Smartphone for Assessing Balance in Patients With Ankle Instability
Condition: Chronic Ankle Instability
MeSH terms: Joint Instability
Study type: Observational

Summary: 
      This study aims at investigating the validity and reliability of a smartphone application
      "MyAnkle: in assessing the balance component of postural control in patients with chronic
      ankle instability (CAI).
    

Detailed description: 
      Lateral ankle sprain (LAS) is a common injury in athletic and regular activities; with an
      incidence of 7 per 1000 exposure. After LAS, residual symptoms may persist leading to chronic
      ankle instability (CAI). This instability is believed to arise from dysfunctional postural
      control, defective proprioception, weak muscles, or reduced ankle range of motion (ROM).Thus,
      assessment of postural control is essential for proper clinical decision-making and treatment
      selection.

      With advances in technology, smartphone has been introduced as an assessment tool for the
      musculoskeletal system. For example, it was used in assessment of ROM and mobility in stroke
      patients and frail elderly conditions. Further, it was used to assess balance and falling
      risk in those population. In addition, it was used to assess balance in healthy and
      participants with chronic ankle sprain. These studies proved that smartphone is a valid and
      reliable tool that is light in weight and inexpensive. Yet, these studies have some
      methodological concerns. For example, the application was not validated against gold standard
      or was validated only in healthy volunteers rather than in patients with musculoskeletal
      dysfunction. Further, a few of these studies did not establish the application discriminative
      validity between patients and healthy controls. Thus, this study will try to answer the
      following question: "Is smartphone application a valid and reliable tool to assess balance in
      patients with CAI compared to gold standards?
    

Intervention name(s): Smartphone "MyAnkle" balance application
Intervention type(s): Diagnostic Test
Intervention description(s): Balance will be assessed simultaneously using "MyAnkle" application and the Biodex balance system. The smartphone will be fixed to the middle of the shin with an armband. Participants will assume a single leg stance on each side under two conditions: eyes opened and closed. Testing will be done at three levels of difficulty; least difficult (level 8), moderate (level 6) and severe difficult (level 4). A conditioning trial for each level will be given for 30 seconds. Further, a 2-minute rest between tests will be given. During the testing, participants should not touch the ground or stance limb by other limb nor to grasp the handrail. Participants will repeat the same testing in two separate sessions, with one-week interval in between.
Other intervention name(s): Biodex Balance system
Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Fifty patients with CAI and 50 gender-, BMI and age-matched healthy volunteers will be
        enrolled in this study.

        Healthy participants will be recruited from undergraduate and graduate students of the
        faculty of Physical Therapy, Cairo University, Egypt. All healthy subjects will be
        asymptomatic with no neuromusculoskeletal signs or symptoms.

        Male and female adult patients with CAI will be recruited from the outpatient clinic of the
        faculties of Physical Therapy and Medicine, Cairo University, Egypt.
      
Keywords: Balance; Smartphone; Validity; Reliability; chronic ankle instability