Efficacy of non-surgical interventions on dynamic balance in patients with ankle instability: A network meta-analysis

Konstantinos Tsikopoulos; Dimitris Mavridis; Dimitrios Georgiannos; Mary Spencer Cain

doi:10.1016/j.jsams.2018.01.017

Efficacy of non-surgical interventions on dynamic balance in patients with ankle instability: A network meta-analysis

J Sci Med Sport. 2018 Sep;21(9):873-879. doi: 10.1016/j.jsams.2018.01.017. Epub 2018 Mar 7.

Authors

Konstantinos Tsikopoulos¹, Dimitris Mavridis², Dimitrios Georgiannos³, Mary Spencer Cain⁴

Affiliations

¹ 424 Army General Training Hospital, Greece; 2nd Orthopaedic Department, Papageorgiou General Hospital, Greece. Electronic address: ktsikopo@auth.gr.
² Department of Primary Education, University of Ioannina, Greece.
³ 1st Orthopaedic Department, 424 Army General Training Hospital, Greece.
⁴ Department of Kinesiology and Health, Georgia State University.

PMID: 29571697
DOI: 10.1016/j.jsams.2018.01.017

Abstract

Objectives: To identify non-surgical treatments which were deemed to be more effective in improving dynamic postural control in patients with chronic ankle instability (CAI).

Design: Systematic review and random-effects network meta-analysis.

Methods: We searched Scopus, CENTRAL, and PubMed until 26 August 2017. We used data from randomized trials comparing the results of different non-surgical interventions for lateral CAI. We assessed dynamic postural control in terms of the star-excursion balance test in the posteromedial direction. We evaluated this outcome at the end of the rehabilitation protocols (i.e., short term) and 6months after treatment (i.e., medium term). We assessed the quality of the included studies with the Cochrane risk of bias tool and evaluated the quality of evidence from the network of interventions using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

Results: Nineteen trials were eligible for inclusion in this systematic review. A 4-6-week supervised balance training program and a 4-6-week strengthening rehabilitation protocol provided significant improvements compared to control (8 studies, standardized mean difference [SMD] was -0.75, 95% CIs [-1.28 to -0.23]); and 2 studies, SMD was -1.2, 95% CIs [-2.36 to -0.08], respectively). A 6-week combined intervention that addressed balance and strength had the highest probability of being among the best treatments. However, the latter rehabilitation intervention was included in only one trial.

Conclusions: The network meta-analysis showed that supervised balance training protocols and strengthening programs significantly improved dynamic balance in patients with CAI. A combination of these interventions may further increase the efficacy of non-surgical treatment options for the first-line management of CAI.

Keywords: Ankle sprain; Evidence-based; Orthopedic sports medicine; Rehabilitation; Systematic review.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Ankle Joint / physiopathology*
Humans
Joint Instability / rehabilitation*
Network Meta-Analysis
Physical Therapy Modalities
Postural Balance*
Randomized Controlled Trials as Topic