What are the predicting factors of chronic ankle instability in first time ankle sprainers?
Electronic database search:
An electronic database search will be conducted of the following databases from the earliest record to the current day: MEDLINE, CINHAL, AMED, Scopus, Sportsdiscus, EMBASE, Web of Science, PubMed, Pedro, Cochrane Register of Clinical Trials.
Abstracts of the IAS and i-FAB conference proceedings will also be hand searched.
There are no language restrictions. Non-English studies will be retrieved but excluded from analysis if an appropriate translation is not available.
Types of study to be included
This systematic review is focused on studies investigating factors that may be related to on-going symptoms of instability and ultimately recurrent sprain. Studies are included if they are longitudinal (observational or randomized control trials) studies with follow up of patients after their first ankle sprain. Randomized clinical trials are included if the interventions are common physiotherapy and rehabilitation treatments (e.g. ice, pressure bandage, taping or exercises). In these studies data from the control group or the group with minimal intervention will be extracted. Studies will be excluded if the interventions include surgery or they have not followed participants for more than 3 month.
Condition or domain being studied
Index ankle sprain.
Ambulant participants of any age, after index ankle sprain.
We classified the interventions for ankle sprains as conservative or surgical. The conservative treatments include immobilization (with bracing or casting), taping, exercises etc. Surgical interventions are rarely used for acute or index ankle sprains. Rather, patients who require surgery usually have recurrent ankle sprain injuries, and persistent ankle pain. Studies with only surgical interventions will be excluded from this systematic review.
All the factors considered to be chronic ankle stability risk factors such as age, sex, BMI, balance, postural sway, foot posture index, lower limb range of motion, lower limb movement detection, lower limb muscle strength, lower limb muscle power, lower limb muscle reaction time, ankle pain, ankle swelling etc. will be investigated
The most important outcomes will be chronic ankle instability (synonyms: functional ankle instability, mechanical ankle instability, repeated ankle sprain, ankle instability), any residual symptoms such as swelling, feeling of weakness, giving way, pain.
Chronic ankle instability can be measured by stress radiology, arthrometry, report of re-injury or instability. Residual symptoms can be measured by questionnaires e.g. CAIT (Cumberland Ankle Instability Tool).
Data extraction, (selection and coding)
All studies identified by the search strategy will be screened using the eligibility criteria outlined above. Titles and abstracts of the search results will be inspected and clearly ineligible papers will be rejected from further analysis. Full copies of potentially eligible papers will be retrieved. This screening process will be undertaken independently by Fereshteh Pourkazemi, and two other reviewers. Any inconsistencies regarding inclusion of trials will be resolved by a fourth reviewer.
Risk of bias (quality) assessment
Risk of bias and methodological quality will be assessed using the quality assessment tool developed from Sanderson et al 2007 and the Strobe Guidlines 2007. Two raters independently will assess quality and a third reviewer will resolve disagreements.
Control for bias:
• Representative sample: participants selected by random selection or as consecutive cases.
• Defined sample: description of source of participants and inclusion and exclusion criteria.
• Blinded outcome rater: assessor unaware of at least one prognostic factor, used to predict prognostic outcome, at time prognostic outcome was measured.
• Follow-up >85%: outcome data were available for at least 85%of participants at one follow-up point
Appropriate measurement of variables:
• Method of assessment: appropriate choice of outcome measures
• Outcome data reported: reporting of outcome data at follow-up
Control for confounding
• Statistical adjustment: multivariate analysis conducted with adjustment for potentially confounding factors. Studies must provide raw data, percentages, survival rates, or continuous outcomes.
Strategy for data synthesis
We will provide a narrative synthesis of the findings from the included studies, structured around the variables measured after the first ankle sprain (such as balance, muscle strength, etc.), on-going symptoms of instability after the first ankle sprain, target population characteristics, type of intervention(if any), type of outcome and intervention content.
We also plan to do a meta analysis but it is likely that there will be limited scope for meta-analysis because of the range of different outcomes measured across the small number of existing trials.
Analysis of subgroups or subsets
Contact details for further information
Discipline of Physiotherapy
Faculty of Health Sciences
University of Sydney
75 East Street
Organisational affiliation of the review
Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney
Ms Fereshteh Pourkazemi, Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney Professor Kathryn Refshauge, Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney Dr Claire Hiller, Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney Dr Jacqueline Raymond, Discipline of Exercise and Sport Sciences, Faculty of Health Sciences, University of Sydney
Anticipated or actual start date
01 March 2012
Anticipated completion date
01 March 2013
Conflicts of interest
Subject index terms status
Subject indexing assigned by CRD
Subject index terms
Ankle Joint; Chronic Disease; Humans; Joint Instability; Sprains and Strains
Date of registration in PROSPERO
10 October 2012
Date of publication of this revision
10 October 2012
Stage of review at time of this submission
Piloting of the study selection process
Formal screening of search results against eligibility criteria
Risk of bias (quality) assessment
PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites.