A balancing act and its significance for injury prevention: neurocognitive performance disparities in patients with chronic ankle instability and healthy controls

Abstract
Background
Lateral ankle sprains (LAS) are common in sports, with around 40% progressing to chronic ankle instability (CAI) marked by persistent dysfunctions. While previous research has explored neural and neurocognitive adaptations to clarify the aetiology and its chronic nature, a need remains to better understand its underlying mechanisms to inform injury prevention strategies. As such, previous studies have mostly used computerised neurocognitive tests or predictable dual-task balance assessment tests to quantify neurocognitive performance. Therefore, we used the reactive balance test (RBT) to evaluate neurocognitive performance and balance ability.
Objective
The primary aim was to assess the neurocognitive performance of patients experiencing CAI compared to healthy controls. The most affected self-reported side was also compared to the contralateral side in the patient group. The main hypothesis is that patients with CAI will exhibit reduced neurocognitive accuracy compared to healthy controls, indicating impaired neurocognitive function as a potential contributor to the development and persistence of CAI.
Design
A retrospective observational case-control study.
Setting
Controlled laboratory study
Participants
We included 27 patients who developed CAI following a LAS as well as 21 healthy controls using the International Ankle Consortium guidelines.
Interventions
The independent variables in this study are the participants' group membership, categorised as patients with CAI or healthy controls, and the lateralisation of CAI symptoms within the patient group.
Main Outcome Measurements
The main outcome measures are accuracy and visuomotor response time (VMRT).
Results
No data was excluded from the final analysis. Group comparison showed no main effects for accuracy (p = 0.324) and VMRT (p = 0.327). Analyses of covariance indicated significant interaction effects for accuracy (p = 0.013), but not for VMRT (p > 0.05). Patients on their self-reported most affected side exhibited significantly lower accuracy than healthy controls (p = 0.015), with a mean differences of 8.7% (± 3.0)%. Additionally, no significant differences were observed within the patient group (p = 1.000, mean difference = -1.3 ± 2.6%).
Conclusions
Patients with CAI showed lower accuracy, but similar VMRT compared to healthy controls during a neurocognitive balance task, indicating impaired neurocognitive function. Future research should gain more insights in which other cognitive domains are affected in patients with CAI for a better grasp of this condition’s underlying mechanism.