Cross-Education for Chronic Ankle Instability

NCT ID: NCT06401681

Last Updated: 2024-05-07

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 30 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2019-05-08
• Study Completion Date: 2022-05-24

Brief Summary

Chronic ankle instability (CAI) results in neuromuscular impairments compromising balance, lumbopelvic stability, and hip strength. Balance training has proven to be an effective intervention for individuals with CAI. Additionally, unilateral balance training for those with CAI has previously led to cross-education effects in which the untrained limb exhibited improved balance performance. However, the ability of unilateral balance training to improve contralateral hip strength and lumbopelvic stability in those with CAI is unknown. The purpose of this study was to determine the cross-education effects of balance training on hip strength and lumbopelvic stability in individuals with CAI.

Thirty individuals with CAI will be randomized into control (CON) and balance (BAL) groups. Baseline testing include a unilateral hip bridge, hip strength, and balance tests of the uninvolved limb. For the unilateral hip bridge, the participant will hold a bridge through the test limb for maximum time. Isometric hip strength will be measured for external rotation (ER), extension (EXT), and abduction (ABD) using a handheld dynamometer. The star excursion balance test (SEBT) requires participants to maintain a single-leg stance while reaching for maximum distance with the opposite leg in three directions: anterior (SEBT-ANT), posterolateral (SEBT-PL), and posteromedial (SEBT-PM). The BAL group will participate in a progressive balance training program three times a week for eight weeks for the involved limb, whereas CON will not. All baseline measures will be reassessed at the end of the 8 weeks. Separate 2-way repeated measures ANOVAs will analyze the effects of group and time on each outcome. Additionally, each group's mean changes from baseline to post-intervention will be assessed with Cohen's d effect sizes. Statistical significance is set a priori at P<0.05.

Conditions

Balance Training Group; Control Group

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Balance training (BAL)

Within one day of baseline testing, BAL will begin a progressive balance training protocol on the involved limb. The balance training program consists of three 20-minute sessions per week for eight weeks. Post-test assessments for BAL will completed within one week of completing the 8-week training interval.

Group Type: EXPERIMENTAL

Balance training

Intervention Type: OTHER

The balance exercises consist of single limb stances with eyes open and closed, single-leg hops with stabilization, and single-leg hops and reach. Thirty-second breaks will be provided between exercise sets. Progressions for single-leg stance exercises involve longer durations and introduction of unstable surfaces. Progressions for hopping exercises involve longer hopping distances. To progress to the next level, participants must complete a balance training session without any errors. Errors include 1) touching the floor or bracing with the opposite limb, 2) excessive lateral trunk flexion or hip abduction, 3) hands coming off hips (hop tasks) or shoulders (stance tasks), 4) missing the landing target, 5) using the reach leg for a substantial amount of weight bearing.

Control (CON)

After baseline testing, CON will be instructed to continue their normal daily routine. They will not participate in the balance training intervention.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Balance training

The balance exercises consist of single limb stances with eyes open and closed, single-leg hops with stabilization, and single-leg hops and reach. Thirty-second breaks will be provided between exercise sets. Progressions for single-leg stance exercises involve longer durations and introduction of unstable surfaces. Progressions for hopping exercises involve longer hopping distances. To progress to the next level, participants must complete a balance training session without any errors. Errors include 1) touching the floor or bracing with the opposite limb, 2) excessive lateral trunk flexion or hip abduction, 3) hands coming off hips (hop tasks) or shoulders (stance tasks), 4) missing the landing target, 5) using the reach leg for a substantial amount of weight bearing.

Intervention Type: OTHER

Other Intervention Names

balance exercise; balance rehabilitation

Eligibility Criteria

Inclusion Criteria

• All participants were required to have CAI based on guidelines published by the International Ankle Consortium. Participants were required to have a history of at least one acute LAS that resulted in swelling, pain, and at least one day of missed activity. The initial LAS must have occurred at least 12 months before study enrollment and the participants needed to be free of ankle sprains in the past three months. Participants were also required to report at least two events of "giving way" of their ankle, instability, or reinjury within the previous six months. Lastly, participants had to record scores of ≥5 on the Ankle Instability Instrument (AII), >11 on the Identification of Functional Ankle Instability (IdFAI), and <24 on the Cumberland Ankle Instability Tool (CAIT).2 One member of the research team completed all screening procedures. The same person block randomized participants into two groups, control (CON) and balance training (BAL), by selecting a sealed envelope that contained group designation.

Exclusion Criteria

• Participants were excluded if they had any history of lower extremity or spine fracture or surgery, any lower extremity or spine injury besides LAS within the past two years, and any significant ankle injury within the past three months.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 40 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Old Dominion University

OTHER

Sponsor Role: lead

Responsible Party

Ryan McCann

Associate Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Ryan McCann, PhD

Role: PRINCIPAL_INVESTIGATOR

Old Dominion University

Locations

Old Dominion University Athletic Training Laboratory

Norfolk, Virginia, United States

Countries

United States

Other Identifiers

1407520-8

Identifier Type: -

Identifier Source: org_study_id