Qualitative analysis of the effect of visualisation during stability training for people with chronic ankle instability

A rehabilitative programme is only effective if adhered to, which is more likely if the programme is enjoyable (Marshall et al,2012,Journal of Sport Rehabilitation,21,18-25). To create a motivating tool for rehabilitation, a stability-based training package was developed using visualisation (biomechanical feedback in a gamified environment). This study was a qualitative analysis to determine the effect of visualisation on motivation and perception of stability for people with chronic ankle instability (CAI) both during the intervention, and in the months following completion. The stability-based package and intervention are described in Forsyth et al. (2022,Medical & Biological Engineering & Computing,60,1199–1209). Three months following completion of the stability training intervention participants were emailed a 12-question survey. Ethical approval was granted prior to initial study participation. The survey was designed using open-ended questions with actions taken to minimise risk of bias. Participants’ subjective survey answers were thematically analysed, and sub-categorised within five main themes - training experience, visualisations, perceptions of stability, impact to current training, and comparison to previous rehab experiences. Of the 17 participants with CAI contacted three months post-training, 16 responded (94%). During the intervention all participants reported remaining motivated to attend training sessions, with only one declaring a decline by completion. The main sources of motivation for the visualisation (VIS) group were scoring, clear levels of progression, rehabilitation pathway (leading to autonomous feelings), and evidence of improvement. Specifically, participants enjoyed the interactive nature and avatar real-time feedback creating an external focus to detach from the rehabilitative environment, distract from repetitive practices, and create an immersive experience. Motivation in the group without visualisations (No-VIS) focused on improvement and challenge. During No-VIS training, external cues were integrated to challenge participants. However, we question the ability to continually challenge and progress training without aid of visualisation while being practical, safe, and simple for clinical practice. Both the VIS and No-VIS groups subjectively reported increased ankle stability and overall postural control following the four-week intervention. In addition, participants self-reported a reduced number of ankle sprains in the months following training compared to normal. The results imply that both the VIS and No-VIS groups found training motivating, and the programme effective, with injuries reduced in subsequent months. Thus, the effect of the visualisation is inconclusive. Sources of motivation during training were described differently between groups and warrants further investigation. For further development, public and patient involvement should retain an integral role to optimise clinical practice implementation.