Effect of Attention Instructions of Balance Training in Athletes With Ankle Instability

Because of the decrease in the quality of life caused by functional limitations and increase attention to functional ankle instability, this study investigated the attentional focus within 4 weeks of exercise therapy on performance improvement and the kinesiophobia in athletes with functional ankle instability. This was a quasi-experimental study with pre-test post-test and control group design. In total, 37 female and male college student athletes of basketball, volleyball and futsal teams, who had functional ankle instability, were selected purposefully. After initial screening, the subjects were recruited based on the inclusion and exclusion criteria and then randomly divided into 3 groups of “internal focus”, “external focus”, and “without instruction”. Then, they performed the same training protocol but with different directions for 4 weeks. Health-related quality of life was investigated and compared between all 3 groups before and after exercises, using the Cumberland Ankle Instability Tool (CAIT) and Tampa Scale of Kinesiophobia (TSK- 17) scores. The obtained data were analyzed by SPSS. The Kolmogorov-Smirnov Test was used to assess the normal distribution of the study variables. Paired t-test was also used to compare within-group pre-test and post-test scores. Analysis of Covariance (ANCOVA) and Bonferroni post Hoc Test were used to compare between-group results, at the significance level of P≤0.05. Paired t test results revealed that after 4 weeks of exercise with wobble board, CAIT scores in all 3 training groups significantly increased regardless of the focal attention but TKS- 17 scores significantly decreased in all 3 groups (P≥0.05). The ANCOVA results demonstrated that after controlling the effect of pre-test (covariate), there were significant differences among 3 groups in post-test CAIT scores (P≥0.05). There were also significant differences among the 3 groups in post-test scores of TKS-17 (P≥0.05). Therefore, Bonferroni post hoc test was used to investigate the differences between the groups. The results of Bonferroni post-hoc test indicated that post-test CAIT scores in all 3 training groups increased significantly (P≥0.05) and TKS-17 scores in all 3 groups decreased significantly (P≥0.05). Applying the “internal focus”, instructions within 4 weeks of exercise therapy to improve the quality of life associated in athletes with functional ankle instability is more effective than other guidelines or exercises without instructions.