Ankle Scientific Knowledge and Physiotherapy Practice: A Thematic Analysis of Clinical Behaviors of French-Speaking Physiotherapists

Context: Chronic ankle instability (CAI) is prevalent among individuals who sustain a lateral ankle sprain (LAS) injury. The persistence of the characteristic long-standing clinical symptoms of CAI may be attributable to the lack of adoption by physiotherapists of evidence-informed clinical guidelines. Objective: To investigate the extent to which Frenchspeaking physiotherapists implement the International Ankle Consortium rehabilitation-oriented assessment (ROAST) framework when providing clinical care for individuals with an acute LAS injury. Design: Cross-sectional study. Setting: Online survey informed by a Delphi process of foot-ankle experts. Patients or Other Participants: A total of 426 Frenchspeaking physiotherapists completed the online survey. Main Outcome Measure(s): The survey was disseminated to French-speaking physiotherapists in France; Switzerland; Quebec, Canada; Luxembourg; and Belgium. It comprised closed and open-ended questions organized in 5 sections: (1) participant demographics, (2) participant self-assessment of expertise, (3) clinical diagnostic assessment of the ankle (bones and ligaments), (4) clinical evaluation after an acute LAS injury (ROAST framework), and (5) CAI. The qualitative data from the open-ended questions were analyzed using best- practice thematic-analysis guidelines. Results: Only 6.3% (n = 27) of the respondents could name all Ottawa Ankle Rules criteria. Only 25.6% (n = 109) of the respondents cited or described criterion standard tests from the literature to assess the integrity of the lateral ankle ligaments. Less than 25% (n = 71) of the respondents reported using clinical evaluation outcome metrics (ROAST) recommended by the International Ankle Consortium to inform their clinical care for individuals with an acute LAS injury. In general, the respondents had a greater knowledge of the functional than the mechanical insufficiencies associated with CAI. Conclusion: A minority of French-speaking physiotherapist survey respondents use the International Ankle Consortium ROAST to inform their clinical care for individuals with an acute LAS injury. This highlights the responsibility of the scientific community to better disseminate evidence-informed research to clinicians.