Perceived instability, pain, and psychological factors predict function and disability in individuals with chronic ankle instability

Context:Chronic ankle instability (CAI) is associated with residual instability, pain, decreased function, and increased disablement. Injury-related fear has been associated with CAI, although its relationship to other impairments is unclear. The Fear-Avoidance Model is a theoretical framework hypothesizing a relationship between injury-related fear, chronic pain, pain catastrophizing, and disability. It has been useful in understanding fear's influence in other musculoskeletal conditions but has yet to be studied in those with CAI.Objective:To explore relationships between instability, pain catastrophizing, injury-related fear, pain, ankle function, and global disability in individuals with CAI.Design:Cross-Sectional StudySetting:Anonymous online surveyPatients or Other Participants:A total of 259 people, recruited via e-mail and social media, with a history of ankle sprain completed the survey; of those, 126 participants (age=32.69±4.38, female=84.92%, highly active=73.81%) were identified to have CAI and were included in the analysis.Main Outcome Measure(s):Demographics included gender identity, age, and physical activity level. Assessments encompassed the Identification of Functional Ankle Instability (instability), the Pain Catastrophizing Scale (pain catastrophizing), the Tampa Scale of Kinesiophobia-11 (injury-related fear), a numeric pain rating scale and activity-based question (pain presence), the Quick-FAAM (ankle function), and the modified Disablement in the Physically Active Scale (disability). Relationships between variables were explored through correlation and regression analyses.Results:After controlling for instability and pain, pain catastrophizing and injury-related fear were significantly related to function and disability ratings in individuals with CAI. Together, the variables predicted 48.7% (P