Chronic Ankle Instability, CAINCT07689747
Neurocognitive Enrichment During Functional Performance Testing in Chronic Ankle Instability
A study testing Standard Testing Condition, Internal Focus of Attention and External Focus of Attention in people with Chronic Ankle Instability, CAI, run by Bahçeşehir University at 1 site in Turkey (Türkiye).
Trial summary
Chronic ankle instability (CAI) is associated with recurrent ankle sprains, impaired postural control, and reduced functional performance. Traditional functional performance tests are commonly used to assess athletes with CAI; however, these assessments are typically conducted under isolated motor conditions and may… Read more about this study
- Who is it for?
- Ages 16 to 25 years
- Conditions the study is for
- Chronic Ankle Instability, CAI
- What is being tested?
- Standard Testing Condition, Internal Focus of Attention and External Focus of Attention
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 40 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 8 Jun 2026to 8 Nov 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 16 to 25 years
- All sexes
- No healthy volunteers
- Child, Adult
Who may be able to join
- Aged between 16 and 25 years.
- Actively participating as a licensed football, basketball, or volleyball athlete.
- History of at least one lateral ankle sprain occurring ≥12 months before study participation, associated with pain and/or swelling and resulting in at least one day of restricted physical activity.
- History of recurrent ankle instability, defined as at least two episodes of giving way during the previous 6 months and/or recurrent ankle sprains.
- Cumberland Ankle Instability Tool (CAIT) score ≤25.
- Participating in regular sports training at least 3 times per week.
Show all 9Show fewer
- No ankle surgery within the previous 6 months.
- Able to safely perform all functional performance tests.
- Willing to undergo assessment of the more symptomatic ankle; in participants with bilateral chronic ankle instability, the ankle with the lower CAIT score will be evaluated.
Who cannot join
- Acute ankle sprain within the previous 6 weeks accompanied by significant pain, swelling, or functional limitation.
- History of major lower-extremity surgery (e.g., knee, hip, or ankle surgery).
- History of neurological, vestibular, or systemic disorders that may affect balance or motor performance.
- Visual or cognitive impairments that could interfere with test performance.
- Lower-extremity injuries other than ankle instability within the previous 6 months that may negatively affect functional performance.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Turkey (Türkiye)1 site, 1 recruiting
- Recruiting
Istanbul Nisantasi University
Istanbul, Sarıyer, 34453
Elif Aleyna Yazgan, Phd, 0000000000, elifaleyna.yazgan@nisantasi.edu.tr
About this study
Official title: Acute Effects of Neurocognitively Enriched Functional Performance Testing Conditions on Balance and Functional Performance in Athletes With Chronic Ankle Instability: A Randomized Crossover Study
Chronic ankle instability (CAI) is associated with recurrent ankle sprains, impaired postural control, and reduced functional performance. Traditional functional performance tests are commonly used to assess athletes with CAI; however, these assessments are typically conducted under isolated motor conditions and may not adequately reflect the neurocognitive demands encountered during sports participation.
The aim of this randomized crossover study is to investigate the acute effects of neurocognitively enriched testing conditions on balance and functional performance in athletes with CAI. Participants will perform functional performance tests under four different conditions: standard testing, internal focus of attention, external focus of attention, and cognitive dual-task conditions. Dynamic balance, vertical jump performance, single-leg hop performance, figure-of-8 hop performance, and dual-task cost will be assessed and compared across conditions.
The findings of this study may contribute to the development of more ecologically valid assessment approaches for athletes with CAI and provide insights into the influence of attentional focus and cognitive load on functional performance.
Read the detailed description
Chronic ankle instability (CAI) is a common consequence of lateral ankle sprains and is characterized by recurrent episodes of giving way, repeated sprains, impaired sensorimotor control, and persistent functional limitations. Although functional performance tests are widely used to assess readiness for sports participation and return-to-sport status, these assessments are typically performed under isolated motor conditions and may not adequately represent the complex neurocognitive demands encountered during athletic activities.
Recent evidence from motor learning and sports medicine literature suggests that attentional focus strategies and cognitive loading can substantially influence movement performance, postural control, and motor execution. Internal focus of attention directs individuals toward body movements and joint positions, whereas external focus of attention emphasizes movement outcomes and environmental effects. In addition, dual-task paradigms introduce cognitive demands that may alter motor performance by increasing attentional load and competing for cognitive resources. Understanding how these neurocognitive factors influence functional performance may provide valuable information for the assessment and management of athletes with CAI.
The present study aims to examine the acute effects of neurocognitively enriched testing conditions on balance and functional performance in athletes with CAI. By comparing performance under standard testing, internal focus, external focus, and cognitive dual-task conditions, the study seeks to determine whether commonly used functional performance tests are sensitive to variations in attentional focus and cognitive load.
This investigation is expected to contribute to a better understanding of the interaction between cognitive processes and motor performance in athletes with CAI. The findings may support the development of more ecologically valid assessment strategies and provide clinically relevant information for rehabilitation planning, functional evaluation, and return-to-sport decision-making in athletic populations with chronic ankle instability.
- Conditions
- Chronic Ankle Instability, CAI
- Being tested
- Standard Testing Condition, Internal Focus of Attention, External Focus of Attention, Cognitive Dual-Task Condition
- Keywords
- Chronic Ankle Instability (CAI), Dynamic Balance, Attentional Focus, dual task
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Standard Testing ConditionBehavioural
Participants perform functional performance tests under standard testing conditions without attentional focus instructions or additional cognitive tasks. This condition serves as the reference condition for comparison with neurocognitively enriched testing conditions
Internal Focus of AttentionBehavioural
Participants perform functional performance tests while receiving internal focus of attention instructions directing attention toward body movements, joint positions, and movement control during task execution.
External Focus of AttentionBehavioural
Participants perform functional performance tests while receiving external focus of attention instructions directing attention toward movement outcomes and environmental targets during task execution.
Cognitive Dual-Task ConditionBehavioural
Participants perform functional performance tests while simultaneously completing a cognitive task involving backward repetition of number sequences, increasing cognitive load during motor performance.
| Study group | Role | What they receive |
|---|---|---|
| Standard Testing Condition | Experimental | Participants perform all functional performance tests under standard testing conditions without attentional focus instructions or additional cognitive tasks. This condition serves as the reference condition for comparison with neurocognitively enriched testing conditions. Receives: Behavioral: Standard Testing Condition |
| Internal Focus of Attention Condition | Experimental | Participants perform all functional performance tests while receiving internal focus of attention instructions directing attention toward body movements, joint positions, and movement control. Receives: Behavioral: Internal Focus of Attention |
| External Focus of Attention Condition | Experimental | Participants perform all functional performance tests while receiving external focus of attention instructions directing attention toward movement outcomes and environmental targets. Receives: Behavioral: External Focus of Attention |
| Cognitive Dual-Task Condition | Experimental | Participants perform all functional performance tests while simultaneously completing a cognitive task involving backward repetition of number sequences to increase cognitive load Receives: Behavioral: Cognitive Dual-Task Condition |
What is being measured
The primary outcome is the main question the study is designed to answer.
Dynamic Balance Performance
Dynamic balance performance assessed using the Y Balance Test under standard, internal focus of attention, external focus of attention, and cognitive dual-task conditions.
Measured: Day 1 (during the study assessment session)
Secondary outcomes (3)
Vertical Jump Performance
Vertical jump height assessed using the My Jump 2 application under different neurocognitive testing conditions.
Measured: Day 1 (during the study assessment session)
Figure-of-8 Hop Performance
Figure-of-8 hop completion time assessed under different neurocognitive testing conditions.
Measured: Day 1 (during the study assessment session)
Dual-Task Cost
Dual-task cost calculated as the percentage change in motor performance between single-task and dual-task conditions.
Measured: Day 1 (during the study assessment session)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted8 Jul 2026
- Study start8 Jun 2026
- Primary completion8 Oct 2026 (estimated)
- Study completion8 Nov 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Chronic Ankle Instability, CAIStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Screening
- Allocation
- Randomised
- Intervention model
- Crossover
- Model description
- This study uses a randomized within-subject crossover design in which all participants are exposed to four experimental conditions: standard testing, internal focus of attention, external focus of attention, and cognitive dual-task conditions. The order of the conditions is randomized and counterbalanced using a Latin-square design to minimize potential order, learning, and carry-over effects. Each participant serves as their own control, allowing direct comparison of performance outcomes across conditions.
- Masking
- None (open label)
- Enrolment
- 40 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Bahçeşehir University
- Sponsor type
- University, hospital or other
- Collaborators
- The Scientific and Technological Research Council of Turkey
- Responsible party
- Principal investigator, Büşra Tamgüç, Bahçeşehir University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07689747
- Sponsor's protocol ID
- E-92045188-115.02-218837
- Status last verified
- Jul 2026
- First submitted
- 13 Jun 2026
- Last updated
- 8 Jul 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: Individual participant data (IPD) will not be made publicly available in order to maintain participant confidentiality and comply with institutional ethical requirements.
Study at a glance
From the registry record, last updated by the sponsor on 8 Jul 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Acute Effects of Neurocognitively Enriched Functional Performance Testing Conditions on Balance and Functional Performance in Athletes With Chronic Ankle Instability: A Randomized Crossover Study
- ClinicalTrials.gov ID
- NCT07689747
- Acronym / sponsor ID
- E-92045188-115.02-218837
- Conditions
- Chronic Ankle Instability, CAI
- Keywords
- Chronic Ankle Instability (CAI), Dynamic Balance, Attentional Focus, dual task
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 40 participants (estimated)
- Lead sponsor
- Bahçeşehir UniversityUniversity, hospital or other
- Collaborators
- The Scientific and Technological Research Council of Turkey
- Study start
- 8 Jun 2026 (actual)
- Primary completion
- 8 Oct 2026 (estimated)
- Study completion
- 8 Nov 2026 (estimated)
- First posted
- 8 Jul 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Chronic ankle instability (CAI) is associated with recurrent ankle sprains, impaired postural control, and reduced functional performance. Traditional functional performance tests are commonly used to assess athletes with CAI; however, these assessments are typically conducted under isolated motor conditions and may not adequately reflect the neurocognitive demands encountered during sports participation.
The aim of this randomized crossover study is to investigate the acute effects of neurocognitively enriched testing conditions on balance and functional performance in athletes with CAI. Participants will perform functional performance tests under four different conditions: standard testing, internal focus of attention, external focus of attention, and cognitive dual-task conditions. Dynamic balance, vertical jump performance, single-leg hop performance, figure-of-8 hop performance, and dual-task cost will be assessed and compared across conditions.
The findings of this study may contribute to the development of more ecologically valid assessment approaches for athletes with CAI and provide insights into the influence of attentional focus and cognitive load on functional performance.
Detailed description
Chronic ankle instability (CAI) is a common consequence of lateral ankle sprains and is characterized by recurrent episodes of giving way, repeated sprains, impaired sensorimotor control, and persistent functional limitations. Although functional performance tests are widely used to assess readiness for sports participation and return-to-sport status, these assessments are typically performed under isolated motor conditions and may not adequately represent the complex neurocognitive demands encountered during athletic activities.
Recent evidence from motor learning and sports medicine literature suggests that attentional focus strategies and cognitive loading can substantially influence movement performance, postural control, and motor execution. Internal focus of attention directs individuals toward body movements and joint positions, whereas external focus of attention emphasizes movement outcomes and environmental effects. In addition, dual-task paradigms introduce cognitive demands that may alter motor performance by increasing attentional load and competing for cognitive resources. Understanding how these neurocognitive factors influence functional performance may provide valuable information for the assessment and management of athletes with CAI.
The present study aims to examine the acute effects of neurocognitively enriched testing conditions on balance and functional performance in athletes with CAI. By comparing performance under standard testing, internal focus, external focus, and cognitive dual-task conditions, the study seeks to determine whether commonly used functional performance tests are sensitive to variations in attentional focus and cognitive load.
This investigation is expected to contribute to a better understanding of the interaction between cognitive processes and motor performance in athletes with CAI. The findings may support the development of more ecologically valid assessment strategies and provide clinically relevant information for rehabilitation planning, functional evaluation, and return-to-sport decision-making in athletic populations with chronic ankle instability.
Study design
- Primary purpose
- Screening
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- None (open label)
- Number of arms
- 4
- Model description
- This study uses a randomized within-subject crossover design in which all participants are exposed to four experimental conditions: standard testing, internal focus of attention, external focus of attention, and cognitive dual-task conditions. The order of the conditions is randomized and counterbalanced using a Latin-square design to minimize potential order, learning, and carry-over effects. Each participant serves as their own control, allowing direct comparison of performance outcomes across conditions.
| Arm | Type | Receives |
|---|---|---|
| Standard Testing Condition | Experimental | Behavioral: Standard Testing ConditionParticipants perform all functional performance tests under standard testing conditions without attentional focus instructions or additional cognitive tasks. This condition serves as the reference condition for comparison with neurocognitively enriched testing conditions. |
| Internal Focus of Attention Condition | Experimental | Behavioral: Internal Focus of AttentionParticipants perform all functional performance tests while receiving internal focus of attention instructions directing attention toward body movements, joint positions, and movement control. |
| External Focus of Attention Condition | Experimental | Behavioral: External Focus of AttentionParticipants perform all functional performance tests while receiving external focus of attention instructions directing attention toward movement outcomes and environmental targets. |
| Cognitive Dual-Task Condition | Experimental | Behavioral: Cognitive Dual-Task ConditionParticipants perform all functional performance tests while simultaneously completing a cognitive task involving backward repetition of number sequences to increase cognitive load |
Who may qualify
- Ages
- 16 to 25 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult
Key inclusion criteria (9 listed)
- Aged between 16 and 25 years.
- Actively participating as a licensed football, basketball, or volleyball athlete.
- History of at least one lateral ankle sprain occurring ≥12 months before study participation, associated with pain and/or swelling and resulting in at least one day of restricted physical activity.
- History of recurrent ankle instability, defined as at least two episodes of giving way during the previous 6 months and/or recurrent ankle sprains.
- Cumberland Ankle Instability Tool (CAIT) score ≤25.
Key exclusion criteria (5 listed)
- Acute ankle sprain within the previous 6 weeks accompanied by significant pain, swelling, or functional limitation.
- History of major lower-extremity surgery (e.g., knee, hip, or ankle surgery).
- History of neurological, vestibular, or systemic disorders that may affect balance or motor performance.
- Visual or cognitive impairments that could interfere with test performance.
- Lower-extremity injuries other than ankle instability within the previous 6 months that may negatively affect functional performance.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Standard Testing ConditionParticipants perform functional performance tests under standard testing conditions without attentional focus instructions or additional cognitive tasks. This condition serves as the reference condition for comparison with neurocognitively enriched testing conditions | Behavioural | Standard Testing Condition |
| Internal Focus of AttentionParticipants perform functional performance tests while receiving internal focus of attention instructions directing attention toward body movements, joint positions, and movement control during task execution. | Behavioural | Internal Focus of Attention Condition |
| External Focus of AttentionParticipants perform functional performance tests while receiving external focus of attention instructions directing attention toward movement outcomes and environmental targets during task execution. | Behavioural | External Focus of Attention Condition |
| Cognitive Dual-Task ConditionParticipants perform functional performance tests while simultaneously completing a cognitive task involving backward repetition of number sequences, increasing cognitive load during motor performance. | Behavioural | Cognitive Dual-Task Condition |
Primary outcome
Dynamic Balance Performance
Time frame: Day 1 (during the study assessment session)
Dynamic balance performance assessed using the Y Balance Test under standard, internal focus of attention, external focus of attention, and cognitive dual-task conditions.
3 secondary outcomes
Vertical Jump Performance
Time frame: Day 1 (during the study assessment session)
Figure-of-8 Hop Performance
Time frame: Day 1 (during the study assessment session)
Dual-Task Cost
Time frame: Day 1 (during the study assessment session)
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 8 Jul 2026.
- Individual participant dataSharing planned: No. Individual participant data (IPD) will not be made publicly available in order to maintain participant confidentiality and comply with institutional ethical requirements.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Standard Testing Condition, Internal Focus of Attention and External Focus of Attention in people with Chronic Ankle Instability, CAI, run by Bahçeşehir University at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 9 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 8 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Elif Aleyna Yazgan, Phd (000000000 ext. 000000000, elifaleyna.yazgan@nisantasi.edu.tr), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Dynamic Balance Performance (time frame: Day 1 (during the study assessment session)). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Jul 2026.