title: Predicting Manual Therapy Treatment Success in Patients With Chronic Ankle Instability: Improving Self-Reported Function.
abstract: BACKGROUND
  Therapeutic modalities that stimulate sensory receptors around the foot-ankle complex improve chronic ankle instability (CAI)-associated impairments. However, not all patients have equal responses to these modalities. Identifying predictors of treatment success could improve clinician efficiency when treating patients with CAI.
  
  
  OBJECTIVE
  To conduct a response analysis on existing data to identify predictors of improved self-reported function in patients with CAI.
  
  
  METHODS
  Secondary analysis of a randomized controlled clinical trial.
  
  
  METHODS
  Sports medicine research laboratories.
  
  
  METHODS
  Fifty-nine patients with CAI, which was defined in accordance with the International Ankle Consortium recommendations.
  
  
  METHODS
  Participants were randomized into 3 treatment groups (plantar massage [PM], ankle-joint mobilization [AJM], or calf stretching [CS]) that received six 5-minute treatments over 2 weeks.
  
  
  METHODS
  Treatment success, defined as a patient exceeding the minimally clinically important difference of the Foot and Ankle Ability Measure-Sport (FAAM-S).
  
  
  RESULTS
  Patients with ≤5 recurrent sprains and ≤82.73% on the Foot and Ankle Ability Measure had a 98% probability of having a meaningful FAAM-S improvement after AJM. As well, ≥5 balance errors demonstrated 98% probability of meaningful FAAM-S improvements from AJM. Patients <22 years old and with ≤9.9 cm of dorsiflexion had a 99% probability of a meaningful FAAM-S improvement after PM. Also, those who made ≥2 single-limb-stance errors had a 98% probability of a meaningful FAAM-S improvement from PM. Patients with ≤53.1% on the FAAM-S had an 83% probability of a meaningful FAAM-S improvement after CS.
  
  
  CONCLUSIONS
  Each sensory-targeted ankle-rehabilitation strategy resulted in a unique combination of predictors of success for patients with CAI. Specific indicators of success with AJM were deficits in self-reported function, single-limb balance, and <5 previous sprains. Age, weight-bearing-dorsiflexion restrictions, and single-limb balance deficits identified patients with CAI who will respond well to PM. Assessing self-reported sport-related function can identify CAI patients who will respond positively to CS.
authors.affiliation: Department of Exercise and Sport Science, University of North Carolina at Chapel Hill.
authors.forename: Erik A
authors.initials: EA
authors.lastname: Wikstrom
authors.affiliation: Department of Exercise and Sport Sciences, Ithaca College, NY.
authors.forename: Patrick O
authors.initials: PO
authors.lastname: McKeon
mesh_terms: D000328:Adult; D000842:Ankle / Q000503:physiopathology; D016512:Ankle Injuries / Q000503:physiopathology / Q000628:therapy*; D000843:Ankle Joint / Q000503:physiopathology; D002908:Chronic Disease; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005528:Foot / Q000503:physiopathology; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000628:therapy*; D035002:Lower Extremity / Q000503:physiopathology; D008297:Male; D008405:Massage / Q000379:methods; D009068:Movement / Q000502:physiology; D026201:Musculoskeletal Manipulations / Q000379:methods*; D026741:Physical Therapy Modalities; D057566:Self Report; D013177:Sports / Q000502:physiology; D013178:Sports Medicine / Q000379:methods; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology; D055815:Young Adult
keywords: clinical prediction rules; joint mobilization; massage; stretching