Date of Award

Summer 2016

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

Matthew C. Hoch (Director)

Committee Member

Johanna M. Hoch

Committee Member

Beth E. Jamali


Ankle sprains are one of the most common injuries sustained by those who are physically active. One in three individuals will develop a condition known as chronic ankle instability (CAI) after suffering a single ankle sprain. These individuals suffer from recurrent bouts of ankle instability, residual symptoms, and a myriad of other mechanical and functional impairments as well as health-related quality of life (HRQL) deficits. Due to the abundance of health consequences associated with this condition it is imperative to establish evidence based interventions that are focused on restoring function and HRQL to pre-injury statuses.

The overarching purpose of this dissertation was to add to the available treatment paradigms for those with CAI. To achieve this overarching goal multiple sub-purposes were employed. The first purpose of this dissertation was to perform a systematic review of the available literature to examine the efficacy of current CAI interventions to enhance HRQL (Project IA). The second purpose was to systematically review the literature to evaluate response shift in patients with various orthopedic conditions following rehabilitation (Project IB). The third purpose was to investigate the effects of a 4-week comprehensive evidence-based intervention on disease-oriented measures in those with CAI. Lastly, the final purpose was to evaluate the effect of a 4-week comprehensive evidence-based intervention on patient-oriented outcomes in those with CAI and to determine if those with CAI who undergo this intervention experience response shift.

The systematic reviews (Project IA, IB) determined that the available evidence-based interventions are effective at enhancing HRQL in those with CAI and that those who undergo care for orthopedic conditions may experience a response shift that can confound assessment of HRQL changes. Project II found that robust improvements in disease-oriented measures were obtained immediately following a 4-week intervention and were maintained for 2-weeks after its completion. In Project III, evidence of response shift was not identified in those with CAI following a 4-week intervention. This finding indicates that traditional pre-to-post methods for assessing HRQL changes are accurate in these patients. Furthermore, significant improvements in ankle- and dimension-specific self-reported function as well as global well-being were identified following a 4-week comprehensive intervention for those with CAI. The results of these investigations demonstrate the clinical efficacy of the investigated 4-week comprehensive intervention to enhance a diverse array of detriments associated with CAI.