{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T20:01:06Z","timestamp":1790539266919,"version":"4.1.0"},"reference-count":48,"publisher":"National Athletic Trainers' Association","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:p>Individuals with chronic ankle instability (CAI) have deficits in neuromuscular control and altered movement patterns. Ankle-destabilization devices have been shown to increase lower extremity muscle activity during functional tasks and may be useful tools for improving common deficits and self-reported function.Context:<\/jats:p>\n                  <jats:p>To determine whether a 4-week rehabilitation program that includes destabilization devices has greater effects on self-reported function, range of motion (ROM), strength, and balance than rehabilitation without devices in patients with CAI.Objective:<\/jats:p>\n                  <jats:p>Randomized controlled clinical trial.Design:<\/jats:p>\n                  <jats:p>Laboratory.Setting:<\/jats:p>\n                  <jats:p>A total of 26 patients with CAI (7 men, 19 women; age = 21.34 \u00b1 3.06 years, height = 168.96 \u00b1 8.77 cm, mass = 70.73 \u00b1 13.86 kg).Patients or Other Participants:<\/jats:p>\n                  <jats:p>Patients completed baseline measures and were randomized into no-device and device groups. Both groups completed 4 weeks of supervised, impairment-based progressive rehabilitation with or without devices and then repeated baseline measures.Intervention(s):<\/jats:p>\n                  <jats:p>\n                    We assessed self-reported function using the Foot and Ankle Ability Measure. Ankle ROM was measured with an inclinometer. Ankle strength was assessed using a handheld dynamometer during maximal voluntary isometric contractions. Balance was measured using a composite score of 3 reach directions from the Star Excursion Balance Test and a force plate to calculate center of pressure during eyes-open and eyes-closed single-limb balance. We compared each dependent variable using a 2 \u00d7 2 (group \u00d7 time) analysis of variance and post hoc tests as appropriate and set an a priori \u03b1 level at .05. The Hedges\n                    <jats:italic>g<\/jats:italic>\n                    effect sizes and associated 95% confidence intervals were calculated.Main Outcome Measure(s):\n                  <\/jats:p>\n                  <jats:p>We observed no differences between the no-device and device groups for any measure. However, both groups had large improvements in self-reported function and ankle strength.Results:<\/jats:p>\n                  <jats:p>Incorporating destabilization devices into rehabilitation did not improve ankle function more effectively than traditional rehabilitation tools because both interventions resulted in similar improvements. Impairment-based progressive rehabilitation improved clinical outcomes associated with CAI.Conclusions:<\/jats:p>","DOI":"10.4085\/1062-6050-51.3.09","type":"journal-article","created":{"date-parts":[[2016,9,19]],"date-time":"2016-09-19T13:47:32Z","timestamp":1474292852000},"page":"233-251","source":"Crossref","is-referenced-by-count":74,"title":["Rehabilitation for Chronic Ankle Instability With or Without Destabilization Devices: A Randomized Controlled Trial"],"prefix":"10.4085","volume":"51","author":[{"given":"Luke","family":"Donovan","sequence":"first","affiliation":[{"name":"Department of Kinesiology, University of Toledo, OH; Departments of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M.","family":"Hart","sequence":"additional","affiliation":[{"name":"Kinesiology and"},{"name":"Orthopaedic Surgery, The University of Virginia, Charlottesville;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan A.","family":"Saliba","sequence":"additional","affiliation":[{"name":"Kinesiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Park","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, The University of Virginia, Charlottesville;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark Anthony","family":"Feger","sequence":"additional","affiliation":[{"name":"Kinesiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher C.","family":"Herb","sequence":"additional","affiliation":[{"name":"Department of Athletic Training & Nutrition, Weber State University, Ogden, UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Hertel","sequence":"additional","affiliation":[{"name":"Kinesiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2557","reference":[{"issue":"2","key":"i1062-6050-51-3-233-b01","series-title":"J Athl Train","first-page":"311","article-title":"Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives","volume":"42","author":"Hootman \n              JM,","year":"2007","unstructured":"Hootman \n              JM, \n            \n            \n              Dick \n              R, \n            \n            \n              Agel \n              J. \n            \n          \n          Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. 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A systematic literature review","volume":"121","author":"van Rijn \n              RM,","year":"2008","unstructured":"van Rijn \n              RM, \n            \n            \n              van Os \n              AG, \n            \n            \n              Bernsen \n              R, \n            \n            \n              Luijsterburg \n              PA, \n            \n            \n              Koes \n              BW, \n            \n            \n              Bierma-Zeinstra \n              S. \n            \n          \n          What is the clinical course of acute ankle sprains? A systematic literature review. 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J Athl Train. 2002;37(4):487\u2013493."},{"issue":"4","key":"i1062-6050-51-3-233-b08","series-title":"J Orthop Sports Phys Ther","first-page":"245","article-title":"Evaluation of kinesthetic deficits indicative of balance control in gymnasts with unilateral chronic ankle sprains","volume":"23","author":"Forkin \n              DM,","year":"1996","unstructured":"Forkin \n              DM, \n            \n            \n              Koczur \n              C, \n            \n            \n              Battle \n              R, \n            \n            \n              Newton \n              RA. \n            \n          \n          Evaluation of kinesthetic deficits indicative of balance control in gymnasts with unilateral chronic ankle sprains. J Orthop Sports Phys Ther. 1996;23(4):245\u2013250."},{"issue":"1","key":"i1062-6050-51-3-233-b09","series-title":"Am J Sports Med","first-page":"72","article-title":"Ankle sensorimotor control and eversion strength after acute ankle inversion injuries","volume":"26","author":"Konradsen \n              L,","year":"1998","unstructured":"Konradsen \n              L, \n            \n            \n              Olesen \n              S, \n            \n            \n              Hansen \n              HM. \n            \n          \n          Ankle sensorimotor control and eversion strength after acute ankle inversion injuries. Am J Sports Med. 1998;26(1):72\u201377."},{"issue":"10","key":"i1062-6050-51-3-233-b10","series-title":"Med Sci Sports Exerc","first-page":"1810","article-title":"Balance training improves function and postural control in those with chronic ankle instability","volume":"40","author":"McKeon \n              PO,","year":"2008","unstructured":"McKeon \n              PO, \n            \n            \n              Ingersoll \n              CD, \n            \n            \n              Kerrigan \n              DC, \n            \n            \n              Saliba \n              E, \n            \n            \n              Bennett \n              BC, \n            \n            \n              Hertel \n              J. \n            \n          \n          Balance training improves function and postural control in those with chronic ankle instability. Med Sci Sports Exerc. 2008;40(10):1810\u20131819."},{"issue":"6","key":"i1062-6050-51-3-233-b11","series-title":"J Sci Med Sport","first-page":"685","article-title":"Dorsiflexion deficit during jogging with chronic ankle instability","volume":"12","author":"Drewes \n              LK,","year":"2009","unstructured":"Drewes \n              LK, \n            \n            \n              McKeon \n              PO, \n            \n            \n              Kerrigan \n              DC, \n            \n            \n              Hertel \n              J. \n            \n          \n          Dorsiflexion deficit during jogging with chronic ankle instability. J Sci Med Sport. 2009;12(6):685\u2013687."},{"issue":"4","key":"i1062-6050-51-3-233-b12","series-title":"J Orthop Sports Phys Ther","first-page":"166","article-title":"The effect of lateral ankle sprain on dorsiflexion range of motion, posterior talar glide, and joint laxity","volume":"32","author":"Denegar \n              CR,","year":"2002","unstructured":"Denegar \n              CR, \n            \n            \n              Hertel \n              J, \n            \n            \n              Fonseca \n              J. \n            \n          \n          The effect of lateral ankle sprain on dorsiflexion range of motion, posterior talar glide, and joint laxity. J Orthop Sports Phys Ther. 2002;32(4):166\u2013173."},{"issue":"2","key":"i1062-6050-51-3-233-b13","series-title":"Med Sci Sports Exerc","first-page":"245","article-title":"Eccentric muscle strength in functional ankle instability","volume":"35","author":"Munn \n              J,","year":"2003","unstructured":"Munn \n              J, \n            \n            \n              Beard \n              DJ, \n            \n            \n              Refshauge \n              KM, \n            \n            \n              Lee \n              RY. \n            \n          \n          Eccentric muscle strength in functional ankle instability. Med Sci Sports Exerc. 2003;35(2):245\u2013250."},{"issue":"3","key":"i1062-6050-51-3-233-b14","series-title":"J Sport Rehabil","first-page":"375","article-title":"Altered ankle kinematics and shank-rear-foot coupling in those with chronic ankle instability","volume":"18","author":"Drewes \n              LK,","year":"2009","unstructured":"Drewes \n              LK, \n            \n            \n              McKeon \n              PO, \n            \n            \n              Paolini \n              G, \n            \n            et al. \n          Altered ankle kinematics and shank-rear-foot coupling in those with chronic ankle instability. J Sport Rehabil. 2009;18(3):375\u2013388."},{"issue":"12","key":"i1062-6050-51-3-233-b15","series-title":"Am J Sports Med","first-page":"1970","article-title":"Altered neuromuscular control and ankle joint kinematics during walking in subjects with functional instability of the ankle joint","volume":"34","author":"Delahunt \n              E,","year":"2006","unstructured":"Delahunt \n              E, \n            \n            \n              Monaghan \n              K, \n            \n            \n              Caulfield \n              B. \n            \n          \n          Altered neuromuscular control and ankle joint kinematics during walking in subjects with functional instability of the ankle joint. Am J Sports Med. 2006;34(12):1970\u20131976."},{"issue":"8","key":"i1062-6050-51-3-233-b16","series-title":"Am J Sports Med","first-page":"1769","article-title":"Foot clearance in walking and running in individuals with ankle instability","volume":"39","author":"Brown \n              C.","year":"2011","unstructured":"Brown \n              C. \n            \n          \n          Foot clearance in walking and running in individuals with ankle instability. Am J Sports Med. 2011;39(8):1769\u20131776."},{"issue":"2","key":"i1062-6050-51-3-233-b17","series-title":"Clin Biomech (Bristol, Avon)","first-page":"168","article-title":"Ankle function during gait in patients with chronic ankle instability compared to controls","volume":"21","author":"Monaghan \n              K,","year":"2006","unstructured":"Monaghan \n              K, \n            \n            \n              Delahunt \n              E, \n            \n            \n              Caulfield \n              B. \n            \n          \n          Ankle function during gait in patients with chronic ankle instability compared to controls. Clin Biomech (Bristol, Avon). 2006;21(2):168\u2013174."},{"issue":"4","key":"i1062-6050-51-3-233-b18","series-title":"Phys Sportsmed","first-page":"41","article-title":"A new paradigm for rehabilitation of patients with chronic ankle instability","volume":"40","author":"Donovan \n              L,","year":"2012","unstructured":"Donovan \n              L, \n            \n            \n              Hertel \n              J. \n            \n          \n          A new paradigm for rehabilitation of patients with chronic ankle instability. Phys Sportsmed. 2012;40(4):41\u201351."},{"issue":"6","key":"i1062-6050-51-3-233-b19","series-title":"Int J Sports Med","first-page":"464","article-title":"The effects of an ankle destabilization device on muscular activity while walking","volume":"26","author":"Forestier \n              N,","year":"2005","unstructured":"Forestier \n              N, \n            \n            \n              Toschi \n              P. \n            \n          \n          The effects of an ankle destabilization device on muscular activity while walking. Int J Sports Med. 2005;26(6):464\u2013470."},{"issue":"2","key":"i1062-6050-51-3-233-b20","series-title":"J Sport Rehabil","first-page":"134","article-title":"Lower-extremity electromyography measures during walking with ankle-destabilization devices","volume":"23","author":"Donovan \n              L,","year":"2014","unstructured":"Donovan \n              L, \n            \n            \n              Hart \n              JM, \n            \n            \n              Hertel \n              J. \n            \n          \n          Lower-extremity electromyography measures during walking with ankle-destabilization devices. 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Evertor muscle strength compares favorably with shoe height, athletic tape, and three orthoses","volume":"24","author":"Ashton-Miller \n              JA,","year":"1996","unstructured":"Ashton-Miller \n              JA, \n            \n            \n              Ottaviani \n              RA, \n            \n            \n              Hutchinson \n              C, \n            \n            \n              Wojtys \n              EM. \n            \n          \n          What best protects the inverted weightbearing ankle against further inversion? Evertor muscle strength compares favorably with shoe height, athletic tape, and three orthoses. 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Charlottesville: University of Virginia;2014."},{"issue":"1\u22124","key":"i1062-6050-51-3-233-b31","series-title":"Serb J Sports Sci","first-page":"67","article-title":"The relationship between forefoot, midfoot and rearfoot static alignment in painfree and painful heel in athletes","volume":"2","author":"Gupta \n              S,","year":"2008","unstructured":"Gupta \n              S, \n            \n            \n              Paul \n              M, \n            \n            \n              Sandhu \n              JS. \n            \n          \n          The relationship between forefoot, midfoot and rearfoot static alignment in painfree and painful heel in athletes. 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J Am Podiatr Med Assoc. 2000;90(6):295\u2013299."},{"issue":"2","key":"i1062-6050-51-3-233-b35","series-title":"Athl Train Sports Health Care","first-page":"76","article-title":"Relationships between measures of posterior talar glide and ankle dorsiflexion range of motion","volume":"3","author":"Cosby \n              NL,","year":"2011","unstructured":"Cosby \n              NL, \n            \n            \n              Hertel \n              J. \n            \n          \n          Relationships between measures of posterior talar glide and ankle dorsiflexion range of motion. Athl Train Sports Health Care. 2011;3(2):76\u201385."},{"issue":"2","key":"i1062-6050-51-3-233-b36","series-title":"J Sport Rehabil","first-page":"160","article-title":"Hand-held dynamometry: reliability of lower extremity muscle testing in healthy, physically active, young adults","volume":"17","author":"Kelln \n              BM,","year":"2008","unstructured":"Kelln \n              BM, \n            \n            \n              McKeon \n              PO, \n            \n            \n              Gontkof \n              LM, \n            \n            \n              Hertel \n              J. \n            \n          \n          Hand-held dynamometry: reliability of lower extremity muscle testing in healthy, physically active, young adults. J Sport Rehabil. 2008;17(2):160\u2013170."},{"issue":"4","key":"i1062-6050-51-3-233-b37","series-title":"J Athl Train","first-page":"321","article-title":"The effects of fatigue and chronic ankle instability on dynamic postural control","volume":"39","author":"Gribble \n              PA,","year":"2004","unstructured":"Gribble \n              PA, \n            \n            \n              Hertel \n              J, \n            \n            \n              Denegar \n              CR, \n            \n            \n              Buckley \n              WE. \n            \n          \n          The effects of fatigue and chronic ankle instability on dynamic postural control. J Athl Train. 2004;39(4):321\u2013329."},{"issue":"12","key":"i1062-6050-51-3-233-b38","series-title":"J Orthop Sports Phys Ther","first-page":"911","article-title":"Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players","volume":"36","author":"Plisky \n              PJ,","year":"2006","unstructured":"Plisky \n              PJ, \n            \n            \n              Rauh \n              MJ, \n            \n            \n              Kaminski \n              TW, \n            \n            \n              Underwood \n              FB. \n            \n          \n          Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. 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PM R. 2014;6(7):602\u2013611."},{"issue":"3","key":"i1062-6050-51-3-233-b40","series-title":"J Man Manip Ther","first-page":"163","article-title":"Global rating of change scales: a review of strengths and weaknesses and considerations for design","volume":"17","author":"Kamper \n              SJ,","year":"2009","unstructured":"Kamper \n              SJ, \n            \n            \n              Maher \n              CG, \n            \n            \n              Mackay \n              G. \n            \n          \n          Global rating of change scales: a review of strengths and weaknesses and considerations for design. 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Med Sci Sports Exerc. 2009;41(1):3\u201313."},{"key":"i1062-6050-51-3-233-b42","series-title":"Statistical Power Analysis for the Behavioral Sciences. 2nd ed","author":"Cohen \n              J.","year":"1988","unstructured":"Cohen \n              J. \n            \n          \n          Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates;1988."},{"issue":"4","key":"i1062-6050-51-3-233-b43","series-title":"J Athl Train","first-page":"428","article-title":"Valovich McLeod TC, Bay RC, Michener LA, Sauers EL. Using disablement models and clinical outcomes assessment to enable evidence-based athletic training practice, part I: disablement models","volume":"43","author":"Snyder \n              AR,","year":"2008","unstructured":"Snyder \n              AR, \n            \n            \n              Parsons \n              JT, \n            \n          \n          Valovich McLeod TC, Bay RC, Michener LA, Sauers EL. Using disablement models and clinical outcomes assessment to enable evidence-based athletic training practice, part I: disablement models. J Athl Train. 2008;43(4):428\u2013436."},{"issue":"6","key":"i1062-6050-51-3-233-b44","series-title":"J Orthop Sports Phys Ther","first-page":"303","article-title":"The effect of a 4-week comprehensive rehabilitation program on postural control and lower extremity function in individuals with chronic ankle instability","volume":"37","author":"Hale \n              SA,","year":"2007","unstructured":"Hale \n              SA, \n            \n            \n              Hertel \n              J, \n            \n            \n              Olmsted-Kramer \n              LC. \n            \n          \n          The effect of a 4-week comprehensive rehabilitation program on postural control and lower extremity function in individuals with chronic ankle instability. J Orthop Sports Phys Ther. 2007;37(6):303\u2013311."},{"issue":"3","key":"i1062-6050-51-3-233-b45","series-title":"J Athl Train","first-page":"282","article-title":"Ankle strength and force sense after a progressive, 6-week strength-training program in people with functional ankle instability","volume":"47","author":"Smith \n              BI,","year":"2012","unstructured":"Smith \n              BI, \n            \n            \n              Docherty \n              CL, \n            \n            \n              Simon \n              J, \n            \n            \n              Klossner \n              J, \n            \n            \n              Schrader \n              J. \n            \n          \n          Ankle strength and force sense after a progressive, 6-week strength-training program in people with functional ankle instability. J Athl Train. 2012;47(3):282\u2013288."},{"issue":"1","key":"i1062-6050-51-3-233-b46","series-title":"Gait Posture","first-page":"33","article-title":"Deficits in time-to-boundary measures of postural control with chronic ankle instability","volume":"25","author":"Hertel \n              J,","year":"2007","unstructured":"Hertel \n              J, \n            \n            \n              Olmsted-Kramer \n              LC. \n            \n          \n          Deficits in time-to-boundary measures of postural control with chronic ankle instability. Gait Posture. 2007;25(1):33\u201339."},{"issue":"4","key":"i1062-6050-51-3-233-b47","series-title":"J Appl Physiol (1985)","first-page":"1318","article-title":"Increased rate of force development and neural drive of human skeletal muscle following resistance training","volume":"93","author":"Aagaard \n              P,","year":"2002","unstructured":"Aagaard \n              P, \n            \n            \n              Simonsen \n              EB, \n            \n            \n              Andersen \n              JL, \n            \n            \n              Magnusson \n              P, \n            \n            \n              Dyhre-Poulsen \n              P. \n            \n          \n          Increased rate of force development and neural drive of human skeletal muscle following resistance training. J Appl Physiol (1985). 2002;93(4):1318\u20131326."},{"issue":"7","key":"i1062-6050-51-3-233-b48","series-title":"Am J Sports Med","first-page":"1103","article-title":"The effect of a balance training program on the risk of ankle sprains in high school athletes","volume":"34","author":"McGuine \n              TA,","year":"2006","unstructured":"McGuine \n              TA, \n            \n            \n              Keene \n              JS. \n            \n          \n          The effect of a balance training program on the risk of ankle sprains in high school athletes. 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