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Guo Y, Cheng T, Yang Z, Huang Y, Li M, Wang T. A systematic review and meta-analysis of balance training in patients with chronic ankle instability. Syst Rev 2024; 13:64. [PMID: 38347564 PMCID: PMC10860262 DOI: 10.1186/s13643-024-02455-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/08/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Chronic ankle instability (CAI) is a common yet serious problem for elder patients. This meta-analysis aimed to evaluate the effects of balance training for CAI, to provide evidence for the clinical treatment, and care of CAI patients. METHODS Two investigators searched PubMed, EMBASE, Science Direct, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and Weipu Databases up to May 20, 2023, for randomized controlled trials (RCTs) on the effects of balance training for CAI. The mean difference (MD) with 95% confidence intervals (95%CIs) was calculated for each outcome with a fixed or random effect model. Review Manager 5.3 software was used for meta-analysis. RESULTS Nine RCTs involving 341 patients were included. Meta-analysis results showed that compared with blank controls, balanced training treatment of CAI could significantly improve the score of CAI [MD = 3.95, 95% CI (3.26, 4.64), P < 0.00001], SEBT-PM [MD = 4.94, 95% CI (1.88, 8.00), P = 0.002], SEBT-PL [MD = 5.19, 95% CI (1.57, 8.81), P = 0.005], and FAAM Sports [MD = 17.74, 95% CI (14.36, 21.11), P < 0.00001]. Compared with strength training, balance training treatment of CAI improved the score of CAIT [MD = 2.36, 95% CI (0.29, 4.44), P = 0.03], FAAM-ADL [MD = 4.06, 95% CI (1.30, 6.83), P = 0.004]. CONCLUSION The analysis outcomes indicate that balance training enhances daily activity capability, motor function, and dynamic balance to different extents. Additionally, when comparing the results of balance training and strength training, no significant difference was observed between the two methods in improving the dynamic stability of CAI patients. However, it is noteworthy that balance training exhibits a more pronounced impact on enhancing functional scale scores.
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Affiliation(s)
- Yiwei Guo
- Department of Rehabilitation, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongi University School of Medicine, Shanghai, China
- Department of Physical Therapy, Tongji University School of Medicine, Shanghai, China
| | - Tianyue Cheng
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongi University School of Medicine, Shanghai, China
- Department of Physical Therapy, Tongji University School of Medicine, Shanghai, China
- Jiading Town Street Community Health Service Center, Shanghai, China
| | - Zihao Yang
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongi University School of Medicine, Shanghai, China
- Department of Physical Therapy, Tongji University School of Medicine, Shanghai, China
- Sanlin Community Health Service Center, Shanghai, China
| | - Yonglei Huang
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongi University School of Medicine, Shanghai, China
| | - Ming Li
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongi University School of Medicine, Shanghai, China
| | - Taoli Wang
- Department of Rehabilitation, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China.
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongi University School of Medicine, Shanghai, China.
- Department of Physical Therapy, Tongji University School of Medicine, Shanghai, China.
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Wen Z, Zhu J, Wu X, Zheng B, Zhao L, Luo X, Wu Z. Effect of Low-Load Blood Flow Restriction Training on Patients With Functional Ankle Instability: A Randomized Controlled Trial. J Sport Rehabil 2023; 32:863-872. [PMID: 37558223 DOI: 10.1123/jsr.2022-0462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 08/11/2023]
Abstract
CONTEXT Decreased muscle strength and balance in patients with functional ankle instability (FAI) can be effectively improved by ankle strength training. Low-load blood flow restriction (LL-BFR) training increases muscle size and strength, but there is limited evidence from studies on muscle strength and balance in FAI patients. OBJECTIVE To study the effects of LL-BFR training versus high-load training (HLT) on muscle strength and balance in FAI patients. DESIGN Randomized controlled trial. PARTICIPANTS Forty-six young adults with a history of FAI. INTERVENTIONS Participants in the LL-BFR and HLT groups performed 4 sets (30 × 15 × 15 × 15) of ankle training at 20% to 40% of the one-repetition maximum and 70% to 85% one-repetition maximum, respectively, twice a week for 6 weeks. MAIN OUTCOME MEASURE(S) Plantar flexion, dorsiflexion, inversion, and eversion muscle strength, and the Y-balance test scores were assessed at baseline and after 3 and 6 weeks; the thickness of the tibialis anterior, triceps surae, and peroneus longus muscles were assessed at baseline and after 6 weeks. RESULTS Inversion, eversion, dorsiflexion, and plantar flexion muscle strength; tibialis anterior, triceps surae, and peroneus longus thickness; and Y-balance test scores were significantly increased in the LL-BFR group after 3 and 6 weeks compared with baseline (P < .05), with no significant difference between the LL-BFR and HLT groups after 6 weeks (P > .05). However, at the end of 3 weeks, eversion muscle strength and Y-balance test scores were significantly higher in the LL-BFR group than in the HLT group (P < .05). CONCLUSIONS Over 6 weeks, LL-BFR training was as effective as HLT in improving ankle muscle strength, muscle thickness, and balance in FAI patients, but LL-BFR training improved the ankle eversion muscle strength and dynamic balance more than HLT did in the early stages of the intervention. This finding will provide a new intervention strategy for the clinical rehabilitation of FAI patients.
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Affiliation(s)
- Ziliang Wen
- Southwest University School of Physical Education, Beibei, CQ,China
- Sport Rehabilitation Research Institute of Southwest University, Beibei, CQ,China
- High School Affiliated to Southwest University, Beibei, CQ,China
| | - Jiang Zhu
- Sport Rehabilitation Research Institute of Southwest University, Beibei, CQ,China
- Southwest University Hospital, Beibei, CQ,China
| | - Xuelian Wu
- Sport Rehabilitation Research Institute of Southwest University, Beibei, CQ,China
- Southwest University Hospital, Beibei, CQ,China
| | - Bing Zheng
- Sport Rehabilitation Research Institute of Southwest University, Beibei, CQ,China
- Southwest University Hospital, Beibei, CQ,China
| | - Li Zhao
- Sport Rehabilitation Research Institute of Southwest University, Beibei, CQ,China
- Southwest University Hospital, Beibei, CQ,China
| | - Xin Luo
- Southwest University School of Physical Education, Beibei, CQ,China
- Sport Rehabilitation Research Institute of Southwest University, Beibei, CQ,China
| | - Zonghui Wu
- Southwest University School of Physical Education, Beibei, CQ,China
- Sport Rehabilitation Research Institute of Southwest University, Beibei, CQ,China
- Southwest University Hospital, Beibei, CQ,China
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Han J, Luan L, Adams R, Witchalls J, Newman P, Tirosh O, Waddington G. Can therapeutic exercises improve proprioception in chronic ankle instability? a systematic review and network meta-analysis. Arch Phys Med Rehabil 2022; 103:2232-2244. [PMID: 35550140 DOI: 10.1016/j.apmr.2022.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/03/2022] [Accepted: 04/11/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To assess exercise therapies that aim to enhance proprioception in individuals with chronic ankle instability (CAI). DATA SOURCES Five databases (PubMed, Embase, Cochrane Library, Web of Science, and EBSCO) were searched in October 2021. STUDY SELECTION Randomized controlled trials involving exercise therapy conducted on individuals with CAI were included. DATA EXTRACTION Data were extracted by two independent reviewers using a standardized form. Methodological quality and risk of bias were assessed with the PEDro scale. DATA SYNTHESIS The end-trial weighted mean difference and standard deviations were analyzed, and the synthetic value for the improvement in error scores of ankle joint position sense (JPS) in multiple directions was evaluated. RESULTS Eleven trials with 333 participants were eligible for inclusion in this systematic review and were included in the Network Meta-Analysis. Foot and ankle muscle strengthening exercise showed the highest probability of being among the best treatments (surface under the cumulative ranking (SUCRA)=74.6%). The next two were static balance exercise only (SUCRA=67.9%) and corrective exercise (SUCRA=56.1%). The SUCRA values of proprioceptive exercise, dynamic balance exercise only, aquatic exercise, rehabilitation exercise with brace, mixed static/dynamic balance exercise, and control were at relatively low levels, and scored at 49.6%, 48.8%, 47.8%, 47.7%, 44.0%, and 13.5%, respectively. CONCLUSIONS Foot and ankle muscle strengthening exercise may have a good effect when used to improve JPS in individuals with CAI. Probably, the more complex balance exercise intervention becomes, the less effective the proprioceptive outcome. PROSPERO REGISTRATION NUMBER CRD42021240331.
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Affiliation(s)
- Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China; Department of Physiotherapy and Sports Rehabilitation, Shanghai University of Sport, Shanghai, China; Research Institute for Sport and Exercise, University of Canberra, Bruce ACT, Australia; Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn VIC, Australia.
| | - Lijiang Luan
- Department of Physiotherapy and Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Roger Adams
- School of Physiotherapy, University of Sydney, Lidcombe NSW, Australia; Research Institute for Sport and Exercise, University of Canberra, Bruce ACT, Australia
| | - Jeremy Witchalls
- Research Institute for Sport and Exercise, University of Canberra, Bruce ACT, Australia
| | - Phillip Newman
- Research Institute for Sport and Exercise, University of Canberra, Bruce ACT, Australia
| | - Oren Tirosh
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn VIC, Australia
| | - Gordon Waddington
- Research Institute for Sport and Exercise, University of Canberra, Bruce ACT, Australia
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Tang H, Mao M, Fong DTP, Song Q, Chen Y, Zhou Z, Zhang C, Wang J, Tian X, Sun W. Effects of Tai Chi on the neuromuscular function of the patients with functional ankle instability: a study protocol for a randomized controlled trial. Trials 2022; 23:107. [PMID: 35109886 PMCID: PMC8812168 DOI: 10.1186/s13063-022-06046-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/19/2022] [Indexed: 11/12/2022] Open
Abstract
Background Ankle instability limits physical activities and undermines a person’s quality of life. Tai Chi’s health benefits have been reported in different population groups. However, the effects of Tai Chi on neuromuscular function among young adults with functional ankle instability (FAI) remain unclear. Therefore, we aim to investigate the effect of Tai Chi on young adults with FAI. Methods This study will be conducted as a randomized controlled trial with blinded assessors. A total of 104 young adults with FAI will be recruited and randomly assigned to intervention and control groups. The participants in the simplified Tai Chi exercise program (STCEP) group will receive a 12-week Tai Chi training. The participants in the control group will receive a low-intensity exercise program and health education for 12 weeks. The primary and secondary outcomes will be assessed at baseline, 4th, 8th, and 12th weeks. Primary outcome measures will include the Cumberland Ankle Instability Tool (CAIT) score, kinematics/kinetics data, electromyography during single-leg landing tasks, and the modified Star Excursion Balance Test (mSEBT). Secondary outcome measures will include the total time of Dynamic Leap and Balance Test (DLBT), ankle muscle strength, and ankle proprioception. Discussion This study will investigate the effects of Tai Chi exercise on the neuromuscular function of patients with FAI, as indicated by ankle joint biomechanics, ankle proprioception, balance, ankle muscle strength, and ankle muscle activation. Results will demonstrate that Tai Chi can be an effective exercise for young adults with FAI. Trial registration Chinese Clinical Trial Registry ChiCTR2100044089. Registered on 10 March 2021
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Affiliation(s)
- Huiru Tang
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Min Mao
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Qipeng Song
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Yan Chen
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Zhipeng Zhou
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Cui Zhang
- Lab of Biomechanics, Shandong Institute of Sport Science, Jinan, China
| | - Jiangna Wang
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Xuewen Tian
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Wei Sun
- College of Sports and Health, Shandong Sport University, Jinan, China.
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Binaei F, Hedayati R, Mirmohammadkhani M, Taghizadeh Delkhoush C, Bagheri R. Examining the Use of Kinesiology Tape During Weight Bearing Exercises on Proprioception in Participants With Functional Ankle Instability. Percept Mot Skills 2021; 128:2654-2668. [PMID: 34396803 DOI: 10.1177/00315125211036425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The aim of this study was to examine the effect of tape worn during weight bearing exercises on proprioception (i.e., ankle angle repositioning error) in participants with functional ankle instability. We employed a randomized, controlled clinical study in a laboratory setting, with 56 participants with functional ankle instability. Participants were randomly assigned to three groups: (a) weight bearing exercises without tape (n = 18), (b) weight bearing exercises with tape (n = 19) and controls not engaged in weight bearing exercises (n = 19). Weight bearing exercises included six weeks of bilateral squats in partial form with up to 45 degrees of knee flexion, and unilateral partial squats with full heel raise, and with full toe raise. In the taped condition, participants wore tape for six weeks with up to three tape replacements per week. Proprioception was measured as ankle repositioning error. Results showed that the mean angle repositioning error among participants in the active weight bearing groups was decreased by the taping intervention, relative to the control group's performance (p = 0.042). There were no significant differences between weight bearing exercise groups and control groups. The addition of kinesiology tape in weight bearing exercises can improve proprioception in active conditions.
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Affiliation(s)
- Fatemeh Binaei
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Rozita Hedayati
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Rasool Bagheri
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
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Luan L, Adams R, Witchalls J, Ganderton C, Han J. Does Strength Training for Chronic Ankle Instability Improve Balance and Patient-Reported Outcomes and by Clinically Detectable Amounts? A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6124780. [PMID: 33517464 DOI: 10.1093/ptj/pzab046] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/28/2020] [Accepted: 01/04/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Strength training as a form of exercise therapy has long been used to maintain or promote strength, but its effectiveness as a treatment intervention in chronic ankle instability (CAI) is not fully understood. The purpose of this study was to evaluate the effects of strength training compared with no exercise and neuromuscular control training on balance and self-reported function in people with CAI. METHODS Eight databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, PEDro, CNKI, and WanFang) were searched in June 2020. Randomized controlled trials (RCTs) involving strength training conducted on individuals with CAI were included. Data were extracted by 2 independent reviewers using a standardized form. Methodological quality and risk of bias were assessed by using the PEDro Scale. In addition, the GRADE evaluation system (Grading of Recommendations Assessment, Development and Evaluation) was used to determine the strength of evidence. A total of 554 studies were initially screened, resulting in a final selection of 11 RCTs involving 428 participants, and 8 RCTs were included in the final meta-analysis. Compared with no exercise, strength training demonstrated some benefits in the Star Excursion Balance Test (anterior: weighted mean difference [WMD] = 2.39, 95% CI = 0.60-4.18; posteromedial: WMD = 3.30, 95% CI = 0.24-6.35; posterolateral: WMD = 2.97, 95% CI = 0.37-5.57), but these intervention results did not reach the minimal detectable change values. CONCLUSION Available evidence showed that, compared with controls, strength training did not produce any minimal detectable changes on Star Excursion Balance Test or Foot and Ankle Ability Measure scores in individuals with CAI. Clinicians should use strength training cautiously for improving balance and symptoms in CAI. IMPACT The results of this study may have an impact on selecting effective physical therapy interventions for managing symptoms associated with CAI.
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Affiliation(s)
- Lijiang Luan
- Xiamen Qingdun Fitness Management Co., Ltd., Xiamen, Fujian, China
| | - Roger Adams
- Research Institute for Sport and Exercise, University of Canberra, ACT, Australia
| | | | - Charlotte Ganderton
- Faculty of Health, Arts and Design, Swinburne University of Technology, VIC, Australia
| | - Jia Han
- Research Institute for Sport and Exercise, University of Canberra, ACT, Australia.,Faculty of Health, Arts and Design, Swinburne University of Technology, VIC, Australia.,Department of Physiotherapy and Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
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Romero-Franco N, Jiménez-Reyes P, González-Hernández JM, Fernández-Domínguez JC. Assessing the concurrent validity and reliability of an iPhone application for the measurement of range of motion and joint position sense in knee and ankle joints of young adults. Phys Ther Sport 2020; 44:136-142. [PMID: 32506036 DOI: 10.1016/j.ptsp.2020.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To analyze the concurrent validity and reliability of an iPhone application for assessing range of motion (ROM) and joint position sense (JPS) in ankle and knee joints. DESIGN Cross-sectional study. SETTING Sport laboratory. PARTICIPANTS Twenty healthy and physically active volunteers. INTERVENTIONS All participants performed a ROM and a JPS test in ankle and knee joints, which were simultaneously evaluated with photo-analysis and the iPhone application. MAIN OUTCOMES MEASURES A total of 80 angles were obtained with the iPhone app and the photo-analysis and compared for concurrent validity. Reliability was evaluated through re-scoring of images with the iPhone app by two different testers. RESULTS Very high correlation was observed between both methods for ankle and knee ROM and knee JPS (r > 0.90), and high correlation for ankle JPS (r = 0.71-0.90), while Bland-Altman plots showed absolute agreement for all the variables. Inter- and intra-tester reliability was perfect for all the variables (ICC > 0.81), except for the inter-tester reliability of ankle JPS, which was substantial (ICC = 0.61-0.81). CONCLUSIONS This new iPhone application is valid and reliable for measuring ankle and knee ROM and JPS, although special attention is needed during ankle evaluation to avoid errors.
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Affiliation(s)
- Natalia Romero-Franco
- Nursing and Physiotherapy Department, University of the Balearic Islands, E-07122, Palma de Mallorca, Spain.
| | - Pedro Jiménez-Reyes
- Centre for Sport Studies, Rey Juan Carlos University, E-28943, Madrid, Spain.
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Generic and psychological patient-reported deficits in those with chronic ankle instability: A cross sectional study. Phys Ther Sport 2019; 40:137-142. [DOI: 10.1016/j.ptsp.2019.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 12/26/2022]
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