Therapeutic interventions for improving self-reported function in patients with chronic ankle instability: a systematic review

OBJECTIVE: To identify which therapeutic intervention may be most effective for improving self-reported function in patients with chronic ankle instability (CAI). DESIGN: Systematic literature review. Articles were appraised using the Downs and Black Checklist by 3 reviewers. DATA SOURCES: PubMed along with CINAHL, MEDLINE and SPORTDiscus within EBSCOhost for pertinent articles from their inception through August 2016. ELIGIBILITY CRITERIA FOR SELECTED STUDIES: Articles included were required to (1) be written in English, (2) report adequate data to calculate effect sizes, (3) identify patients with CAI, (4) use some form of therapeutic intervention and (5) use a self-reported questionnaire as a main outcome measurement. RESULTS: A broad spectrum of therapeutic interventions were identified related to balance training, multimodal rehabilitation, joint mobilisation, resistive training, soft-tissue mobilisation, passive calf stretching and orthotics. All of the articles included in the balance training category had moderate-to-strong Hedges g with none of the 95% CIs crossing 0. Hedges g effect sizes ranged from -0.67 to -2.31 and -0.51 to -1.43 for activities of daily living and physical activity, respectively. The multimodal rehabilitation category also produced moderate-to-strong Hedges g effect sizes but with large CIs crossing 0. Hedges g effect sizes ranged from -0.47 to -9.29 and -0.62 to -24.29 for activities of daily living and physical activity, respectively. CONCLUSIONS: The main findings from this systematic review were balance training provided the most consistent improvements in self-reported function for patients with CAI.