Prevalence and Impact of Chronic Musculoskeletal Ankle Disorders in the Community

doi:10.1016/j.apmr.2012.04.023

Archives of Physical Medicine and Rehabilitation

Volume 93, Issue 10, October 2012, Pages 1801-1807

Presented in part to the American College of Sports Medicine, June 5, 2010, Baltimore, MD, and International Foot and Ankle Biomechanics Congress, September 16, 2010, Seattle, WA.

https://doi.org/10.1016/j.apmr.2012.04.023 Get rights and content

Abstract

Hiller CE, Nightingale EJ, Raymond J, Kilbreath SL, Burns J, Black DA, Refshauge KM. Prevalence and impact of chronic musculoskeletal ankle disorders in the community.

Objective

To determine the point prevalence of chronic musculoskeletal ankle disorders in the community.

Design

Cross-sectional stratified (metropolitan vs regional) random sample.

Setting

General community.

Participants

Population-based computer-aided telephone survey of people (N=2078) aged 18 to 65 years in New South Wales, Australia. Of those contacted, 751 participants provided data.

Interventions

Not applicable.

Main Outcome Measures

Point prevalence for no history of ankle injury or chronic ankle problems (no ankle problems), history of ankle injury without residual problems, and chronic ankle disorders. Chronic musculoskeletal ankle disorders due to ankle sprain, fracture, arthritis, or other disorder compared by chi-square test for the presence of pain, weakness, giving way, swelling and instability, activity limitation, and health care use in the past year.

Results

There were 231 (30.8%) participants with no ankle problems, 342 (45.5%) with a history of ankle injury but no chronic problems, and 178 (23.7%) with chronic ankle disorders. The major component of chronic ankle disorders was musculoskeletal disorders (n=147, 19.6% of the total sample), most of which were due to ankle injury (n=117, 15.6% of the total). There was no difference among the arthritis, fracture, sprain, and other groups in the prevalence of the specific complaints, or health care use. Significantly more participants with arthritis had to limit activity than in the sprain group (Chi-square test, P=.035).

Conclusions

Chronic musculoskeletal ankle disorders affected almost 20% of the Australian community. The majority were due to a previous ankle injury, and most people had to limit or change their physical activity because of the ankle disorder.

Section snippets

Sampling

The sample was drawn from eligible residents in a defined population that was broadly representative of the Australian community. Data were collected by computer-assisted telephone interviews from a random sample of known landline telephone numbers of residents in New South Wales—the state with the largest population (7.1 million, 2009) in Australia. We chose to stratify according to domicile, that is, metropolitan versus regional. We did not stratify for sex or age because there is no evidence

Sample

We contacted 2078 residences resulting in 751 responses. The response rate of 36.1% was consistent with current telephone survey trends.²² Age was 46.0±12.5 years (mean ± SD), but the sample was skewed toward the older age groups (Australian Bureau of Statistics [2009] mean for same age range=40.2y). The median age was 48 years (interquartile range 37–57y). Most participants resided in metropolitan areas (73%), reflecting the New South Wales distribution (2009: 73.9%). There were more women

Discussion

Three quarter of the participants in this community-based survey had either injured an ankle in the past or had chronic ankle problems. The majority who injured an ankle recovered fully; however, 1 in 5 reported a chronic problem.

Of those with a chronic musculoskeletal ankle disorder, almost 80% were due to an injury and more than 60% of these people had modified their physical activity. The most common symptoms were occasional moderate pain and weakness. Health care consultation at the time of

Conclusions

To the best of our knowledge, this is the first study to survey a community-dwelling sample to determine the prevalence and impact of chronic musculoskeletal ankle disorders. This initial broad screening survey demonstrates that chronic musculoskeletal ankle disorders are highly prevalent, affecting almost 1 in 5 Australians. Persisting ankle problems are particularly common following ankle injury, suggesting a need for further work to quantify the impact, for example, by more specific

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The CAIT-TR demonstrated high Internal consistency (Cronbach's alpha = 0.854) and test-retest reliability (ICC = 0.919). Regarding convergent validity, the CAIT-TR exhibited a moderate-strong correlation with both the FAOS and VAS. The confirmatory factor analysis supported the unidimensional structure of the questionnaire. The identified cut-off value for the CAIT-TR was 25, and the MDC for individual-level CAIT-TR scores was determined to be 1.87. No floor or ceiling effects were observed.
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The prevalence of pain during ADL and sports in the three groups was 16.7%–42.0% and 33.3%–56.5%, respectively. FAAM-Sports and IdFAI score were significantly associated with pain during ADL and sports in the CAI group (odd ratio: 0.923 and 1.145), respectively. No significant pain-related factors were found in the coper and LAS groups.
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A total 131 out of 362 patients with a mean follow-up of 3.0 ± 0.6 years (mean ± SD; 2.0–4.1 years) developed CAI after first-episode LAS. According to multivariable regression, development of CAI after first-episode LAS was associated with 5 prognostic factors: age (odds ratio (OR) = 0.96, 95% confidence interval (95%CI): 0.93–1.00, p = 0.032); body mass index (OR = 1.09, 95%CI: 1.02–1.17, p = 0.009); posterior talofibular ligament injury (OR = 2.17, 95%CI: 1.05–4.48, p = 0.035); large bone marrow lesion of the talus (OR = 2.69, 95%CI: 1.30–5.58, p = 0.008), and Grade 2 effusion of the tibiotalar joint (OR = 2.61, 95%CI: 1.39–4.89, p = 0.003). When patients had at least 1 positive clinical finding in the 10-m walk test, anterior drawer test, or inversion tilt test, they had a 90.2% sensitivity and 77.4% specificity in terms of detecting at least 1 prognostic factor by MRI.
MRI scanning is valuable in predicting CAI after first-episode LAS for those patients with at least 1 positive clinical finding in the 10-m walk test, anterior drawer test, and inversion tilt test. Further prospective and large-scale studies are necessary for validation.
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Non-elite netballers aged > 14 years were recruited from Australia, United Kingdom, and New Zealand. Participants completed an online survey regarding their last ankle sprain and were queried regarding health care sought, health professionals consulted, treatments received, time missed, and return-to-play clearance. Data were described using number (proportion) for the overall cohort and countries. Between-country differences in health care use were compared using chi-square tests. Descriptive statistics were presented for management practices.
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: In-press corrected proof published online on Jun 8, 2012, at www.archives-pmr.org.

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Original articlePrevalence and Impact of Chronic Musculoskeletal Ankle Disorders in the Community

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Sampling

Sample

Discussion

Conclusions

Injury

Pain

Injury

A systematic review on ankle injury and ankle sprain in sports

Sports Med

Review of sports injuries presenting to an accident and emergency department

Emerg Med J

The epidemiology of ankle sprains in the United States

J Bone Joint Surg Am

Population-based epidemiology of ankle sprains attending accident and emergency units in the West Midlands of England, and a survey of UK practice for severe ankle sprains

Emerg Med J

Epidemiology of sprains in the lateral ankle and foot

Foot Ankle Int

Epidemiology of ankle fractures: a prospective population-based study of 212 cases in Aalborg, Denmark

Acta Orthop Scand

Risk factors for sports injuries–a methodological approach

Br J Sports Med

Ankle injuries in basketball: injury rate and risk factors

Br J Sports Med

Ambulatory medical care utilization estimates for 2007

Vital Health Stat 13

Ankle fractures: functional and lifestyle outcomes at 2 years

ANZ J Surg

Operative treatment of ankle fractures: a minimum ten-year follow-up

Foot Ankle Int

Original article
Prevalence and Impact of Chronic Musculoskeletal Ankle Disorders in the Community