Background: Ankle fractures are one of the most common fractures of the lower limb and contribute significantly to mortality, morbidity and costs to the patient, hospital and healthcare system. Ankle fractures account for approximately 9% of all fractures with a rate of prevalence of 187 per 100,000 of population. Complaints of ongoing stiffness, swelling and pain with walking, as well as chronic deficits in balance are common outcomes post ankle fracture.
Objectives: The aim of this study is to determine proof of principle that the Star Excursion Balance Test (SEBT), when used as a rehabilitation tool, will show positive results compared to the widely used Single Leg Stance Test (SLS) in balance measures post ankle fracture. A further outcome of this study was to compare change in functional activity between the two interventions, using the Lower Extremity Functional Scale (LEFS).
Methods: The study design employed was a cohort study (of 40 subjects) with two cohort groups; the SEBT treatment group and the SLS treatment group. Subjects were assessed at one week and six weeks after removal of immobilisation, post ankle fracture.
Results: SEBT Results: There were significant between-group difference in percentage change in SEBT scores, normalised to leg length, in favour of the SEBT intervention group [Anterior 58% v 20% (p > 0.01)], [posterolateral 53% v 23% (p > 0.01)], [posteromedial 46% v 20% (p > 0.01)].
BESS Results: There was no significant between-group difference in percentage change in BESS scores. Both groups exhibited a substantial improvement in BESS score as indicated by a decrease in errors observed [SEBT group: 27% decrease in BESS score; SLS group: 22% decrease in BESS score].
LEFS Results: There was no significant between-group difference in percentage change in LEFS score. Both groups exhibited a substantial improvement in LEFS score [SEBT group: 58% increase in LEFS score; SLS group: 40% increase in LEFS score].
Conclusion: The SEBT, when used as a rehabilitation tool, shows statistically significant results compared to an SLS treatment programme in dynamic balance measures, at 6 weeks post removal of immobilisation following ankle fracture. Positive results were also found in terms of BESS and LEFS outcome measure scores.
Implications: This study offers a novel approach for musculoskeletal physiotherapists that may guide and develop the implementation of balance rehabilitation programmes, specifically in optimising dynamic postural stability, post ankle fracture.
Keywords: balance, ankle fracture, star excursion balance test
Ethical Approval: Yes – SJH/AMNCH ethics committee.
