Study On The Assessment Of Ankle Proprioception During Landing And Trampoline Training Intervention In Patients With Chronic Ankle Instability

Objective:Acute ankle sprains that are not treated appropriately are highly likely to develop into chronic ankle instability(CAI),which is characterized by subjective ankle instability,impaired proprioception,decreased balance capacity,and other neuromuscular control dysfunction.Study 1 was aimed to explore the effects of different landing heights and loads on the proprioception of the CAI during landing.Study 2 was based on the effect of height on ankle proprioception during landing in study 1,exploring the effects of trampoline jumping and trampoline balance training on ankle proprioception during landing,subjective proprioceptive visual analogue scores,dynamic balance,lower limb functional performance and ankle dorsiflexion mobility in patients with CAI.Methods:This thesis consists of two studies,both of them were approved by the ethics committee of the Shanghai University of Sport.Each study included the CAI group and the healthy control group.The inclusion and exclusion criteria for CAI patients were according to the International Ankle Consortium guidelines,and the Cumberland Chronic Ankle Instability Tool(CAIT)score was<24.Study 1,the effect of different landing heights and loads on ankle inversion proprioception during landing of CAI patients.A total of 43 participants were recruited,including 21 CAI(age:23.4±3.2 years,height:171.3±8.2 cm,weight:65.6±11.6 kg,CAIT score:15.6±4.9)and 22 healthy controls(age:24.1±2.1 years,height:169.1±6.3 cm,weight:64.6±9.0 kg,CAIT score:28.6±1.8).The Ankle Inversion Discrimination Apparatus for Landing(AIDAL),with one foot landing on a horizontal surface and the test foot landing on an angled surface(10°,12°,14°,16°),was utilized to assess ankle proprioception during landing.All participants performed the task from a landing height of 10 cm and 20 cm with 100%and 110%body weight loading.The four testing conditions were randomized with 15 minutes of break between sessions.The final proprioceptive ability of the participants was represented by calculating the Area Under the ROC Curve(AUC).The AUC value ranges between 0.500 and 1.000.A higher value represents more accurate proprioception sensitivity.Repeated measures Analysis of Variance(ANOVA)was conducted to compare main effects and interaction effects across test conditions.Study 2,effect of trampoline training on improving lower limb function in patients with CAI.44 participants were recruited in total,including 22 CAI(age:22.6±2.4 years,height:169.0±8.1 cm,weight:62.1±11.5 kg,CAIT score:16.2±3.4)and 22 healthy subjects(age:23.4±2.1 years,height:166.4±9.0 cm,weight:59.1±8.8 kg,CAIT score:30.0(2)).All participants were randomly divided into 22 each in the trampoline jumping group and trampoline balancing group according to group,where each group included 11 CAI and healthy subjects each,respectively.After the collection of basic information,the baseline tests were performed,including AIDAL test,proprioceptive subjective perception-visual analogue scale(VAS),Y Balance Test(YBT),Figure-8 hop test,Single-leg hop test and Weight-bearing Lunge Test(WBLT),The testing orders were randomized.During the intervention,the trampoline jumping group performed jumping on the surface of the trampoline,requiring more than 20 cm of landing height each time,50 jumps per block,with a total of 5 blocks,and 1minute-break between blocks;the trampoline balance group stood on the surface of the trampoline,and performed the same number and time as the trampoline jumping group.All participants were barefoot during the intervention.The baseline tests were performed again after 15 minutes of break.A three-way repeated measures ANOVA was conducted to compare the outcomes of ankle proprioception during landing,VAS,YBT,figure-8 hop test,single-leg hop test and WBLT scores in CAI and healthy participants at baseline and post-intervention in trampoline jumping or trampoline balance training.Pearson correlation analysis was used to analyze the correlation between proprioceptive AUC values and proprioceptive subjective perception VAS scores in each group of CAI patients and healthy subjects before and after trampoline training;Spearman correlation analysis was used to analyze the correlation between CAIT scores and the results of figure-8 hop test and single-leg hop test before and after the intervention.Results:The result of study 1 showed that individuals with CAI performed significantly worse across the four testing conditions(F=6.120,p=0.018,partialη~2=0.130).In addition,an increased landing height(F=7.216,p=0.010,partialη~2=0.150),not loading(p>0.05),significantly impaired ankle inversion discrimination sensitivity.And there was no interaction effect.The result of study 2 showed that in terms of ankle proprioception,there was a CAI main effect for ankle proprioception during landing before and after trampoline jumping and trampoline balance training,indicating that the CAI population performed significantly worse on ankle inversion proprioception during landing than healthy control subjects(F=5.176,p=0.046,partialη~2=0.341);compared to the pre-intervention test.Both ankle inversion proprioceptive performance during landing was significantly improved after the trampoline intervention(F=16.602,p=0.002,partialη~2=0.624).A two-factor interaction effect was found for population and time(F=5.642,p=0.039,partialη~2=0.361),and further pairwise comparisons indicated that the CAI group(p=0.006,95%CI=-0.089,0.020)had a significantly higher improvement in proprioception than healthy subjects after the intervention(p=0.160,95%CI=-0.028,0.005)for post-intervention outcomes.In addition,no main effect of intervention modality(F=0.671,p=0.432,partialη~2=0.063)or other interaction effects were found.In terms of proprioceptive subjective perception during the AIDAL test,there was a time main effect,indicating that overall CAI and healthy control subjects had significantly improved proprioceptive subjective perception scores after trampoline training compared to the baseline test(F=18.243,p=0.002,partialη~2=0.646).An interaction effect of time and intervention modality was also observed(F=6.793,p=0.026,partialη~2=0.405).Further post hoc analysis revealed that proprioceptive subjective perception VAS scores were significantly improved after trampoline jumping training compared to before the training(p<0.001,95%CI=0.942,2.422).However,there was no significant change before and after trampoline balance training(p=0.341,95%CI=-0.447,1.174).The Pearson’s correlation analysis showed no significant correlation between CAI and healthy participants’proprioceptive AUC values during landing and proprioceptive subjective perception VAS scores before and after trampoline jump training and trampoline balance training,respectively(p>0.05).In terms of lower limb dynamic balance capacity,there was a CAI population main effect,indicating that the CAI population had significantly lower limb dynamic balance capacity than healthy participants(F=5.003,p=0.049,partialη~2=0.333).A three-way interaction effect between population,intervention modality and time was also found(F=5.742,p=0.038,partialη~2=0.365),and no main effect of intervention modality and time was observed(p>0.05).A simple two-factor interaction analysis found an interaction effect for population and time in the trampoline balancing group(p=0.02,partialη~2=0.435),whereas there was no main effect or interaction effect in the trampoline jumping group.Further post hoc analyses found that YBT scores in the CAI population were significantly higher after trampoline balance training compared to baseline testing(p=0.004,95%CI=-5.458,-1.364),but no significant changes were found in healthy control subjects(p=0.996,95%CI=-2.956,2.943).Concerning the functional performance of the lower limbs,no significant improvement occurred in both CAI and healthy subjects on the figure-8 hop and single-leg hop test results after both trampoline jumping and trampoline balance training(p>0.05).However,Spearman’s correlation analysis showed that CAIT scores had a moderate negative correlation with figure-8 hop performance(rho=-0.445,p=0.038)and a moderate positive correlation with single-leg hop performance on the baseline test(rho=0.426,p=0.048)in participants with CAI,indicating that the more unstable ankle,the worse lower extremity functional performance.However,there was no significant correlation(p>0.05)between functional performance and CAIT scores in CAI after the intervention and in the healthy population before and after the intervention.In terms of ankle dorsiflexion mobility,no significant changes in ankle dorsiflexion mobility were found in CAI and healthy participants after trampoline jumping and trampoline balance training(p>0.05).Conclusion:(1)Compared to the healthy individuals,CAI patients showed significantly worse ankle inversion proprioception during landing and lower extremity dynamic balance performance.(2)An increased landing height,not loading,resulted in decreased ankle proprioceptive sensitivity.(3)Both trampoline jumping and trampoline balance training significantly improved ankle inversion proprioception during landing,but the improvement was more pronounced in CAI patients than in healthy individuals;both modalities improved participants’self-confidence during proprioceptive testing,and the improvement was more pronounced with trampoline jumping training.(4)Compared with trampoline jumping,trampoline balance training could significantly improve the dynamic balance of the lower limbs in CAI patients.However,both training procedures did not improve the dynamic balance of the lower limbs in the healthy group.