Effect of Mobilization in Conjunction With Exercise in Participants With a History of Chronic Ankle Instability

NCT ID: NCT03428620

Last Updated: 2018-04-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-02-14

Study Completion Date

2019-06-30

Brief Summary

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Our purpose is to examine the combined effects of thrust mobilization of the ankle joints in conjunction with a six-week rehabilitation program on functional performance in subjects reporting chronic ankle instability (CAI).

Detailed Description

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Joint mobilizations are reported to increase range of motion (ROM), postural control and proprioception, and decrease pain in individuals with CAI. However, there is no research supporting the combined effects of thrust mobilization and exercise on function in this population.

Inclusion and exclusion criterion have been established utilizing the International Ankle Consortium guidelines. Using a convenience sampling, participants will be randomized into the exercise only or mobilization (experimental) and exercise group. Both groups will undergo 12 supervised training sessions across a six-week period. The mobilization (experimental) group will also receive high-velocity-low-amplitude (HVLA) thrust mobilizations at the talocrural, proximal, and distal tibiofibular joints prior to the first three treatment sessions.

An examiner, who is blinded to involved limb and group allocation, will perform a baseline and six-week follow-up examination of joint mobility, range of motion, and functional performance. The participants will complete subjective outcome measures at baseline, 2 weeks, 4 weeks, and 6 weeks including the Foot and Ankle Ability Measurement (FAAM), FAAM-Sport, Ankle Joint Functional Assessment Tool (AJFAT), and the Cumberland Ankle Instability Tool (CAIT). Participants will also complete baseline and six-week follow up assessments of the figure-of-8 hop test, side hop test, and three directions of the Star Excursion Balance test (SEBT).

The exercise protocol is a modified version of the balance training program described by McKeon et al. Participants will complete this protocol twice a week for six weeks. Treatment sessions will last approximately 30 minutes. Participants will individually progress on particular exercises if zero errors are observed. In addition, all participants will be given a home exercise program (HEP) to complete every day of the week excluding treatment days.

The mobilization (experimental) group will receive HVLA thrust mobilizations at the three joints stated above for the first three sessions prior to completing the exercise protocol. Each mobilization will be performed one time at each joint. The order of joint mobilizations will be randomized prior to administering.

Data analysis will be performed using International Business Machines Statistical Package for the Social Sciences (SPSS). Alpha level will be set p\<0.05. Expecting to utilize separate 2 x 2 repeated measures analysis of variance (ANOVA) to assess changes in the FAAM, FAAM-Sport, AJFAT, CAIT, figure-of-8 hop test, side hop test, and three directions of the SEBT.

Conditions

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Ankle Sprains

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Mobilization

High Velocity Low Amplitude mobilization group. The three joints that will be manipulated include proximal tibiofibular, the distal tibiofibular, and talocrural joints and will be mobilized the first three sessions prior to the participants performing the exercise protocol.

Group Type EXPERIMENTAL

High Velocity Low Amplitude mobilization

Intervention Type OTHER

Mobilizations will be performed one time at each joint, prior to completing the exercise protocol during the first three treatment sessions.

Exercise protocol

Intervention Type OTHER

This exercise regimen is a modified version of the balance training program described by McKeon et al.

Exercise Protocol

This exercise regimen is a modified version of the balance training program described by McKeon et al.

Group Type ACTIVE_COMPARATOR

Exercise protocol

Intervention Type OTHER

This exercise regimen is a modified version of the balance training program described by McKeon et al.

Interventions

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High Velocity Low Amplitude mobilization

Mobilizations will be performed one time at each joint, prior to completing the exercise protocol during the first three treatment sessions.

Intervention Type OTHER

Exercise protocol

This exercise regimen is a modified version of the balance training program described by McKeon et al.

Intervention Type OTHER

Other Intervention Names

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HVLA thrust mobilization

Eligibility Criteria

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Inclusion Criteria

* 18-35 years of age
* A history of at least 1 significant ankle sprain (The initial sprain must have occurred at least 12 months prior to study enrollment, associated with inflammatory symptoms (pain, swelling, etc), created at least 1 interrupted day of desired physical activity)
* The most recent injury must have occurred more than 3 months prior to study enrollment.
* A history of the previously injured ankle joint "giving way" and/or recurrent sprain and/or "feelings of instability."
* Cumberland Ankle Instability Tool (CAIT) \< 24
* Foot and Ankle Ability Measure (FAAM)42: ADL scale \< 90%, Sport scale \< 80%

Exclusion Criteria

* A history of previous surgeries to the musculoskeletal structures (ie, bones, joint structures, nerves) in either limb of the lower extremity.
* A history of a fracture in either limb of the lower extremity requiring realignment
* Acute injury to musculoskeletal structures of other joints of the lower extremity in the previous 3 months, which impacted joint integrity and function (ie, sprains, fractures) resulting in at least 1 interrupted day of desired physical activity
Minimum Eligible Age

18 Years

Maximum Eligible Age

35 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Methodist University, North Carolina

OTHER

Sponsor Role collaborator

Shenandoah University

OTHER

Sponsor Role lead

Responsible Party

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Cameron Bolton

Assistant Professor Division of Physical Therapy

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Cameron J Bolton, DPT

Role: PRINCIPAL_INVESTIGATOR

Shenandoah University

Sheri Hale, PhD, PT

Role: PRINCIPAL_INVESTIGATOR

Shenandoah University

Locations

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Methodist University

Fayetteville, North Carolina, United States

Site Status RECRUITING

Shenandoah University

Winchester, Virginia, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Cameron J Bolton, DPT

Role: CONTACT

5405426540

Sheri Hale, PhD, PT

Role: CONTACT

5405457240

Facility Contacts

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Todd Telemeco, DPT, PhD

Role: primary

910-630-7216

Cameron Bolton, DPT

Role: primary

540-542-6540

Sheri, PhD, PT

Role: backup

5405457240

References

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Gribble PA, Delahunt E, Bleakley CM, Caulfield B, Docherty CL, Fong DT, Fourchet F, Hertel J, Hiller CE, Kaminski TW, McKeon PO, Refshauge KM, van der Wees P, Vicenzino W, Wikstrom EA. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. J Athl Train. 2014 Jan-Feb;49(1):121-7. doi: 10.4085/1062-6050-49.1.14. Epub 2013 Dec 30.

Reference Type BACKGROUND
PMID: 24377963 (View on PubMed)

McKeon PO, Ingersoll CD, Kerrigan DC, Saliba E, Bennett BC, Hertel J. Balance training improves function and postural control in those with chronic ankle instability. Med Sci Sports Exerc. 2008 Oct;40(10):1810-9. doi: 10.1249/MSS.0b013e31817e0f92.

Reference Type BACKGROUND
PMID: 18799992 (View on PubMed)

Hale SA, Hertel J, Olmsted-Kramer LC. The effect of a 4-week comprehensive rehabilitation program on postural control and lower extremity function in individuals with chronic ankle instability. J Orthop Sports Phys Ther. 2007 Jun;37(6):303-11. doi: 10.2519/jospt.2007.2322.

Reference Type BACKGROUND
PMID: 17612356 (View on PubMed)

Beazell JR, Grindstaff TL, Sauer LD, Magrum EM, Ingersoll CD, Hertel J. Effects of a proximal or distal tibiofibular joint manipulation on ankle range of motion and functional outcomes in individuals with chronic ankle instability. J Orthop Sports Phys Ther. 2012 Feb;42(2):125-34. doi: 10.2519/jospt.2012.3729. Epub 2012 Feb 1.

Reference Type BACKGROUND
PMID: 22333567 (View on PubMed)

Other Identifiers

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511

Identifier Type: -

Identifier Source: org_study_id

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