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Baseline characteristics and recruitment results of participants
A total of 58 individuals were initially recruited for this experiment. Following screening based on the inclusion and exclusion criteria, 30 specialized sports dance participants who met the experimental criteria were included (Refer to Fig. 5). These participants were randomly assigned to two groups: the Test group (n = 15, BFRT combined with IASTM) and the traditional ankle joint strength stability training group (n = 15). Detailed participant information comparison can be found in Table 4. The recruitment and allocation of participants, intervention measures, data recording, and statistical analysis for this experiment were all overseen by the first author. Basic participant information, including gender, age, height, weight, and duration of pain, was analyzed using paired t-tests, revealing no significant differences between the two groups (p > 0.05) (Refer to Table 4).
Flow chart of subject recruitment
CAIT score results
A repeated measures analysis of variance was performed on the CAIT scores at three different time points: pre-intervention, post-initial intervention, and 4 weeks post-intervention. The results indicated that the group factor did not yield a significant effect on CAIT scores (F = 0.23, P = 0.63). However, there was a noteworthy impact of measurement time on CAIT scores (F = 331.91, P < 0.05). Furthermore, the interaction between measurement time and group factor exhibited a significant effect on CAIT scores (F = 10.45, P < 0.05). These findings suggest that both the measurement time and the interaction between group and measurement time influenced the changes in CAIT scores among the participants. (Table 5).
When comparing between groups, a significant difference in CAIT scores was observed after 4 weeks of intervention (P > 0.05). The Test group exhibited higher CAIT scores than the control group, suggesting that the combined intervention had a more favorable therapeutic effect on ankle joint stability in the participants following the exercise treatment. When comparing within groups, both groups demonstrated significantly higher CAIT scores after the initial intervention and 4 weeks of intervention compared to pre-intervention (P < 0.05). Additionally, the CAIT scores after 4 weeks of intervention were also higher than those after the initial intervention (P < 0.05), indicating that both intervention groups had a notable impact on enhancing ankle joint stability in the participants. (Table 5).
FAAM ankle functional assessment results
By conducting statistical analysis on the FAAM score sheets, including FAAM-ADL and FAAM-SPORT, related to ankle function:
FAAM-adl score
The group factor did not yield a significant effect on FAAM-ADL scores (F = 2.63, P = 0.12). However, there was a notable impact of measurement time on FAAM-ADL scores (F = 128.428, P < 0.05). The interaction between measurement time and group factor did not yield a significant effect on FAAM-ADL scores (F = 2.63, P = 0.68). These findings suggest that the different groups and the interaction between group and measurement time did not influence FAAM-ADL scores, while different measurement times had a significant effect on FAAM-ADL scores.
When comparing between groups, no significant differences in FAAM-ADL scores were observed at the three time points (P > 0.05).
When comparing within groups, both groups exhibited significantly higher FAAM-ADL scores after the initial intervention and 4 weeks of intervention compared to pre-intervention (P < 0.05). Furthermore, the FAAM-ADL scores after 4 weeks of intervention were also higher than those after the initial intervention (P < 0.05), indicating that both intervention groups had a substantial positive impact on enhancing ankle joint function in daily activities for the participants. (Table 6).
FAAM-sport score
The group factor did not yield a significant effect on FAAM-SPORT scores (F = 0.22, P = 0.09). However, there was a noteworthy impact of measurement time on FAAM-SPORT scores (F = 273.84, P < 0.05). The interaction between measurement time and group factor did not yield a significant effect on FAAM-SPORT scores (F = 4.93, P = 0.02). These findings suggest that the different groups did not influence FAAM-SPORT scores, while different measurement times and the interaction between group and measurement time had a significant effect on FAAM-SPORT scores. (Specific data can be found in Table 7).
When comparing between groups, significant differences in FAAM-SPORT scores were observed after the initial intervention and 4 weeks of intervention (P < 0.05). The Test group exhibited significantly higher FAAM-SPORT scores than the control group, indicating that the combined intervention had a positive effect on enhancing daily physical activities for patients with chronic ankle instability.
When comparing within groups, both groups demonstrated significantly higher FAAM-SPORT scores after the initial intervention and 4 weeks of intervention compared to pre-intervention (P < 0.05). In the Test group, the FAAM-SPORT scores after 4 weeks of intervention were also higher than those after the initial intervention (P < 0.05). However, there was no significant difference in FAAM-SPORT scores between the initial intervention and 4 weeks of intervention in the control group (P > 0.05). (Table 8).
Measurement results of ankle joint range of motion
In this experiment, a high-precision joint motion angle measurement device was used to measure the range of motion for different functions of the ankle joint in sitting and supine positions, including measurements of ankle dorsiflexion and plantarflexion angles, inversion and eversion angles of the foot, and abduction and adduction angles of the foot.
Dorsiflexion and plantarflexion
In the assessment of ankle dorsiflexion and plantarflexion angles in the supine position, the results of repeated measures analysis of variance conducted at three different time points (pre-intervention, post-initial intervention, and 4 weeks post-intervention) revealed the following: The group factor had a significant effect on ankle dorsiflexion angle (F = 17.69, P < 0.05), but not on ankle plantarflexion angle (F = 1.79, P = 0.19). Measurement time exhibited a significant effect on both ankle dorsiflexion and plantarflexion angles (F = 1271.87, P < 0.05; F = 286.75, P < 0.01). Additionally, the interaction between measurement time and group factor had a significant effect on ankle dorsiflexion and plantarflexion angles (F = 147.76, P < 0.01; F = 24.90, P < 0.01). These findings indicate that different groups, measurement times, and the interaction between group and measurement time had a significant effect on ankle dorsiflexion and plantarflexion angles.
When comparing between groups, significant differences in ankle dorsiflexion angles were observed after the initial intervention and 4 weeks of intervention (P < 0.05), while ankle plantarflexion angles exhibited significant differences only after the initial intervention (P < 0.05).
When comparing within groups, both groups demonstrated significantly higher ankle dorsiflexion and plantarflexion angles after the initial intervention and 4 weeks of intervention compared to pre-intervention (P < 0.05). Furthermore, after 4 weeks of intervention, both the Test group and the control group exhibited higher ankle dorsiflexion and plantarflexion angles compared to after the initial intervention (P < 0.05). (Table 9).
Inversion and eversion
In the assessment of ankle inversion and eversion angles in the sitting position, the results of repeated measures analysis of variance conducted at three different time points (pre-intervention, post-initial intervention, and 4 weeks post-intervention) revealed the following: The group factor had a significant effect on ankle inversion angle (F = 17.92, P < 0.05), but not on ankle eversion angle (F = 0.42, P > 0.51). Measurement time exhibited a significant effect on both ankle inversion and eversion angles (F = 182.20, P < 0.05; F = 204.91, P < 0.05). Additionally, the interaction between measurement time and group factor had a significant effect on ankle inversion and eversion angles (F = 53.79, P < 0.05; F = 11.32, P < 0.05). These findings indicate that different groups, measurement times, and the interaction between group and measurement time had a significant effect on ankle inversion angle measurements.
When comparing between groups, significant differences in ankle inversion angles were observed after the initial intervention and 4 weeks of intervention (P < 0.05), with greater increases observed in the Test group. However, there were no significant differences in ankle eversion angles between the two intervention groups (P > 0.05), indicating that both intervention groups had no significant effect on ankle eversion angles in CAI patients.
When comparing within groups, both groups demonstrated significantly higher ankle inversion angles after the initial intervention and 4 weeks of intervention compared to pre-intervention (P < 0.05). Furthermore, there was a significant difference in ankle inversion angles between 4 weeks of intervention and the initial intervention within each group, with the best improvement observed after 4 weeks of intervention. For ankle eversion angles, the Test group exhibited significant increases after the initial intervention and 4 weeks of intervention compared to pre-intervention (P < 0.05). Additionally, ankle eversion angles after 4 weeks of intervention were significantly higher than those after the initial intervention and pre-intervention (P < 0.05) in the Test group. However, in the control group, ankle eversion angles were only significantly higher after 4 weeks of intervention compared to after the initial intervention and pre-intervention (P < 0.05). (Table 7)
Abduction and adduction
In the assessment of ankle abduction and adduction angles in the sitting position, the results of repeated measures analysis of variance conducted at three different time points (pre-intervention, post-initial intervention, and 4 weeks post-intervention) revealed the following: The group factor did not yield a significant effect on ankle adduction angles (F = 0.06, P = 0.80), but did have a significant effect on ankle abduction angles (F = 13.09, P < 0.05). Measurement time exhibited a significant effect on both ankle abduction and adduction angles (F = 94.01, P < 0.05; F = 312.68, P < 0.05). Additionally, the interaction between measurement time and group factor did not yield a significant effect on ankle adduction angles (F = 2.79, P = 0.08), but did have a significant effect on ankle abduction angles (F = 9.01, P < 0.05). These findings indicate that different groups, measurement times, and the interaction between group and measurement time had a significant effect on ankle abduction angles, but not on ankle adduction angles.
When comparing between groups, significant differences in ankle abduction angles were observed after the initial intervention and 4 weeks of intervention (P < 0.05), with greater increases observed in the Test group. However, there were no significant differences in ankle adduction angles between the two intervention groups (P > 0.05), indicating that both intervention groups had no significant effect on ankle adduction angles in CAI patients.
When comparing within groups, both groups demonstrated significantly higher ankle abduction and adduction angles after the initial intervention and 4 weeks of intervention compared to pre-intervention (P < 0.05). Furthermore, there were significant differences in ankle abduction angles between 4 weeks of intervention and the initial intervention within each group, with the best improvement observed after 4 weeks of intervention. For ankle adduction angles, there were no significant differences between the two time points (P > 0.05) in both groups.( Table 10.
Ankle joint strength testing
In this experiment, a handheld muscle strength tester was utilized to measure the maximum strength of various functions (ankle dorsiflexion, ankle plantarflexion, ankle inversion, and ankle eversion) in CAI patients.
Within-group comparisons demonstrated significant improvements in ankle strength for all four movement patterns before and after the intervention in both intervention groups (P < 0.05). These findings indicate that both interventions effectively enhanced ankle joint strength in CAI patients.
Between-group comparisons revealed that the Test group exhibited significantly higher ankle plantarflexion and ankle inversion strength after the intervention compared to the control group (P < 0.05). However, there were no significant differences between the groups in other ankle strength measurements (P > 0.05). ( Table 11).
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