Predictors of health-related quality of life in adults with recurrent lateral ankle sprain in Saudi Arabia: A cross-sectional study

Abstract

Background

Recurrent lateral ankle sprain (RLAS) often results in persistent symptoms, functional limitations, and reduced health-related quality of life (HRQOL). However, psychosocial and behavioral factors influencing recovery, particularly in Saudi Arabia, remain underexplored.

Objective

To identify demographic, clinical, and behavioral predictors of HRQOL among adults with RLAS, focusing on fear-avoidance beliefs (FABs) and physical activity levels.

Methods

A cross-sectional, web-based survey was conducted among 461 adults who reported ≥2 lateral ankle sprains within the previous 12 months or persistent symptoms consistent with recurrent injury. HRQOL was assessed using the Arabic version of the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L), and FABs were measured using the Arabic Fear-Avoidance Beliefs Questionnaire (FABQ-Arabic). Internal consistency of the FABQ-Arabic in the present sample was high (Cronbach's α = 0.89). Participants self-reported physical activity levels, demographics, and clinical characteristics. Multiple linear regression was used to identify independent predictors.

Results

Higher FABQ-Arabic scores were strongly associated with lower HRQOL (standardized β = –0.328, p < 0.001). Additional factors predicting reduced HRQOL included age ≥45 years (β = –0.091, p = 0.017), being retired or unemployed (β = –0.082, p = 0.024), and the presence of foot deformity (β = –0.069, p = 0.043). Engagement in moderate (β = 0.112, p = 0.011) and high (β = 0.141, p = 0.001) levels of physical activity was independently associated with higher HRQOL.

Conclusion

Psychological factors (fear), age, employment status, physical activity, and foot deformities influence HRQOL. Rehabilitation should target FABs and promote physical activity to enhance recovery.

Graphical Abstract