide test (degrees), the anterior drawer, talar tilt, figure of 8 for swelling (millimeters) and knee to wall (millimeters) tests, and handheld goniometric range of motion (inversion, eversion, and plantarflexion [in degrees]). Scores on the Cumberland Ankle Instability Tool taken 12 months after the clinical test battery were used to classify participants as having chronic ankle instability (CAI) or as being LAS copers.

Results

Forty percent of participants were designated as having CAI, with 60% being designated as LAS copers. A logistic regression analysis revealed that a combined model using scores from the talar glide, talar tilt, and anterior drawer tests in addition to plantarflexion range of motion was statistically significant (P<.01) and correctly classified cases with moderate accuracy (68.8%). The final model had moderate sensitivity (64%) and good specificity (72%).

Conclusions

The clinical tests used in this investigation have limited predictive value for CAI when conducted in the acute phase of a first-time LAS injury.

Section snippets

Design

This was a cohort study.

Participants

Eighty-two participants were recruited at convenience from a university-affiliated hospital emergency department within 2 weeks of sustaining an acute first-time LAS injury. All participants were provided with basic advice on applying ice and compression for the week on discharge from the emergency department. Activities of daily living were encouraged: participants were instructed to weight bear and walk within the limits of pain when possible. All participants were

Results

Descriptive statistics for the clinical tests are presented in table 2. Results of preliminary correlation analyses are presented in table 3. The potential predictors were entered into a direct logistic regression model in 1 block. Scores on the knee to wall test, figure of 8 test, eversion ROM, and inversion ROM were then removed sequentially from the model using a backward elimination technique in the optimization of its predictive capacity. The regression analysis was then repeated with the

Discussion

Findings from this study have revealed that several clinician-oriented outcomes demonstrate statistically significant predictive value for CAI development. These outcome measures were administered on a cohort of individuals within 2 weeks of incurring a first-time LAS injury. The cohort was subsequently stratified into CAI and LAS coper groups 12 months later. This cohort was simultaneously evaluated across a spectrum of movement patterns as part of another investigation, whereby biomechanical

Conclusions

This is the first analysis in which the predictive value of a clinical test battery for ankle sprain injury for determining CAI has been investigated. Although our results showed that some of these clinical tests demonstrate predictive value, the accuracy at which they identify individuals at risk of developing CAI is moderate. Further research is required to determine whether performing these tests in a less heterogenous sample of individuals, representative of the subgroups of the CAI

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    Supported by the Health Research Board (grant no. HRA_POR/2011/46).

    Disclosures: none.

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