Effects of external biofeedback interventions in individuals with chronic ankle instability: a scoping review

Abstract

Clinical scenario: Evidence has demonstrated that about 1 in 3 acute lateral ankle sprains results in chronic ankle instability. Chronic ankle instability (CAI) is a condition characterized by a history of one significant lateral ankle sprain, episodes of the ankle "giving way”, pain, and decreased self-reported function. People with chronic ankle instability show a multitude of mechanical and functional impairments, including a more inverted position of the foot during walking and consequently an increased lateral plantar pressure distribution. These factors contribute to high recurrence of ankle sprains, a decrease in self-reported function and the development of early onset ankle post-traumatic osteoarthritis (OA). Traditional rehabilitation and prevention strategies against the development of CAI have not successfully improved the biomechanics of movement, thus new intervention strategies have been proposed in the last years to specifically target biomechanics impairments in individuals with CAI. Among these, intervention with biofeedback seem to be promising, but the actual effect is still not clear. Purpose: To perform a literature review and examine the effects of biofeedback interventions on biomechanics during gait and functional tasks in individuals with chronic ankle instability. Methods: The following literature databases were searched: Pubmed, PEDro, Cochrane Library and Scopus. The search strategy was based on the combination of different keywords associated with the Boolean operators “AND” or “OR” to create a string. Results were screened based on determined inclusion and exclusion criteria and the articles which were assessed as eligible after the screening phase were included in the qualitative evaluation. Results & discussion: At the end of the study selection, from a total of 178 articles, seven articles were included in the research. Studies assessed interventions using visual biofeedback (n = 4), auditory biofeedback (n = 3), and haptic biofeedback (n = 1). Four articles demonstrated reduced plantar pressure in the lateral column of the foot and a medial shift of the center of pressure after the intervention. One study demonstrated reduced ankle inversion after 8 sessions of biofeedback training and improvements in patient-reported outcomes. Another study found evidence that biofeedback is able to decrease vertical ground reaction force and ankle joint forces. One study demonstrated that biofeedback strategy is effective in altering the plantar pressure distribution causing a medial shift of the center of pressure during 4 different functional tasks (step downs, forward lunges, single-limb static balance, lateral hops). Conclusion: The use of biofeedback in individuals with chronic ankle instability resulted in several positive effects on clinical-oriented outcome as well as patient-reported outcome. Therefore, implementing external biofeedback training into an impairment-based rehabilitation program may allow for a greater improvement in impairments associated with CAI. However, future research to assess long-term effects of external biofeedback strategies in patients with CAI is needed.Clinical scenario: Evidence has demonstrated that about 1 in 3 acute lateral ankle sprains results in chronic ankle instability. Chronic ankle instability (CAI) is a condition characterized by a history of one significant lateral ankle sprain, episodes of the ankle "giving way”, pain, and decreased self-reported function. People with chronic ankle instability show a multitude of mechanical and functional impairments, including a more inverted position of the foot during walking and consequently an increased lateral plantar pressure distribution. These factors contribute to high recurrence of ankle sprains, a decrease in self-reported function and the development of early onset ankle post-traumatic osteoarthritis (OA). Traditional rehabilitation and prevention strategies against the development of CAI have not successfully improved the biomechanics of movement, thus new intervention strategies have been proposed in the last years to specifically target biomechanics impairments in individuals with CAI. Among these, intervention with biofeedback seem to be promising, but the actual effect is still not clear. Purpose: To perform a literature review and examine the effects of biofeedback interventions on biomechanics during gait and functional tasks in individuals with chronic ankle instability. Methods: The following literature databases were searched: Pubmed, PEDro, Cochrane Library and Scopus. The search strategy was based on the combination of different keywords associated with the Boolean operators “AND” or “OR” to create a string. Results were screened based on determined inclusion and exclusion criteria and the articles which were assessed as eligible after the screening phase were included in the qualitative evaluation. Results & discussion: At the end of the study selection, from a total of 178 articles, seven articles were included in the research. Studies assessed interventions using visual biofeedback (n = 4), auditory biofeedback (n = 3), and haptic biofeedback (n = 1). Four articles demonstrated reduced plantar pressure in the lateral column of the foot and a medial shift of the center of pressure after the intervention. One study demonstrated reduced ankle inversion after 8 sessions of biofeedback training and improvements in patient-reported outcomes. Another study found evidence that biofeedback is able to decrease vertical ground reaction force and ankle joint forces. One study demonstrated that biofeedback strategy is effective in altering the plantar pressure distribution causing a medial shift of the center of pressure during 4 different functional tasks (step downs, forward lunges, single-limb static balance, lateral hops). Conclusion: The use of biofeedback in individuals with chronic ankle instability resulted in several positive effects on clinical-oriented outcome as well as patient-reported outcome. Therefore, implementing external biofeedback training into an impairment-based rehabilitation program may allow for a greater improvement in impairments associated with CAI. However, future research to assess long-term effects of external biofeedback strategies in patients with CAI is needed