Reliability and Responsiveness of Disablement Measures Following Acute Ankle Sprains Among Athletes
abstract & commentary
Synopsis: Some typical clinical measures are sensitive to change during rehabilitation following ankle sprains in athletes.
Source: Wilson RW, et al. Reliability and responsiveness of disablement measures following acute ankle sprains among athletes. J Orthop Sports Phys Ther 1998; 27(5):348-355.
In this study, selected, commonly used measures of impairment are evaluated in a group of athletes with ankle sprains to determine their reliability. Wilson and associates used a "prospective multivariate within subjects design" to observe the "stability and responsiveness of clinical measures during the early clinical rehabilitation period following acute ankle sprain." Twenty-four consecutive athletes who presented with grade 1 or grade 2 ankle sprains volunteered for the study. However, because of lack of adherence to protocol, this number dwindled to 13. All were male. The following measures were taken at day 3 and at day 10: joint swelling using a volumetric measurement, dorsiflexion and plantar flexion range of motion, and motor activity. Motor activity was measured using the following: (1) 40-meter walk; (2) 40-meter run; (3) figure-of-8 run; (4) single hop; (5) cross-over hop; and (6) self-reported athletic activity assessed on an analog scale. Data analysis was done using "distribution free statistics." Reliability was determined for all measures as follows: "intra-occasion tests/re-test reliability coefficients and standard errors of measurements were calculated from univariate repeated-measures ANOVAs."
All measures were compared to each other and compared at day 3 and day 10. Results indicated that the motor activity score had an internal consistency of 0.90. Therefore, a motor activity score was computed by summing the individual task scores for each subject. Within-group changes were detected both in swelling and motor activity; however, range-of-motion changes were not sensitive to change.
Comment by Clayton F. Holmes, EdD, PT, ATC
The findings of this study indicate that some typical clinical measures are sensitive to change during rehabilitation following ankle sprain in athletes. It should be pointed out that a major weakness of this study is that Wilson et al did not determine inter-rater reliability of any of these measures before beginning this study. This should be done by the individuals who will perform the measurements before any study is undertaken. It is important to note that they found that so-called "objective" measures may not be any more reliable than "subjective" measures. As a matter of fact, this study shows that "simple motor performance and self-reported measures employed three days post injury were as responsive to change as highly reliable impairment measures such as volumetric displacement." This finding is consistent with other studies regarding self-reported measures, particularly in athletes, and seems to indicate that these subjective measures are at least as important as "objective" measures. Finally, it is encouraging to know that some of the measures taken on a daily basis in rehabilitation environments are sensitive enough to determine change despite a lack of emphasis on these measures in the current health care environment.
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