Patient-Reported Outcome Measures in Individuals With Chronic Ankle Instability: A Systematic Review

Abstract

Context: A comprehensive systematic literature review of the health-related quality-of-life (HRQOL) differences among individuals with chronic ankle instability (CAI), ankle-sprain copers, and healthy control participants has not been conducted. It could provide a better indication of the self-reported deficits that may be present in individuals with CAI.

Objective: To systematically summarize the extent to which HRQOL deficits are present in individuals with CAI.

Data sources: We searched for articles in the electronic databases of EBSCO Host and PubMed Central using key words chronic, functional, mechanical, coper, instability, sprains, and patient-assessed. We also performed a hand search of reference lists, authors, and patient-reported outcomes (PROs) of the articles screened for inclusion.

Study selection: Studies were included if they (1) incorporated a PRO as a participant descriptor or as a study outcome to compare adults with CAI to ankle-sprain copers or healthy controls, (2) were written in English, and (3) were published in peer-reviewed journals.

Data extraction: Two authors independently assessed methodologic quality using the modified Downs and Black Index. Articles were filtered into 3 categories based on between-groups comparisons: CAI and copers, CAI and healthy control participants, copers and healthy participants. We calculated Hedges g effect sizes and 95% confidence intervals to examine PRO group differences.

Data synthesis: Of the 124 studies assessed for eligibility, 27 were included. A total of 24 articles compared PROs in individuals with CAI and healthy controls, 7 compared individuals with CAI and copers, and 4 compared copers and healthy controls. Quality scores on the modified Downs and Black Index ranged from 52.9% to 88.2%, with 8 high-, 16 moderate-, and 3 low-quality studies. Overall, we observed moderate to strong evidence that individuals with CAI displayed deficits on generic and region-specific PROs compared with copers and healthy controls. However, evidence that differences exist between copers and healthy controls was conflicting. In addition, for dimension-specific outcomes, evidence to suggest that fear of reinjury is heightened in individuals with CAI was limited.

Conclusions: The evidence suggested that CAI is associated with functional and HRQOL deficits, particularly when examined with region-specific PROs. However, PROs do not appear to differ between copers and healthy controls.

Keywords: ankle sprains; patient-centered care; region-specific outcomes.

Figure 1.

Flow chart of articles reviewed for inclusion.

Figure 2.

Summary of Hedges g effect sizes and 95% confidence intervals for the comparison between the chronic ankle instability and healthy control groups.^a–aaa Corresponds with the actual values presented in Table 4. Abbreviation: HRQOL, health-related quality of life.

Figure 3.

Summary of Hedges g effect sizes and 95% confidence intervals for the comparison between the chronic ankle instability and ankle-sprain–coper groups.^a–p Corresponds with the actual values presented in Table 5. Abbreviation: HRQOL, health-related quality of life.

Figure 4.

Summary of Hedges g effect sizes and 95% confidence intervals for the comparison between the ankle-sprain–coper and healthy control groups.^a–i Corresponds with the actual values presented in Table 6. Abbreviation: HRQOL, health-related quality of life.