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

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 6 months 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% Cls [-1.28 to -0.23]); and 2 studies, SMD was -1.2, 95% Cls [-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. (C) 2018 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.