Effects of balance training on functionality, ankle instability, and dynamic balance outcomes in people with chronic ankle instability: Systematic review and meta-analysis

Aim: To identify the effects of balance and strength training on function, ankle instability and dynamic balance in people with chronic ankle instability. Method: The search was conducted on randomized controlled trials that investigated the effects of balance training or strength training in people with chronic ankle instability compared to a control group. Therefore, a systematic electronic search was performed until April 2021 in Pubmed/MEDLINE, Cochrane, and Embase databases. Moreover, an additional search was further performed checking the reference lists of the selected articles. The main outcomes were ankle instability, functionality, and dynamic balance. Finally, a qualitative and quantitative synthesis was performed. Results: Fifteen randomized controlled trials with 457 volunteers were included. Compared to regular exercise, balance training demonstrated to be more effective in terms of improving functionality (0.81 (0.48, 1.14)), ankle instability (0.77 (0.27, 1.26)), and dynamic balance (0.83 (0.57, 1.10)) outcomes. However, when compared to strength training, the effectiveness of balance training was only greater in terms of the functionality outcome (0.49 (0.06, 0.92)), since no differences were found for instability (0.43 (0.00, 0.85)) and dynamic balance (0.21 (−0.15, 0.58)). Conclusions: Based on fair-to-high quality evidence, balance training significantly improves functionality, instability, and dynamic balance outcomes in people with chronic ankle instability Moreover, results of the comparison between balance training versus strength training suggest that the former achieves greater benefits for functionality, but not for instability and dynamic balance. Systematic review registration number: CRD42021224179.