AJ Dorsiflexion Articles (5)

Question 1

Saxena, 2003
“Ankle Dorsiflexion in Adolescent Athletes”

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Answer 1

Hierarchy: 5 non experimental descriptive
Paradigm: Challenges Root Model (own)
Aim: Obtain standard values for AJ DF in adolescent athletes & compare to previous literature
Methods: 40 athletes (16 female, 24 male) volunteered to participate, supine, neutral foot, measured knee flexed & extended, using goniometer.
Results: 0 degrees DF with knee extension & 5 degrees DF with knee flexed = average ROM at AJ.
Values less than previous studies. Study indicates some degree of equinus is normal
Stats: Mean/ SD, Student t-test (p< 0.05) for comparison males/females & R/L leg
Article= Bad. Arguments/ evidence is weak. Poor reproducibility. Nil inter or intra reliability, External validity, only american athletes, poor construction of method, SD> mean indicates high variability in data. No power calculations, no images.

Question 2

Scharfbillig, 2004
“Measurement of foot dorsiflexion, a modified lidcombe template”

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Answer 2

Hierarchy: Level 5 non experimental descriptive, RELIABILITY study
Paradigm: Root
Aim: To modify Lidcombe template so that DF can be measured in knee extension as it’s more clinically significant. Test reliability of apparatus in healthy sample of children. Gastroc tightness major cause of reduced foot DF.
Methods: Added strain gauge to the template, so pressure was consistent during the motion. Increased the size of force plate & added hinge to provide constant axis. 14 participants, 7 male & 7 female, sample of convenience, ethics committee approval, examiners blinded, both legs tested, procedure repeated.
Results: Excellent inter & intra reliability. ROM measured= -8.1 to 30.7 degrees ankle DF. Averages of 3 samples for each person & SD for examiners.
Stats: ICC over inflated due to high std deviation, ICC would not pick up small variations in measurements
Article= Good, excellent reliability & reproduceability, detailed methods, photographs, used appropriate statistics.
Although didn’t compare to gold standard

Question 3

Munteanu, 2009
“A weight bearing method technique for the measurement of ankle joint DF with knee extended is reliable”

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Answer 3

Hierarchy: 5 non experimental descriptive study - RELIABILITY STUDY
Paradigm: Root
Aim: Test intra & inter rater reliability of ankle DF in weight bearing & knee extended. Need 10 degrees of DF during gait for foot clearance
Methods: 30 uni students, 19-42yo, 20 female, 10 male, 4 raters with varying clinical experience. Participant has knee flexed, angle of tibia made with vertical line measured using 2 apparatus: digital inclinometer & clear acrylic plate apparatus. Test repeated in a week.
Results: High inter-rater reliablity
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Article=
Strengths: Good inter-rater reliability, used 4 raters.
Good intra-rater reliability for inexperienced rater- measured twice. Tested one leg only. Two outcome measures used.
Weakness: Testing DF in gait not representative normal gait. Low level of evidence. Small sample size n=30.

Question 4

Gatt, 2011
“Clinical assessment of AJ DF, a review of measurement techniques”

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Answer 4

Hierarchy: Level 1, Systematic review
Paradigm: Root
Aim: Investigate various techniques of measuring AJ DF & compare to currently accepted measurement tool, goniometer to obtain degrees of AJ DF & whether valid & reliable.
Methods: 10 techniques identified in review, goniometer is highly reliable & clinically unacceptable, all current techniques are unreliable, due to differences in measurement techniques it’s hard to standardize results.
Results: 755 papers measuring AJ DF used, methodological quality of studies tested with quality assessment tool (assessed by 2 clinicians) & given score. Quality assessment tool not validated & total scores incorrectly calculated. Proposed vertical arm placement, use of plate for other arm & amount of force applied should be standardized, subject positioning should be considered. Radiography should be considered as gold standard DF measurement.
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Article: Bad article, not clear what’s being measured, search strategy not reproducible, no dates etc, quality assessment tool not assessed for reliability or validity

Question 5

Nix, 2013
“Interventions for increasing ankle joint dorsiflexion: a systematic review & meta-analysis”

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Answer 5

Hierarchy: 1 [Meta-analysis of RCT & other studies in Systematic Review]
Paradigm: Root
Aim: Investigate safety & effectiveness of common conservative (non-surgical) interventions for improving ankle joint ROM (dorsiflexion) in a healthy population
Methods: Database search performed of 4 databases. Search criteria included conservative interventions for AJ ROM increase, exclusion criteria included history of pathology or surgery. Articles reviewed using critical assessment tool (PEDro scale).
Results: Improvement in AJ ROM due to significant positive effect of stretching, measured using goniometer
Stats: Study designs & effect size (means & standard deviations & confidence intervals) were calculated for interventions allocated in studies.
Article= Good/Bad
(Strengths vs Weaknesses):
Good article, strengths & weaknesses stated by author, including bias, measurement of ROM measurement tool not validated, showing low reliability.