Les facteurs qui contribuent à l’instabilité chronique de cheville : une revue systématique et une méta-analyse de revues systématiques
Introduction
On estime que chaque jour, 712 000 personnes se tordent la cheville dans le monde. Au lieu d’être considérées comme une charge considérable d’un point de vue santé et économique, les entorses de cheville sont souvent relayées à de banales blessures, sensées se résoudre rapidement et spontanément. Or, 70% des patients déclarent ressentir une sensation d’instabilité ou des entorses récurrentes. La connaissance des facteurs contribuant à l’instabilité chronique de cheville est cruciale pour développer des interventions ciblées et prévenir une prolongation des symptômes.
Malgré de nombreuses recherches, une faculté affaiblie de l’équilibre est le seul facteur bien établi contribuant à l’instabilité chronique de cheville. Des revues systématiques ont évalué les dysfonctions de proprioception, le retard de temps de réaction des muscles fibulaires, les déficits de force, et des caractéristiques articulaires, mais leurs conclusions sont contradictoires.
Objectif
L’objectif de cette revue systématique et méta analyse est d’établir l’importance statistique et la taille de l’effet des facteurs primaires qui contribuent à l’instabilité chronique de cheville, et d’identifier les probables raisons de l’inconsistance de la littérature à ce sujet.
Méthodes
- Les bases de données notables ont été utilisées pour la recherche : CINAHL, MEDLINE, PubMed, Scopus et SPORTDiscus. Ci-dessous un exemple d’utilisation des mots clés dans la base de données CINAHL pour la stratégie de recherche.
- Les revues systématiques ont été inclues si elles répondaient à une question de recherche ciblée, si elles définissaient clairement les critères de la stratégie de recherche et le mode de sélection/inclusion des études, et si elles avaient complété une recherche compréhensive de la littérature.
- Les études inclues devaient être publiées dans des revues scientifiques validées par les pairs et devaient passer en revue des études d’observations des facteurs et/ou caractéristiques de personnes avec instabilité chroniques de cheville, avec ou sans méta analyse.
- La façon dont chaque étude définissaient l’instabilité chronique de cheville a été comparée avec la classification établie par l’International Ankle Consortium
- Il n’y a pas eu de restriction de langage
- La qualité méthodologique des revues systématiques a été évaluée en utilisant l’outil R-AMSTAR modifié.
Résultats
Seulement 17% des études primaires ont fait leurs mesures sur une population clairement définie comment ayant une instabilité de cheville.
Les résultats de la stratégie de recherche sont récapitulés dans le tableau ci-dessous :
Un total de 12 études a pu être utilisé. Six sur l’équilibre, 4 sur la proprioception, 3 sur le temps de réaction, 2 sur la force, les caractéristiques articulaires et les différences biomécaniques et 1 sur les facteurs fonctionnels de la performance.
Il en ressort des preuves fortes en faveur du déficit d’équilibre dynamique, du temps de réaction des muscles fibulaires, et du déficit de force des muscles éverseurs. Il y a des preuves modérées pour la proprioception et le déficit d’équilibre statique.
Les preuves des précédentes revues systématiques ne reflètent pas précisément la population d’instabilité chronique de cheville. Les auteurs reconnaissent parmi d’autres biais que la plupart des études inclues dans cette revue ont été publiées avant le positionnement de l’International Ankle Consortium.
D’un point de vue traitement des instabilités non spécifique de cheville, les praticiens devraient se concentrer sur l’équilibre dynamique, le temps de réaction et le déficit de force. Néanmoins, ces résultats pourraient ne pas se transposer à la population d’instabilité chronique de cheville. Les recherches futures devraient s’actualiser avec une population d’instabilité chronique de cheville adéquatement contrôlée.
Factors Contributing to Chronic Ankle Instability: A Systematic Review and Meta-Analysis of Systematic Reviews
Bibliographie
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Il en ressort des preuves fortes en faveur du déficit d’équilibre dynamique, du temps de réaction des muscles fibulaires, et du déficit de force des muscles éverseurs. Il y a des preuves modérées pour la proprioception et le déficit d’équilibre statique.
Conclusions
Les preuves des précédentes revues systématiques ne reflètent pas précisément la population d’instabilité chronique de cheville. Les auteurs reconnaissent parmi d’autres biais que la plupart des études inclues dans cette revue ont été publiées avant le positionnement de l’International Ankle Consortium.
D’un point de vue traitement des instabilités non spécifique de cheville, les praticiens devraient se concentrer sur l’équilibre dynamique, le temps de réaction et le déficit de force. Néanmoins, ces résultats pourraient ne pas se transposer à la population d’instabilité chronique de cheville. Les recherches futures devraient s’actualiser avec une population d’instabilité chronique de cheville adéquatement contrôlée.
Article original
Factors Contributing to Chronic Ankle Instability: A Systematic Review and Meta-Analysis of Systematic Reviews
Bibliographie
1. Soboroff SH, Pappius EM, Komaroff AL. Benefits, risks, and costs of alternative approaches to the evaluation and treatment of severe ankle sprain. Clin Orthop Relat Res. 1984;183:160–8.
2. Verhagen E, Van Tulder M, Van der Beek A, et al. An economic evaluation of a proprioceptive balance board training pro- gramme for the prevention of ankle sprains in volleyball. Br J Sports Med. 2005;39(2):111–5.
3. Yeung M, Chan KM, So C, et al. An epidemiological survey on ankle sprain. Br J Sports Med. 1994;28(2):112–6.
4. Hintermann B, Valderrabano V, Dereymaeker G, et al. The HINTEGRA ankle: rationale and short-term results of 122 consecutive ankles. Clin Orthop Relat Res. 2004;424:57–68.
5. Valderrabano V, Hintermann B, Dick W. Scandinavian total ankle replacement: a 3.7-year average followup of 65 patients. Clin Orthop Relat Res. 2004;424:47–56.
6. Hiller CE, Kilbreath SL, Refshauge KM. Chronic ankle insta- bility: evolution of the model. J Athl Train. 2011;46(2):133–41.
7. Arnold BL, De La Motte S, Linens S, et al. Ankle instability is associated with balance impairments: A meta-analysis. Med Sci Sports Exerc. 2009;41(5):1048–62.
8. Hiller CE, Nightingale EJ, Lin C-WC, et al. Characteristics of
people with recurrent ankle sprains: a systematic review with metaanalysis. Br J Sports Med. 2011;45(8):660–72.
9. Munn J, Sullivan SJ, Schneiders AG. Evidence of sensorimotor deficits in functional ankle instability: a systematic review with meta-analysis. J Sci Med Sport. 2010;13(1):2–12.
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