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

J Athl Train. 2015 Oct;50(10):1019-33. doi: 10.4085/1062-6050-50.9.01. Epub 2015 Sep 2.


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.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adaptation, Psychological / physiology*
  • Adult
  • Ankle Injuries* / physiopathology
  • Ankle Injuries* / psychology
  • Ankle Joint / physiopathology*
  • Chronic Disease
  • Humans
  • Joint Instability* / diagnosis
  • Joint Instability* / physiopathology
  • Male
  • Patient Outcome Assessment
  • Quality of Life*
  • Self Report
  • Young Adult