Ankle Inversion Proprioception Impairment in Persons with Chronic Ankle Instability Is Task-Specific

Abstract

While investigators have often compared ankle proprioception between groups with and without chronic ankle instability (CAI), findings have been inconsistent. Possibly this is because ankle proprioceptive impairment in this population is task-specific. Thus, we aimed to compare ankle inversion proprioception in individuals with and without CAI in two task conditions: (i) when standing (not challenging) and (ii) when on a step-down landing (minimally-challenging). Ankle inversion proprioception was measured in both conditions for 38 recreational sport player volunteers with CAI ( n = 19) and without CAI ( n = 19). We used the Active Movement Extent Discrimination Apparatus (AMEDA) for the standing condition and the Ankle Inversion Discrimination Apparatus-Landing (AIDAL) for step-down landing. From analysis of variance (ANOVA) tests, CAI and non-CAI participants performed equally well on the AMEDA when standing; but the CAI group performed significantly worse than the non-CAI group on the AIDAL step-down landing task ( p = 0.03). Within the non-CAI group, the AIDAL proprioceptive scores, as area under the receiver operating characteristics curve (AUC), were significantly higher than their AMEDA AUC scores ( p = 0.03), while there was no significant difference between AIDAL and AMEDA AUC scores in the CAI group. Cumberland Ankle Instability Tool CAIT scores were significantly correlated with AIDAL scores (Spearman’s rho = 0.391, p = 0.015), but not with the AMEDA scores; and there was no significant correlation between the AIDAL and AMEDA scores. Thus, an ankle inversion proprioceptive deficit was evident for persons with CAI on the step-down AIDAL, and in a dose-response way, but not evident on the standing AMEDA, suggesting that ankle proprioceptive impairment is task-specific. Selected proprioceptive tests must present some minimal degree of challenge to the ankle joint in a functional task in order to differentiate CAI from non-CAI participants.

Reliability and validity of the ankle inversion discrimination apparatus during walking in individuals with chronic ankle instability

“…Only when the testing value is changed above the MDC value can the change value be considered as the effect of treatment or intervention (Portney, 2020). In the current study, the AIDAW MDC 90 values were similar to those of the AIDAL method (0.04 for both the CAI group and the non-CAI groups) (Han et al, 2021). These results suggest that the measurement error was small and that when the AIDAW is used as an evaluation tool for rehabilitation of ankle proprioception, an improvement of the AIDAW proprioceptive score greater than 0.04 can be considered as true change.…”

“…Previous research has reported comparable test-retest reliability for movement discrimination assessment devices. Specifically, the ICC values were 0.70-0.80 for CAI and non-CAI groups tested using the AIDAL (Han et al, 2021), and ICC values were 0.70-0.88 for the young and elderly groups when assessing their postural sway movement discrimination sensitivity using the Sway discrimination apparatus (SwayDA) (Chen et al, 2019). Therefore, this novel AIDAW method can be considered to be reliable for assessing ankle proprioception during walking in individuals with and without CAI.…”

“…However, although only 50% of patients go on to seek medical help (Doherty et al, 2016), nearly 40% of LAS will proceed to chronic ankle instability (CAI) (Miklovic et al, 2018). Individuals with CAI usually present with various physical deficits (Gribble et al, 2013), such as reduced range of motion (Hoch and McKeon, 2011), decreased muscle strength (Khalaj et al, 2020), altered muscle activation (Lin et al, 2021), and diminished ankle proprioception (Han et al, 2021), which together are associated with giving way sensations and recurrent ankle sprains (Alghadir et al, 2020).…”

“…Indeed, Han et al (2016) have argued that users of a proprioception test must consider its ecological validity in order for the test to reflect the natural working state of the proprioception system during normal function when interacting with the environment. Following this principle, they developed the ankle inversion discrimination apparatus for landing (AIDAL) for assessing ankle inversion proprioception during landing, because individuals with CAI usually experience giving away and recurrently sprain their ankles during landing (Han et al, 2021). Their results showed for the first time that an ankle proprioceptive measure-the AIDAL score-was significantly correlated with the ankle instability symptoms, measured by Cumberland Ankle Instability Tool (CAIT), which had a sensitivity of 80.7% and a specificity of 84.9% with a score less than 24 points the cutoff for identifying CAI patients (Li et al, 2021), and thus the AIDAL can be used to differentiate between individuals with and without CAI (Han et al, 2021).…”

“…The CAIT is a patient-reported measure and has been used widely because it can reflect the degree of ankle instability (McGee, 2020). Research has shown ankle proprioception at landing (Han et al, 2021) and going downstairs (in press) to be associated with CAIT scores. Dynamic balance can be measured by the Y Balance Test (YBT) (Hertel et al, 2006;Ko et al, 2020).…”