Can Therapeutic Exercises Improve Proprioception in Chronic Ankle Instability? A Systematic Review and Network Meta-analysis

Jia Han; Lijiang Luan; Roger Adams; Jeremy Witchalls; Phillip Newman; Oren Tirosh; Gordon Waddington

doi:10.1016/j.apmr.2022.04.007

Can Therapeutic Exercises Improve Proprioception in Chronic Ankle Instability? A Systematic Review and Network Meta-analysis

Arch Phys Med Rehabil. 2022 Nov;103(11):2232-2244. doi: 10.1016/j.apmr.2022.04.007. Epub 2022 May 10.

Authors

Jia Han¹, Lijiang Luan², Roger Adams³, Jeremy Witchalls⁴, Phillip Newman⁴, Oren Tirosh⁵, Gordon Waddington⁴

Affiliations

¹ College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China; Department of Physiotherapy and Sports Rehabilitation, Shanghai University of Sport, Shanghai, China; Research Institute for Sport and Exercise, University of Canberra, Bruce, Australia; Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia. Electronic address: Jia.Han@Canberra.edu.au.
² Department of Physiotherapy and Sports Rehabilitation, Shanghai University of Sport, Shanghai, China.
³ Research Institute for Sport and Exercise, University of Canberra, Bruce, Australia; School of Physiotherapy, University of Sydney, Lidcombe, Australia.
⁴ Research Institute for Sport and Exercise, University of Canberra, Bruce, Australia.
⁵ Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia.

PMID: 35550140
DOI: 10.1016/j.apmr.2022.04.007

Abstract

Objective: To assess exercise therapies that aim to enhance proprioception in individuals with chronic ankle instability (CAI).

Data sources: Five databases (PubMed, Embase, Cochrane Library, Web of Science, and EBSCO) were searched in October 2021.

Study selection: Randomized controlled trials involving exercise therapy conducted on individuals with CAI were included.

Data extraction: Data were extracted by 2 independent reviewers using a standardized form. Methodological quality and risk of bias were assessed with the Physiotherapy Evidence Database scale.

Data synthesis: The end trial weighted mean difference and standard deviations were analyzed, and the synthetic value for the improvement in error scores of ankle joint position sense in multiple directions was evaluated.

Results: Eleven trials with 333 participants were eligible for inclusion in this systematic review and were included in the network meta-analysis. Foot and ankle muscle strengthening exercise showed the highest probability of being among the best treatments (surface under the cumulative ranking [SUCRA]=74.6%). The next 2 were static balance exercise only (SUCRA=67.9%) and corrective exercise (SUCRA=56.1%). The SUCRA values of proprioceptive exercise, dynamic balance exercise only, aquatic exercise, rehabilitation exercise with brace, mixed static/dynamic balance exercise, and control were at relatively low levels and scored at 49.6%, 48.8%, 47.8%, 47.7%, 44.0%, and 13.5%, respectively.

Conclusions: Foot and ankle muscle strengthening exercise may have a good effect when used to improve joint position sense in individuals with CAI. The more complex balance exercise intervention becomes, the less effective the proprioceptive outcome.

Keywords: Ankle instability; Exercise therapy; Network meta-analysis; Proprioception; Rehabilitation; Systematic review.

Publication types

Meta-Analysis
Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Ankle Joint
Ankle*
Exercise Therapy
Humans
Joint Instability* / rehabilitation
Network Meta-Analysis
Proprioception