Effects of SMART VS FIRE Training in Chronic Ankle Instability
Study Details
Study Description
Brief Summary
The study will be a randomized clinical trial with the sample size of 26. The study will be conducted at Sports Club Sheikhupura. Subjects will be enrolled according to eligibility criteria. Patients will be divided into two groups, each with 13 patients. Group A will receive SMART training intervention and warm-up exercises, while group B will receive Foot intensive rehabilitation exercises (FIRE) and warm up exercises. The session will be around 45 to 60 min on each patient with three sessions per week on alternate days. A total of Three weeks treatment regime will be given to the patients and assessment of patient's strength (CAIT) and performance (FAAM) will be done at the baseline, after the completion of treatment at three weeks and after six weeks to observe the long-term effects.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Ankle sprain is one of the most common sports injuries in physically active individuals and causes a high financial burden on the healthcare system. Seventy-four percent of patients with an acute ankle sprain suffered from residual symptoms lasting 29 months after the initial ankle sprain, such as pain, perceived instability, weakness and swelling. Lateral ankle sprains (LASs) are a common injury sustained by individuals who participate in recreational physical activities and sports. After LAS, a large proportion of individuals develop long-term symptoms, which contribute to the development of chronic ankle instability (CAI).The aim of this study to determine the comparative effects of SMART training intervention versus foot intensive rehabilitation (FIRE) on strength and performance in athletes with chronic ankle instability.
The study will be a randomized clinical trial with the sample size of 26. The study will be conducted at Sports Club Sheikhupura. Subjects will be enrolled according to eligibility criteria. Patients will be divided into two groups, each with 13 patients. Group A will receive SMART training intervention and warm-up exercises, while group B will receive Foot intensive rehabilitation exercises (FIRE) and warm up exercises. The session will be around 45 to 60 min on each patient with three sessions per week on alternate days. A total of Three weeks treatment regime will be given to the patients and assessment of patient's strength (CAIT) and performance (FAAM) will be done at the baseline, after the completion of treatment at three weeks and after six weeks to observe the long-term effects.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: Group A: warm up exercises with SMART training For sensory stimulation planter massage will be given, and it will be applied to entire planter surface. Grade III anterior to posterior talocrural joint mobilization will be given. For balance, single and double leg stance will be performed. For functional training, lateral hops and SEBT will be performed. And at the end, for resistance training, theraband will be used with normal ankle joint movement. There is a progress in focus between the five domains over the 3weeks, as described below: The domains S and M are present across the whole intervention. In week 1, the main focus is on the A domain, in week 2 on the R domain, and in week 3 on the T domain. During the 3-week intervention period, 3 training sessions will be held per week each lasting approximately 45 - 60 min, including 10 min warm up. |
Other: SMART TRAINING
Patients in Group A will receive SMART training intervention. For sensory stimulation planter massage will be given, and it will be applied to entire planter surface. Grade III anterior to posterior talocrural joint mobilization will be given (26). For balance, single and double leg stance will be performed. For functional training, lateral hops and SEBT will be performed. And at the end, for resistance training, theraband will be used with normal ankle joint movement. There is a progress in focus between the five domains over the 3weeks, as described below: The domains S and M are present across the whole intervention. In week 1, the main focus is on the A domain, in week 2 on the R domain, and in week 3 on the T domain. During the 3-week intervention period, 3 training sessions will be held per week each lasting approximately 45 - 60 min, including 10 min warm up
|
| Active Comparator: Group B: Warm up exercises with foot intensive rehabilitation(FIRE) The FIRE intervention will include the progressive balance training, ankle and hip strengthening, range of motion exercises and foot massage. Plantar massage will consist of two, 1-min plantar massages with a 1-min rest between sets. Four previously established exercises will target the IFMs including the short-foot, toe-spread-out, hallux extension, and lesser-toe extension. |
Other: FIRE training
Patients in Group B will receive foot intensive rehabilitation (FIRE).The FIRE intervention will include the progressive balance training, ankle and hip strengthening, range of motion exercises and foot massage. Plantar massage will consist of two, 1-min plantar massages with a 1-min rest between sets. Four previously established exercises will target the IFMs including the short-foot, toe-spread-out, hallux extension, and lesser-toe extension
|
Outcome Measures
Primary Outcome Measures
- Cumberland Ankle Instability Tool (CAIT) [Change from Baseline at 3 weeks and 6 weeks]
Cumberland Ankle Instability Tool (CAIT) was originally developed in English and proved to be of high content validity and good reliability. The main advantage of the questionnaire is that it consists of only 9 items, minimizing patient burden and increasing reliability. The precision of the instrument is increased as it is a multiple answer option instrument
- Foot and Ankle Ability Measurement (FAAM) [Change from Baseline at 3 weeks and 6 weeks]
The Foot and Ankle Ability Measure (FAAM) assess the functional limitation of the foot and ankle. The FAAM has 29 items, scored between 0 and 4, divided into two sub-scales: activities of daily living (21 items) and sports (8 items)(24).For score analysis, the percentage of each sub scale is used separately. For FAAM ADL, person reliability is 0.87 and item reliability is0.99. For FAAM Sport, person reliability is 0.89 and item reliability is 1.0
Eligibility Criteria
Criteria
Inclusion Criteria:
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Athletes 18-45 years of age,
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2 repeated episodes of giving way, feelings of instability
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Core training not less than 4 week.
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Chronic ankle instability more than 6 months.
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Repeated ankle sprain more than twice and patients with <24 points based on CAIT.
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Athletes with single side ankle instability
Exclusion Criteria:
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Acute concomitant injuries of the ankle.
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Individuals who were able to return to pre-injury levels of activity
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Serious lower-extremity injuries of the last 6 months
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Lower-extremity surgery, and neurological diseases
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Simultaneous severe sprain of both ankle joints
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Sports Club Sheikhupura | Sheikhupura | Punjab | Pakistan |
Sponsors and Collaborators
- Sehat Medical Complex
Investigators
- Principal Investigator: wajeeha konain, MSPT, Riphah International University
Study Documents (Full-Text)
None provided.More Information
Publications
- Abadi FH, Sankaravel M, Zainuddin FF, Elumalai G, Razli AI. The effect of aquatic exercise program on low-back pain disability in obese women. J Exerc Rehabil. 2019 Dec 31;15(6):855-860. doi: 10.12965/jer.1938688.344. eCollection 2019 Dec.
- Al-Mohrej OA, Al-Kenani NS. Chronic ankle instability: Current perspectives. Avicenna J Med. 2016 Oct-Dec;6(4):103-108. doi: 10.4103/2231-0770.191446.
- Delahunt E, Remus A. Risk Factors for Lateral Ankle Sprains and Chronic Ankle Instability. J Athl Train. 2019 Jun;54(6):611-616. doi: 10.4085/1062-6050-44-18. Epub 2019 Jun 4.
- Hall EA, Chomistek AK, Kingma JJ, Docherty CL. Balance- and Strength-Training Protocols to Improve Chronic Ankle Instability Deficits, Part II: Assessing Patient-Reported Outcome Measures. J Athl Train. 2018 Jun;53(6):578-583. doi: 10.4085/1062-6050-387-16. Epub 2018 Jul 11.
- Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA. Epidemiology of Ankle Sprains and Chronic Ankle Instability. J Athl Train. 2019 Jun;54(6):603-610. doi: 10.4085/1062-6050-447-17. Epub 2019 May 28.
- Jaber H, Lohman E, Daher N, Bains G, Nagaraj A, Mayekar P, Shanbhag M, Alameri M. Neuromuscular control of ankle and hip during performance of the star excursion balance test in subjects with and without chronic ankle instability. PLoS One. 2018 Aug 13;13(8):e0201479. doi: 10.1371/journal.pone.0201479. eCollection 2018.
- Kim J, Kang S, Kim SJ. A smart insole system capable of identifying proper heel raise posture for chronic ankle instability rehabilitation. Sci Rep. 2022 Jun 24;12(1):10796. doi: 10.1038/s41598-022-14313-8.
- Lin CI, Houtenbos S, Lu YH, Mayer F, Wippert PM. The epidemiology of chronic ankle instability with perceived ankle instability- a systematic review. J Foot Ankle Res. 2021 May 28;14(1):41. doi: 10.1186/s13047-021-00480-w.
- Molla-Casanova S, Ingles M, Serra-Ano P. Effects of balance training on functionality, ankle instability, and dynamic balance outcomes in people with chronic ankle instability: Systematic review and meta-analysis. Clin Rehabil. 2021 Dec;35(12):1694-1709. doi: 10.1177/02692155211022009. Epub 2021 May 31.
- REC/RCRS/1021 Wajeeha