Investigating the Mediating Role of Pain in the Relationship between Ankle Joint Position Sense and Balance Assessed Using Computerized Posturography in Individuals with Unilateral Chronic Ankle Instability: A Cross-Sectional Study

Abstract

Chronic ankle instability (CAI) is characterized by impaired ankle joint position sense (JPS) and compromised balance. Despite previous studies investigating the correlation between ankle JPS and balance in individuals with CAI, the potential mediating effect of pain in this relationship remains unclear. Understanding the role of pain as a mediator between ankle JPS and balance could provide valuable insights into the complex interplay among these variables in individuals with CAI. Therefore, further research is needed to elucidate the mediating effect of pain and its implications in assessing and managing ankle JPS and balance deficits in individuals with CAI. This cross-sectional study aimed to investigate the mediating role of pain in the association between ankle JPS and balance in individuals with unilateral CAI. Methods: Fifty-five individuals diagnosed with CAI participated in this study. Ankle JPS was assessed using a digital inclinometer, whereas the balance was measured using a computerized dynamic posturography device. Results: Participants with CAI showed impaired ankle JPS in the affected leg compared to that in the asymptomatic leg (p < 0.001). Ankle JPS errors were greater in both dorsiflexion and plantarflexion directions in the CAI. Balance was compromised in the CAI leg (p < 0.001). Moderate correlations (p < 0.001, r = 0.31 to 0.48) were found between the balance variables. Pain significantly mediated the ankle JPS-balance relationship in the CAI (p < 0.05, Sobel test). The findings suggest that individuals with CAI exhibit impaired ankle JPS and compromised balance. Pain plays a mediating role in the association between ankle JPS and balance in individuals with CAI. These results highlight the importance of considering pain as a potential mediator when assessing and treating balance issues in individuals with CAI. Healthcare professionals should incorporate assessments of ankle JPS and pain into the management of interventions that address these factors and improve balance and functional ability.