Suttmiller Ashley M B, Johnson Kelly R, Chung Sunghoon, Gruskiewicz Vanessa M, Foreman Niara N, Reyes Matthew C, McCann Ryan S
Atlantic Orthopaedic Specialists, Virginia Beach, VA, USA.
Norfolk Christian Academy, Norfolk, VA, USA.
J Sport Rehabil. 2024 Oct 28;34(2):67-76. doi: 10.1123/jsr.2024-0049. Print 2025 Feb 1.
Chronic ankle instability (CAI) is associated with motor-behavioral and sensory-perceptual impairments, including reduced balance performance, hip strength, and ankle function, and increased disablement, and injury-related fear. Progressive balance training (BAL) and hip strengthening (HIP) can both improve balance and function, but their comparative effects are unknown. Our objective was to compare the effects of progressive BAL and HIP on balance, hip strength, and patient-reported outcomes in those with CAI.
Forty-five individuals with CAI volunteered for this randomized control study. Participants were randomly allocated to BAL, HIP, and control (CON) groups (n = 15 per group). BAL and HIP each participated in 8-week interventions while CON did not. Participants' involved limbs underwent testing of patient-reported outcomes (Foot and Ankle Ability Measure [FAAM-ADL, FAAM-S], modified Disablement in the Physically Active Scale [mDPA], Tampa Scale of Kinesiophobia-11 [TSK-11], Fear-Avoidance Beliefs Questionnaire [FABQ], and Self-Efficacy of Balance Scale [SEBS]), Star Excursion Balance Test (SEBT), and isometric hip strength (extension [EXT], abduction [ABD], and external rotation [ER]) before and after the intervention. Multiple imputation was used for missing data. Multivariate repeated-measures analyses of variance analyzed effects of the interventions.
A significant group × time interaction existed for psychosocial outcomes (P = .008), but not for balance (P = .159), strength (P = .492), or ankle function and disability (P = .128). Time main effects existed for balance (P = .003), strength (P < .001), function and disability (P < .001), and psychosocial outcomes (P = .006). BAL significantly improved in SEBT, EXT, ABD, and all patient-reported outcomes. HIP significantly improved in EXT, ABD, ER, FAAM-S, mDPA, FABQ, and SEBS.
Balance training and hip strengthening can both improve motor-behavioral and sensory-perceptual impairments in individuals with CAI; however, balance training remains the most effective option for clinicians.
慢性踝关节不稳（CAI）与运动行为和感觉知觉障碍有关，包括平衡能力下降、髋部力量减弱和踝关节功能受损，以及残疾增加和与损伤相关的恐惧。渐进性平衡训练（BAL）和髋部强化训练（HIP）都可以改善平衡和功能，但它们的比较效果尚不清楚。我们的目的是比较渐进性BAL和HIP对CAI患者平衡、髋部力量和患者报告结局的影响。
45名CAI患者自愿参加这项随机对照研究。参与者被随机分配到BAL组、HIP组和对照组（CON）（每组n = 15）。BAL组和HIP组各参加为期8周的干预，而CON组不参加。在干预前后，对参与者受累肢体进行患者报告结局测试（足踝能力量表[FAAM-ADL、FAAM-S]、改良身体活动障碍量表[mDPA]、坦帕运动恐惧量表-11[TSK-11]、恐惧回避信念问卷[FABQ]和平衡自我效能量表[SEBS]）、星形偏移平衡测试（SEBT）和等长髋部力量测试（伸展[EXT]、外展[ABD]和外旋[ER]）。对缺失数据采用多重填补法。多变量重复测量方差分析干预效果。
心理社会结局存在显著的组×时间交互作用（P = 0.008），但平衡（P = 0.159）、力量（P = 0.492）、踝关节功能和残疾（P = 0.128）方面不存在。时间主效应在平衡（P = 0.003）、力量（P < 0.001）、功能和残疾（P < 0.001）以及心理社会结局（P = 0.006）方面存在。BAL组在SEBT、EXT、ABD以及所有患者报告结局方面均有显著改善。HIP组在EXT、ABD、ER、FAAM-S、mDPA、FABQ和SEBS方面有显著改善。
平衡训练和髋部强化训练均可改善CAI患者的运动行为和感觉知觉障碍；然而，平衡训练对临床医生来说仍然是最有效的选择。
