Using External Visual Feedback Techniques to Improve Chronic Ankle Instability: A Critically Appraised Topic

Introduction: Lateral ankle sprains (LAS) are among the most common musculoskeletal injury in physically active populations posing a substantial health burden. Individuals who sustain ankle sprains often have a diminished quality of life with prolonged symptoms, decreased levels of physical activity, and the propensity to develop chronic ankle instability (CAI). It is estimated that up to 40% of people who sustain an initial lateral ankle sprain will develop CAI. Many therapeutic interventions exist to help alleviate symptoms and the feeling of “giving out.” This critically appraised topic will examine multiple interventions that involve using external visual feedback methods to improve the quality of the ankle stability. Methods: The following studies were found doing an online search using PubMed, EBSCOHost, and SPORTDiscus. The articles were selected by being at least a level 2 on the Oxford Centre for Evidence-Based Medicine 2011 levels of evidence. The outcomes must have included postural control, balance or increased ankle stability reported by patient reported outcomes. Results: The 4 articles chosen to be part of the appraisal supported using external visual feedback techniques to improve chronic ankle instability conditions. Four studies found that their method of external visual feedback improved ankle stability in patients with chronic ankle instability. The interventions included stroboscopic glasses, laser visual feedback, and a Biodex balance platform with visual feedback. Conclusions: There is a moderate amount of evidence available to support incorporating external visual feedback techniques in rehabilitation plans. Though these studies proved improvement in ankle stability, there is no defined technique that is suggested over the other. More high quality randomized controlled trial studies should be done to make this recommendation stronger.