The clinical responsiveness of motion palpation as a post-manipulation diagnostic tool in patients with chronic ankle instability syndrome

Abstract

Introduction: Motion palpation is a commonly utilised clinical assessment tool of joint fixations. Most research surrounding motion palpation discusses inter and/or intra-examiner reliability as a pre-treatment tool. However, only two studies have assessed the reliability of motion palpation as a post-treatment diagnostic tool, and both these studies demonstrated that motion palpation has the ability to identify end-feel improvement in a restricted segment which had been manipulated. Therefore the use of motion palpation as a post-manipulation tool within the spine showed a relatively high level of responsiveness/efficacy of motion palpation. However little research has yet to be conducted on the use of motion palpation as a post-manipulation tool on the extremities and therefore this study aims to provide a clearer insight into the use of motion palpation as a post-treatment assessment tool in an extremity in terms of clinical responsiveness/validity of motion palpation. Furthermore the relationship between motion palpation and other clinical measures/short term outcomes, such as pain, functionality, range of motion and proprioception has yet to be seen i.e. when motion palpation indicates a reduction in a fixation due to manipulation does this correlate to a decrease in pain and increase in functionality, range of motion and proprioception. Therefore the primary aim of this study was to determine the clinical responsiveness of motion palpation as a post-manipulation diagnostic tool within the joints of the ankle in symptomatic participants with Chronic Ankle Instability (CAI). Method: Forty participants with CAI (Grade I and II) were recruited. One Group received manipulation (n=21), the other Group received no treatment (n=19). Motion palpation was performed, and subjective/objective measures were taken in both Groups pre- and posttreatment. Statistical analysis was performed using SPSS 15.0. Results: The findings of this study demonstrated that when using motion palpation as a posttreatment assessment tool a high level of responsiveness was observed (a highly significant association between being manipulated and End-Feel Improvement (EFI) occurred (p<0.001)); it was highly sensitive (0.90); and was highly specific (0.95). Overall no statistically significant association was observed in either group between, motion palpation results (with respect to EFI or no EFI noted) and any of the short term outcomes (the five subjective/objective clinical measures). Within the manipulation group; Visual Analogue Scale (VAS) (p=0.944), Functional Ankle Disability Index (FADI) (p=0.490), Pressure Algometer v (p=0.634), Berg Balance Scale (BBS) (p=0.512) and Weight Bearing Dorsiflexion (WBD) (p=0.966). In comparison, the control group; Visual Analogue Scale (VAS) (p=0.063), Functional Ankle Disability Index (FADI) (p=0.491), Pressure Algometer (p=0.828), Berg Balance Scale (BBS) (p=0.695) and Weight Bearing Dorsiflexion (WBD) (p=0.747). The most common fixations noted in this study, were mortise Long Axis Distraction (LAD), subtalar LAD and subtalar eversion. Conclusion: Therefore, motion palpation appears to be valid when used as a post-treatment tool in the foot and ankle; and overall, common fixations found in symptomatic participants with CAI in this study are similar to those found in previous studies.