Efficacy of non-surgical interventions on
dynamic balance in patients with ankle instability: A network meta-analysis
K, Mavridis D, Gerogiannos D, and Cain MS. J Sci Med Sport. 2018. [Epub Ahead of
Take Home Message:
A patient with chronic ankle instability is likely to get the best gains in
dynamic balance when completing a rehabilitation program with balance and
supervised strength training.
While many patients with chronic ankle
instability (CAI) are treated with non-surgical interventions, there is no
consensus on which intervention is best at improving dynamic balance among
people with CAI. A better understanding of what non-surgical treatment methods
is most effective would allow clinicians to improve function in patients with
CAI. Therefore, Tsikopoulos and colleagues completed a systematic review and
meta-analysis of randomized trials to compare the results of different
non-surgical interventions on dynamic balance in people with CAI. The
researchers identified 593 articles through a comprehensive literature search. They
then screened the articles and included them if they: (1) used a randomized
controlled-trial study design, (2) enrolled patients with a history of ankle
sprain and ankle instability, (3) confirmed the diagnosis or quantify the
functionality of the unstable ankles, (4) measured the efficacy of at least 1
non-surgical treatment method for CAI, and (5) evaluated dynamic balance with
the star-excursion balance test. Nineteen studies met the inclusion criteria
and 16  were included in the
meta-analysis. The quality of these articles was graded using the Grading of
Recommendations, Assessment, Development, and Evaluation (GRADE) framework.
Only 7 of 19 included studies were deemed high quality. Two investigators
independently extracted demographic data, activity level, geographic location,
outcome measurements, and follow-up data from the included studies. Overall, balance
training improved dynamic balance compared to a control group. Further, one set
of investigators found that ankle mobilizations improved dynamic balance 6
months after treatment. The subsequent network meta-analysis demonstrated that
a 4-6-week balance training or supervised strengthening program improved
dynamic balance compared to controls. Finally, the authors found that a 6-week
rehabilitation protocol that included balance and strength training had the best
chance of optimal outcomes.
These findings are important because
they highlight that clinicians should consider providing a balance or
strengthening program for patients with CAI. As revealed in the network meta-analysis,
a program that combines balance exercises and strength exercises would likely
yield the best results. Also, an interesting take-away for clinicians and
researchers is the low number of studies that were deemed to be of high
quality. This also presents an opportunity for clinical research to further
explore the best treatment options to further advance these non-surgical
interventions. Ultimately, as more studies help bolster the quality and volume
of research, clinicians should use a combination of balance and strength
training to help patients with CAI regain dynamic balance.
Questions for Discussion: What interventions do you use to treat
patients with CAI? Are your protocols in line with the results of this study?
Written by: Kyle Harris
Reviewed by:  Jeffrey Driban
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