From the 281 questionnaires distributed, 151 were returned completed. Thus, the response rate was 53%.
After the demographic information had been gathered, respondents were asked a series of questions about their understanding of CAI, MI, and FI. These answers were compared with commonly accepted definitions outlined in Hertel’s5 CAI paradigm and were deemed either satisfactory or unsatisfactory depending on whether they identified the main themes of each definition. A summary of the respondents understanding of CAI, MI, and FI is presented in Figure 1.
Figure 1. Understanding of Chronic Ankle Instability (CAI), Functional Instability (FI), and Mechanical Instability (MI). (Percent of Participant Responses.)
Approximately 71% of the respondents were judged to have satisfactory understanding of the meaning of CAI, and the replies indicated that 73% and 71% had satisfactory understanding of MI and FI, respectively. There was a strong overlap between those participants who were able to successfully describe these entities, whereas 21% displayed an unsatisfactory understanding of all 3.
The physiotherapists were then asked to list both the mechanical and functional insufficiencies associated with CAI, and these were also compared with those outlined in the literature.5 There were 4 separate mechanical and functional insufficiencies and deficits associated with CAI. The mechanical insufficiencies included arthrokinematic deficits, pathological laxity, synovial changes, and degenerative changes. The functional insufficiencies and deficits included strength, proprioception, postural control, and neuromuscular. The respondents’ understanding of this is presented in Figure 2.
Figure 2. Identification of Functional and Mechanical Insufficiencies. (Percent of Participant Responses.)
Nearly half of the respondents (48%) were able to identify only 1 mechanical insufficiency, but none of the respondents could name all 4. Approximately 21% were unable to identify any mechanical insufficiency. Pathological laxity was identified by all respondents that were able to name at least 1 deficit, and it was the most frequently identified mechanical deficit, listed by 80% of respondents. Arthrokinematics was the second most commonly identified mechanical deficit, although just 17% could name it.
The results showed a better knowledge of the functional insufficiencies than the mechanical insufficiencies. Seventy-one percent were able to name at least 1 functional deficit and 19% were able to name 3 or more. Proprioception was commonly identified as a deficit by almost 70% of respondents, and almost half (49%) identified deficits in strength. Postural control was identified by only 20% of the respondents as a functional insufficiency.
Having established the background knowledge of the conditions, the physiotherapists’ management trends were then ascertained. The results indicated that radiograph and MRI are not commonly used by physiotherapists to help their management of CAI. Approximately 64% and 61%, respectively, use these imaging techniques either sometimes or never. Only 12% always use radiograph, and 8% always use MRI.
The responses suggest that mobilization techniques are commonly used, and each technique listed was used by at least 40% of respondents (always or frequently). The most commonly used techniques were subtalar mobilization (72%), talocrural joint mobilization with movement (68%), and inferior tibiofibular joint mobilization (64%). Of note, 16% of physiotherapists indicated that they always used inversion mobilization as part of their treatment.
In addition, the results suggest that strengthening programs are commonly used, indicating that dorsiflexion (76%), plantar flexion (85%), invertor (77%), and evertor (89%) strengthening protocols were used either always or frequently.
The most commonly used balance training methods were single leg balance exercises (93%), hopping practice (91%), and wobble board training (84%). Jump landing was used by 72% of physiotherapists, and only one-third of respondents used the Star Excursion Balance Test (SEBT) as a balance training measure. The respondents’ preferences of balance training techniques are presented in Figure 3.
Figure 3. Balance Training Methods Used. (Percent of Participant Responses.) Abbreviation: SEBT, Star Excursion Balance Test.
Functional tests, such as ability to perform multi-directional jumps, perception of pain, swelling, and the patient’s subjective feeling of readiness were the most common outcome measures used to determine suitability for return to sport. The majority (62%) indicated they used taping during rehabilitation, although few indicated which methods of taping were used.