Effects of 12 weeks of Tai Chi Chuan intervention on the postural stability and self-reported instability in subjects with functional ankle instability: Study protocol for a randomized controlled trial

Xiao-Hua Ke, Dun-Bing Huang, Yin-Yan Li, Xiao-Mei Li, Jin-Hua Guo, Miao-Miao Guo, Sheng-Xian Yu, Sheng-Chao Ma, Cai Jiang, Zhong-Hua Lin, Xiao-Hua Ke, Dun-Bing Huang, Yin-Yan Li, Xiao-Mei Li, Jin-Hua Guo, Miao-Miao Guo, Sheng-Xian Yu, Sheng-Chao Ma, Cai Jiang, Zhong-Hua Lin

Abstract

Background: Tai Chi Chuan (TCC) is a physical activity modality that originated in China and is now widely popular around the world. Although there are a series of articles reporting that TCC can improve balance and other functional symptoms in a variety of populations, including the elderly, patients with stroke, and patients with Parkinson's disease, its efficiency has not been scientifically and methodically evaluated in subjects with functional ankle instability (FAI). Moreover, there is no literature directly comparing TCC and conventional balance training (CBT) interventions for FAI. The objective of this study is to investigate the comparative effects of TCC intervention and CBT protocols in improving postural balance and subjective instability feelings in patients with FAI.

Methods: This study will be a single-center, parallel group, randomized controlled trial. Sixty-eight patients with FAI will be included and randomly assigned in a 1:1 ratio to either an intervention group (n =34) or a control group (n = 34). The participants in the intervention group will complete 12 weeks of TCC intervention (40 min/time, 3 times/week for 12 weeks) on the basis of health education treatment. The control group will receive health education and 36 CBT sessions during a 12-week period. Outcome measures include postural stability and self-reported feelings of instability at baseline, after the end of the intervention, and 3-month follow-up. The postural stability assessment of patients with FAI will be detected by performing static and dynamic postural tests, which will be carried out through a specific balance platform (TecnoBody ProKin). Self-reported feelings of instability will be assessed by Cumberland Ankle Instability Tool (CAIT), American Orthopedics Foot and Ankle Society's Ankle-Hindfoot Evaluation Scale (AOFAS-AHES), and the MOS item Short Form Health Survey (SF-36).

Discussion: This trial will demonstrate whether a 12-week TCC intervention positively affects postural stability and self-reported outcomes in patients with FAI. At the same time, the superiority of its clinical efficacy will also be compared with that of CBT. This study may also help to redefine the value of traditional Chinese exercises in the treatment of chronic ankle instability.

Clinical trial registration: Chinese Clinical Trial Registry: ChiCTR2100041790. Registration date: 22 March 2021. http://www.chictr.org.cn/edit.aspx?pid=119501&htm=4.

Keywords: Tai Chi Chuan; functional ankle instability; postural stability; protocol; self-reported instability.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Ke, Huang, Li, Li, Guo, Guo, Yu, Ma, Jiang and Lin.

Figures

Figure 1
Figure 1
Flow diagram of participants.

References

    1. Cloak R, Nevill A, Day S, Wyon M. Six-week combined vibration and wobble board training on balance and stability in footballers with functional ankle instability. Clin J Sport Med. (2013) 23:384–91. 10.1097/JSM.0b013e318291d22d
    1. Yeung MS, Chan KM, So CH, Yuan WY. An epidemiological survey on ankle sprain. Bullet Br Assoc Sport Med. (1994) 28:112. 10.1136/bjsm.28.2.112
    1. Freeman MA, Dean MR, Hanham IW. The etiology and prevention of functional instability of the foot. Bone Joint J. (1965) 47:678–85. 10.1302/0301-620X.47B4.678
    1. Williams GN, Jones MH, Amendola A. Syndesmotic ankle sprains in athletes. Am J Sport Med 36. (2008) 1197. 10.1177/0363546507302545
    1. Tropp H. Commentary: functional ankle instability revisited. J Athl Train. (2002) 37:512–515. 10.1152/japplphysiol.00007.2002
    1. Konradsen L, Magnusson P. Increased inversion angle replication error in functional ankle instability. Knee Surg Sports Traumatol Arthro Off J Esska. (2000) 8:246. 10.1007/s001670000124
    1. Ryan L. Mechanical stability, muscle strength and proprioception in the functionally unstable ankle. Aust J Physiother. (1994) 40:41. 10.1016/S0004-9514(14)60453-0
    1. Docherty CL, Mcleod TV, Shultz SJ. Postural control deficits in participants with functional ankle instability as measured by the balance error scoring system. Clin J Sport Med Off J Can Acad Sport Med. (2006) 16:203. 10.1097/00042752-200605000-00003
    1. Ross SE, Guskiewicz KM, Gross MT, Yu B. Balance measures for discriminating between functionally unstable and stable ankles. Med Sci Sports Exerc. (2009) 41:399–407. 10.1249/MSS.0b013e3181872d89
    1. Arnold BL, Wright CJ, Ross SE. Functional ankle instability and health-related quality of life. J Athl Train. (2011) 46:634. 10.4085/1062-6050-46.6.634
    1. Nam SM, Kim K, Lee DY. Effects of visual feedback balance training on the balance and ankle instability in adult men with functional ankle instability. J Phys Ther Sci. (2018) 30:113–5. 10.1589/jpts.30.113
    1. Xs A, Jia H, Jw B, Ra BGW. Does treatment duration of manual therapy influence functional outcomes for individuals with chronic ankle instability: a systematic review with meta-analysis? Science direct. Musculoskel Sci Prac. (2019) 40:87–95. 10.1016/j.msksp.2019.01.015
    1. Mollà-Casanova S, Inglés M, Serra-Aó P. Effects of balance training on functionality, ankle instability, and dynamic balance outcomes in people with chronic ankle instability: systematic review and meta-analysis. Clin Rehabil. (2021) 35:1694–709. 10.1177/02692155211022009
    1. Eils E, Rosenbaum DA. multi-station proprioceptive exercise program in patients with ankle instability. Med Sci Sports Exer. (2002) 33:1991–8. 10.1097/00005768-200112000-00003
    1. Wang LC, Ye MZ, Xiong J, Wang XQ, Wu JW, Zheng GH. Optimal exercise parameters of tai chi for balance performance in older adults: a meta-analysis. J Am Geriatr Soc. (2021) 69:2000–10. 10.1111/jgs.17094
    1. Cruz-Díaz D, Kim KM, Hita-Contreras F, Bergamin M, Aibar-Almazán A, Martínez-Amat A, et al. . Effects of 12 weeks of Tai Chi intervention in patients with chronic ankle instability: a randomized controlled trial. J Sport Rehab. (2020) 29:326–31. 10.1123/jsr.2018-0222
    1. Cheng TO. Tai Chi: the Chinese ancient wisdom of an ideal exercise for cardiac patients. Int J Cardiol. (2007) 117:293–5. 10.1016/j.ijcard.2006.06.021
    1. Cruz-Díaz D, Kyung-Min K, Hita-Contreras F, Bergamin M, Martínez-Amat A. Effects of a twelve-week tai chi intervention in patients with chronic ankle instability: a randomized controlled tri. J Sport Rehabil. (2019) 29:1–6.
    1. Cruz-Díaz D, Vega RL, Osuna-Pérez MC, Hita-Contreras F, Martínez-Amat A. Effects of joint mobilization on chronic ankle instability: a randomized controlled trial. Disability Rehabil. (2014) 37:601–10. 10.3109/09638288.2014.935877
    1. Kim KM, Estepa-Gallego A, Estudillo-Martínez MD, Castellote-Caballero Y, Cruz-Díaz D. Comparative effects of neuromuscular-and strength-training protocols on pathomechanical, sensory-perceptual, and motor-behavioral impairments in patients with chronic ankle instability: randomized controlled trial. Healthcare. (2022) 10:1364. 10.3390/healthcare10081364
    1. Li F, Harmer P, Liu Y, Chou LS. Tai Ji Quan and global cognitive function in older adults with cognitive impairment: a pilot study. Arch Gerontol Geriatr. (2014) 58:434–9. 10.1016/j.archger.2013.12.003
    1. Hiller CE, Refshauge KM, Bundy AC, Herbert RD, Kilbreath SL. The Cumberland ankle instability tool: a report of validity and reliability testing. Arch Phys Med Rehabil. (2006) 87:1235–41. 10.1016/j.apmr.2006.05.022
    1. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M, et al. . Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot and ankle international Am Ortho Foot Ankle Soc. (1994) 15:349–53. 10.1177/107110079401500701
    1. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). Conceptual framework and item selection. Med Care. (2019) 30:473–83. 10.1097/00005650-199206000-00002
    1. Amico AP, Nisi M, Covelli I, Polito AM, Damiani S. Efficacy of proprioceptive training with prokin system in balance disorders from multiple sclerosis. J Multi Scler. (2013) 1:1–8. 10.4172/jmso.1000110
    1. Dumanlidag S, Milanlioglu A. Comparison of static and dynamic balance measurements among chronic and episodic migraine patients. Arq Neuro Psiquiatr. (2021) 79:399–406. 10.1590/0004-282x-anp-2020-0319
    1. Hertel J, Corbett RO. An updated model of chronic ankle instability. J Athl Train. (2019) 54:574–88. 10.4085/1062-6050-344-18
    1. Alahmari KA, Kakaraparthi VN, Reddy RS, Silvian P, Tedla JS, Rengaramanujam K, et al. . Combined effects of strengthening and proprioceptive training onstability, balance, and proprioception among subjects with chronic ankle instability in different age groups: evaluation of clinical outcome measures. Indian J Orthop. (2021) 55:199–208. 10.1007/s43465-020-00192-6
    1. Song K, Rhodes E, Wikstrom EA. Balance training does not alter reliance on visual information during static stance in those with chronic ankle instability: a systematic review with meta-analysis. Sports Med. (2018) 48:893–905. 10.1007/s40279-017-0850-8
    1. Chang WD, Chen S, Tsou YA. Effects of whole-body vibration and balance training on female athletes with chronic ankle instability. J Clin Med. (2021) 10:2380. 10.3390/jcm10112380
    1. Rios JL, Gorges AL, Santos M. Individuals with chronic ankle instability compensate for their ankle deficits using proximal musculature to maintain reduced postural sway while kicking a ball. Hum Movement Sci. (2015) 43:33–44. 10.1016/j.humov.2015.07.001
    1. Wei S, Ma X, Wang L, Cui Z, Song Q, Gu H, et al. . Effects of Tai Chi Chuan and brisk walking exercise on balance ability in elderly women: a randomized controlled trial. Motor Control. (2018) 23:1–15. 10.1123/mc.2017-0055
    1. Tavakoli S, Forghany S, Nester C. The effect of dual tasking on foot kinematics in people with functional ankle instability. Gait Post. (2016) 49:364–70. 10.1016/j.gaitpost.2016.07.302
    1. Springer S, Gottlieb U. Effects of dual-task and walking speed on gait variability in people with chronic ankle instability: a cross-sectional study. BMC Musculoskel Dis. (2017) 18:316. 10.1186/s12891-017-1675-1
    1. Rosen AB, Mcgrath ML, Maerlender AL. Males with chronic ankle instability demonstrate deficits in neurocognitive function compared to control and copers. Res Sports Med. (2020) 29:116–28. 10.1080/15438627.2020.1723099
    1. Mohammadi N, Hadian MR, Olyaei G. Information processing speed and accuracy in basketball players with and without functional ankle instability. J Mod Rehabil. (2020) 13:179–84. 10.32598/JMR.13.3.179
    1. Wayne PM, Walsh JN, Taylor-Piliae RE, Wells RE, Papp KV, Donovan NJ, et al. . Effect of Tai Chi on cognitive performance in older adults: systematic review and meta-analysis. J Am Geriatr Soc. (2014) 62:25–39. 10.1111/jgs.12611
    1. Miller SM, Taylor-Piliae RE. Effects of Tai Chi on cognitive function in community-dwelling older adults: a review. Geriatr Nurs. (2014) 35:9–19. 10.1016/j.gerinurse.2013.10.013
    1. Liao YY, Liu MN, Wang HC, Walsh V, Lau CI. Combining transcranial direct current stimulation with tai chi to improve dual-task gait performance in older adults with mild cognitive impairment: a randomized controlled trial. Front Aging Neurosci. (2021) 13:766649. 10.3389/fnagi.2021.766649

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