Selection Criteria for Patients With Chronic Ankle Instability in Controlled Research: A Position Statement of the International Ankle Consortium

Abstract

The International Ankle Consortium is an international community of researchers and clinicians whose primary scholastic purpose is to promote scholarship and dissemination of research-informed knowledge related to pathologies of the ankle complex. The constituents of the International Ankle Consortium and other similar organizations have yet to properly define the clinical phenomenon known as chronic ankle instability (CAI) and its related characteristics for consistent patient recruitment and advancement of research in this area. Although research on CAI and awareness of its impact on society and healthcare systems have grown substantially in the last 2 decades, the inconsistency in participant/patient selection criteria across studies presents a potential obstacle to addressing the problem properly. This major gap within the literature limits the ability to generalize this evidence to the target patient population. Therefore, there is a need to provide standards for patient/participant selection criteria in research focused on CAI, with justifications using the best available evidence. J Orthop Sports Phys Ther 2013;43(8):585–591. doi:10.2519/jospt.2013.0303

The improvement of postural control in patients with mechanical ankle instability after lateral ankle ligaments reconstruction

“…"giving way") or signs of inflammation (e.g. pain and swelling) for at least 12 months; (2) at least one interrupted day of desired physical activity [8];…”

“…The exclusion criteria for the patients were as follows: (1) previous injury or surgery to the lower limb; (2) balance or motion disorder; (3) cavus feet; (4) tendon injury of the lower leg or ankle; (5) required use of foot orthotics; (6) any open wound on the foot [22]; (7) grade IV chondral injury; (8) ankle arthritis; (9) neurologic disease; (10) bilateral ankle disease; (11) vestibular problems; and (12) acute injury to musculoskeletal structures of other joints of the lower extremity during the previous 3 months that affected joint integrity and function [8]. Also, if the lateral ligaments were seen to be completely absorbed on US and MRI examinations, the patients were excluded from the study.…”

Postural stability and lower leg muscle activity during a diagonal single-leg landing differs in male collegiate soccer players with and without functional ankle instability

“…The exclusion criteria were as follows: (a) history of surgery on musculoskeletal structures, and/or fracture, requiring realignment of either lower limb; (b) acute injury to the musculoskeletal structures of another lower extremity joint, in the previous three months, which impacted joint integrity and function, resulting in at least one day of interrupted desired physical activity; and (c) daily performance of balance training. This final criterion is based on the International Ankle Consortium 25) . Performance of balance training was included in the exclusion criteria as soccer players with FAI improved their postural stability after ankle disk training 26) .…”

Fibular taping does not alter lower extremity spinal reflex excitability in individuals with chronic ankle instability

“…Inclusion criteria for CAI was defined as recurrent episodes of ankle instability following at least a single lateral ankle sprain and decreased patient reported function, defined as either a FAAM Sport measure less than 85% (Martin et al, 2005) or scoring 3 or greater on the Ankle Instability Instrument (Docherty et al, 2006). Both forms are often used to discriminate between individuals with and without CAI (Gribble et al, 2013). Lower FAAM Sport scores are indicative of decreased self-reported function while higher Ankle Instability Instrument scores indicate likelihood of ankle instability.…”