Author Names
Burton, C., Arthur, R., Rivera, M., Powden, C.
Reviewer Name
Katherine Morgan, SPT
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Context: Chronic ankle instability (CAI) is one of the most common chronic conditions in the world, resulting in millions of dollars contributed to the health care system. Joint mobilizations have been shown to effectively improve patient and disease-specific impairments secondary to CAI. The ability for patients to complete an effective manual therapy intervention without the need for continuous visits to a health care provider can alleviate burdens on the health care system and improve patient satisfaction. Objective: To examine the effect of clinician-applied Maitland talocrural joint mobilization and self-mobilization (Self-Mob) on dorsiflexion range of motion (DFROM), dynamic balance, strength, and perceived function in those with CAI. Design: Single-blind randomized trial. Setting: Research laboratory. Participants: A total of 18 participants (7 males and 11 females; age = 20.78 [2.02] y, height = 67.66 [3.83] cm, limb length = 87.74 [5.05] cm) with self-reported CAI participated. Interventions: The participants received 6 interventions over a 2-week period. The participants received either Maitland grade III anterior-to-posterior talocrural joint mobilizations or weight-bearing lunge Self-Mob. Each intervention consisted of four 2-minute sets, with a 1-minute rest between sets. Main Outcome Measures: The DFROM (weight-bearing lunge), dynamic balance (Y-Balance Test), isometric strength, Foot and Ankle Ability Measure Quick, Disablement of the Physically Active modified, Fear Avoidance Beliefs Questionnaire, and Tampa Scale of Kinesiophobia-11 were measured preintervention and postintervention. Results: Dynamic balance, isometric strength, and perceived function significantly improved in both groups at postintervention. The DFROM significantly improved in the Self-Mob group. Higher individual responder rates were demonstrated within the Self-Mob group compared with clinician-applied mobilizations. Conclusions: Clinician-applied mobilizations and Self-Mobs are effective interventions for improving dynamic balance, isometric strength, and perceived function. Application of Self-Mobs can effectively improve DFROM compared with joint mobilization. Self-Mobs may be an effective intervention to incorporate into a home care plan.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- No
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- Yes
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Yes
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Yes
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Cannot Determine, Not Reported, or Not Applicable
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- No
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Cannot Determine, Not Reported, or Not Applicable
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
Dorsiflexion ROM significantly improved for the self-mob group, but not for the group that received mobilizations from clinicians.
Key Finding #2
Both groups displayed improved dynamic postural control demonstrated by increased reach in the posteromedial (both groups) and posterolateral (clinician-mob group only) directions on the Y-balance test.
Key Finding #3
Both groups demonstrated increased ankle isometric strength as measured via handheld dynamometry
Key Finding #4
The self-mob group had significant improvements in self reported outcomes including the quick-FAAM, modified DPA, and FABQ. These changes show that self mobilization can increase a patient’s perception of their physical ability and decrease their self-reported fear avoidance and fear of reinjury.
Please provide your summary of the paper
The researchers aimed to evaluate the effect of clinician applied Maitland talocrural joint mobilization (grade III, AP) compared a weight bearing lunge self-mobilization on dorsiflexion range of motion, dynamic balance, isometric ankle strength, and perceived function in people with chronic ankle instability. Participants received 6 interventions over two weeks, with each intervention session consisting of four, two-minute sets of mobilizations with a one minute rest between sets. Outcome measures assessed pre and post intervention included dorsiflexion ROM (in a weight bearing lunge position), Y-Balance test, ankle isometric strength, the Quick Foot and Ankle Ability Measure, modified Disability of the Physically Active, FABQ, and the Tampa Scale of Kinesiophobia-11. Both groups showed improvements in dynamic balance, isometric strength, and perceived function. Additionally, the self-mob group showed improvements in DF ROM and higher individual responder rates than the clinician-mob group.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This study shows that incorporating self mobilization into a home program may be effective in improving dynamic balance and isometric strength as well as decreasing self-reported fear avoidance and fear of re-injury in people with chronic ankle instability.
