Verbal Encouragement Improves Star Excursion Balance Test Performance In Patients With Chronic Ankle Instability

Abstract

PURPOSE:The Star Excursion Balance Test (SEBT) is a common dynamic balance test. Functional limitations on the SEBT are associated with CAI, but psychological constraints such as kinesiophobia or a lack of confidence may affect performance. The purpose of this study was to investigate the effects of verbal encouragement (VE) on maximum reach distance performance between CAI and healthy participants on the SEBT and to explore the role of kinesiophobia with this functional. METHODS:Thirty-four individuals: 17 CAI (10 F/7 M; age= 21.06±3.19yr; height=171.2±11.9 cm; weight=67.7±10.8 kg) and 17 healthy controls (10 F/7 M; age=19.41 ±1.23yr; height=169.35±6.36 cm; weight=64.89±8.76kg) volunteered. Independent variables included condition (VE vs No VE) and group (CAI vs Healthy). The Fear Avoidance Beliefs Questionnaire (FABQ) was administered. Participants completed 3 SEBT trials per condition, starting with No VE followed by VE to eliminate the effect of heightened motivation with a randomized order. Analysis of Variance (ANOVA) examined group differences and whether VE affected performance for Anterior (ANT), Posteromedial (PM), and Posterolateral (PL) reach distances. FABQ was compared between the CAI and Healthy groups using a t-test; all alpha levels were <.05 a priori. RESULTS:With No VE, a significant group-by-condition interaction was observed in both the ANT (CAI: 66.90 ± 5.50 vs Healthy:70.65 ± 4.52) and PM (CAI: 77.60 ± 7.70 vs Healthy: 81.89 ± 8.25 reach directions, which diminished with VE: ANT (CAI: 70.43 ± 4.52 vs Healthy: 71.77 ± 5.10) and PM (CAI: 85.41 ± 7.19 vs Healthy: 86.45 ± 8.71), showing that the two groups behaved similarly with VE. There was no statistically significant interaction (p=0.48) for the PL reach direction without VE (CAI: 73.60 ± 7.84 vs Healthy: 75.16 ±11.72) or with VE (CAI: 80.18 ±9.79 vs Healthy: 80.06 ± 11.93). The CAI group had significantly higher FABQ scores (10.53 ±9.45) than the healthy group (0.41 ± 1.70) (p<.001). CONCLUSIONS: The CAI group had lower performance on the SEBT without VE, but with VE, the scores were comparable to healthy controls. Clinicians and researchers should acknowledge the impact that motivation and psychological stresses have on functional performance in patients with pathologies such as CAI.