The Clinical Effectiveness of Pulsed Electromagnetic Field Therapy on the Management of Chronic Ankle Instability

The primary objective is to investigate the effectiveness of PEMF therapy on the clinical and functional outcomes in the CAI population. We hypothesize that PEMF therapy will effectively improve the clinical and functional outcomes of patients with CAI.

Methods: This is a prospective, randomized, double-blinded, placebo-controlled trial with blinded assessors. A total of 40 adults with CAI will be recruited and randomly allocated into either the intervention or control group. In the intervention group, the participants (n=20) will receive active PEMF therapy and standard exercise training, while the control group (n=20) will receive sham-PEMF therapy and standard exercise training. The PEMF intervention will last for 8 weeks. The primary and secondary outcomes will be evaluated at baseline, week 4, week 8, 3rd month, 6th month after the PEMF therapy.

Rationale: Pulse electromagnetic field therapy (PEMF) as an adjunct biophysical therapy can improve stability by mitigating peroneal muscle weakness and activating peroneal muscle. Therefore, we postulate the combination of standard care (muscle strengthening, balance training, and range of motion exercise) augmented with pulse electromagnetic field therapy elicits a significant improvement in postural control stability and peroneal muscle weakness.

• Inclusion in the CAI stratum:
• Requires a history of at least one significant sprain > 12 months prior to consent
• Continued perceived or episodic "giving way" of the ankle
• Reported Cumberland Ankle Instability Tool (CAIT score < 24)

Exclusion criteria

for CAI:

• A history of surgeries or fractures of either lower extremity limbs
• Concomitant lower extremity pathology, e.g. vascular disease and osteoarthritis
• Inadequate muscle strength in lower limb which require ambulation support (e.g., crutches) or any vestibular or balance disorders
• Pregnancy
• Cognitive impairment/Neurological conditions, and neurological disorders (e.g. dementia) -Concussion within the last 6 months
• Bilateral instability condition
• Regular use of medicine or antibiotics
• Metal implantation in their body
• Unable to walk at enrolment
• Non-removable cast