Effect of Postoperative Intensive Rehabilitation on Ankle Function Recovery in Patients with Chronic Ankle Instability

Geon Sang Lee; Sung Hyun Lee; So Hee Park; Min Cheol Joo; Hyun Jun Kim; Min Su Kim

doi:10.5763/kjsm.2020.38.1.20

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Lee, Lee, Park, Joo, Kim, and Kim: Effect of Postoperative Intensive Rehabilitation on Ankle Function Recovery in Patients with Chronic Ankle Instability

Clinical Article

Korean J Sports Med 2020;38(1):20-27.

Published online: 20 January 2020

DOI: https://doi.org/10.5763/kjsm.2020.38.1.20

Effect of Postoperative Intensive Rehabilitation on Ankle Function Recovery in Patients with Chronic Ankle Instability

Geon Sang Lee¹, Sung Hyun Lee², So Hee Park¹, Min Cheol Joo¹, Hyun Jun Kim¹, Min Su Kim^1,

¹Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea

²Department of Orthopedic Surgery, Wonkwang University School of Medicine, Iksan, Korea

Correspondence: Min Su Kim Department of Rehabilitation Medicine, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan 54538, Korea Tel: +82-63-859-1610, Fax: +82-63-859-2128, E-mail: helmaine@naver.com

^∗ This study was supported by research grant of Korean Society of Sports Medicine for 2018.

Received 20 January 2020 Revised 27 February 2020 Accepted 28 February 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study aimed to investigate the effect of hospital-based intensive rehabilitation program after ankle ligament operation.

Methods

A total of 35 patients were included in this randomized controlled trial. Fifty-minute sessions of hospital-based rehabilitation were performed three times weekly for 12 weeks in the intervention group. Home-based exercise was conducted in the control group. Outcomes were evaluated at baseline, 12 weeks, and 16 weeks. The primary outcome was measured using the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included the American Orthopedic Foot and Ankle Society (AOFAS) score, ankle strength measured using an isokinetic device, fall index measured using a Tetrax posturography device, and the Berg Balance Scale.

Results

Significant improvements in FAOS, AOFAS, ankle strength, and fall index were found in the intervention group after performing the hospital-based rehabilitation (all p＜ 0.05) and these improvements were sustained at T2 (all p＜ 0.05). Between-group comparisons demonstrated significantly greater improvements in FAOS, AOFAS, ankle strength, and fall index in the intervention group than those in the control group at both T1 (all p＜ 0.05), and T2 (all p＜ 0.05).

Conclusion

The rehabilitation program in this study improved postoperative pain, sports function, quality of life, and strength and balance of the ankle significantly better than home-based self-care. Therefore, we recommend hospital-based systematic rehabilitation programs after surgical treatment for chronic ankle instability.

Keywords: Ankle, Hospital-based, Ligament, Operation, Rehabilitation

References

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Fig. 1.

Early stage of the rehabilitation program. (A) Passive range of motion (ROM). (B) Ankle pump. (C) Weight shifting. (D) Active ROM of ankle dorsi/plantarflexion. (E) Leg raise. (F) Bridge exercise.

Fig. 2.

Middle stage of the rehabilitation program. (A) Stationary bicycle exercise. (B) Active range of motion of ankle in-version/eversion. (C) Calf raise. (D) One leg lunge. (E) One leg standing. (F) One leg standing on a balance ball.

Fig. 3.

Late stage of rehabilitation program. (A) Treadmill exercise. (B) Lunge exercise. (C) Squat. (D) Hop on one foot.

Fig. 4.

Patient selection flowchart.

Fig. 5.

Changes in the Foot and Ankle Outcome Score (FAOS) across the three time points (at baseline [T0], after intervation [T1], 4 weeks of follow-up [T2]). All five subscales of the FAOS significantly improved in the intervention group over time, and a between-group comparison showed a significant difference between groups after intervention and at 4 weeks of follow-up. ∗p＜0.05.

Table 1.

Baseline characteristics of the participants

Characteristics	Intervention (n=18)	Control (n=17)	p-value
Affected side (left:right)	8:10	9:8	0.172
Duration after MBO (day)	17.5±3.3	18.3±4.8	0.320
Age (yr)	39.7±6.3	40.1±7.2	0.642
Sex (male:female)	10:8	9:8	0.438
Height (cm)	169.1	168.3	0.219
Weight (kg)	69.5	70.1	0.556
BMI (kg/m²)	21.2	22.2	0.308

Values are presented as mean±standard deviation.

MBO: modified Broström operation, BMI: body mass index

Table 2.

Comparison of the effects on secondary outcome measures between the groups

Variable	T0	T1∗	T2∗	p-value^†
FAOS
Intervention	61.0	81.7	88.1	0.027^‡
Control	61.5	66.3	68.5
AOFAS score
Intervention	73.2	83.3^‡	89.1^‡	0.024^‡
Control	74.5	76.5	78.3
Motor, ankle inversion (N)
Intervention	7.6	8.4^‡	9.0^‡	0.008^‡
Control	7.7	7.7	7.7
Motor, ankle eversion (N)
Intervention	7.9	8.5^‡	9.0^‡	0.012^‡
Control	7.9	7.8	7.9
Motor, ankle dorsiflexion (N)
Intervention	7.5	8.3^‡	8.9^‡	0.016^‡
Control	7.6	7.7	7.6
Motor, ankle plantarflexion (N)
Intervention	8.0	8.7^‡	9.1^‡	0.008^‡
Control	8.0	7.8	7.9
Fall index (%)
Intervention	37.3	24.5^‡	13.6^‡	0.036^‡
Control	35.9	33.5	32.8
BBS
Intervention	51.6	55.4	55.9	0.091
Control	51.9	52.3	52.4

Values are presented as mean.

T0: baseline, T1: after intervention, T2: 4 weeks of followup, FAOS: Foot and Ankle Outcome Score, AOFAS: American Orthopedic Foot & Ankle Society, BBS: Berg Balance Scale.

^∗ p-value of a difference between the two group on independent t-test; ^†p-value of a time-group interaction effect between the groups on repeated measures analysis of variance; ^‡p<0.05.

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