Effects of Conservative Interventions on Static and Dynamic Balance in Individuals With Chronic Ankle Instability: A Systematic Review and Meta-analysis

Objective: To determine which conservative interventions are effective for static and dynamic balance in patients with chronic ankle instability (CAI).Data Sources: PubMed, Cochrane Library, Web of Sciences, and CINAHL databases were searched up to March 20, 2022.Study Selection: Randomized controlled trials investigating the effects of conservative interventions on static and/or dynamic balance in patients with CAI compared with those of different conservative interventions or controls were included.Data Extraction: Two independent reviewers extracted the data. Certainty of the evidence was assessed using the GRADE approach.Data Synthesis: Forty-eight studies (1906 participants) were included. Whole-body vibration training (WBVT) was significantly more effective than controls for both static (standardized mean difference, 1.13; 95% confidence interval [CI], 0.58-1.68; moderate-certainty evidence) and dynamic balance (0.56; CI, 0.24-0.88; low-certainty evidence). Balance training (BT) and joint mobilization were significantly more effective than controls for dynamic balance (0.77; CI, 0.41-1.14; and 0.75; CI, 0.35-1.14, respectively), but not for static balance (very low to low-certainty evidence). Adding other interventions to BT had no significant effect on either type of balance compared with that of BT alone (moderate to low-certainty evidence). Strength training (ST) and taping had no significant effect on either type of balance (very low-to low-certainty evidence). Multimodal interventions were significantly effective in improving dynamic balance (0.76; CI, 0.32-1.20; low-certainty evidence). Adding trans-cranial direct current stimulation to ST was significantly more effective for dynamic balance than ST (0.81; CI, 0.08-1.53; moderate-certainty evi-dence). The effects on balance were not significantly different among BT, ST, and WBVT (very low-to low-certainty evidence).Conclusions: The significantly effective interventions reviewed may be treatment options for balance impairments associated with CAI. However, interventions should be chosen carefully, as much of the certainty of evidence is very low to low. Archives of Physical Medicine and Rehabilitation 2023;104:673-85 (c) 2022 by the American Congress of Rehabilitation Medicine.