Meta-analysis of the dosage of balance training on ankle function and dynamic balance ability in patients with chronic ankle instability.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of 20 studies
PubMed 39217316 · doi:10.1186/s12891-024-07800-8
What was done
Authors searched PubMed, Embase, Web of Science, Medline, and Cochrane through December 2023 for studies evaluating the dosage of balance training on ankle function and dynamic balance in patients with chronic ankle instability (CAI). Quality was assessed using Cochrane risk-of-bias guidelines. Pooled effects were calculated as standardized mean differences (SMD) or mean differences (MD), and meta-regression and subgroup analyses were conducted across session duration, weekly frequency, and program length.
What was found
Twenty studies comprising 682 participants were analyzed. Balance training significantly improved self-reported functional scores (SMD = 1.02, 95% CI: 0.61 to 1.43, p < 0.00001, I² = 72%) and Star Excursion Balance Test (SEBT) reach distances: anterior (MD = 5.88, 95% CI: 3.37 to 8.40, p < 0.00001, I² = 84%), posteromedial (MD = 5.47, 95% CI: 3.40 to 7.54, p < 0.00001, I² = 61%), and posterolateral (MD = 6.04, 95% CI: 3.30 to 8.79, p < 0.0001, I² = 79%). Meta-regression identified intervention duration per session as a primary cause of heterogeneity (p = 0.046). Subgroup analyses showed optimal improvements with session durations of 20–30 minutes (MD = 1.21, 95% CI: 0.96 to 1.46, I² = 55%), program durations of 4 weeks (MD = 0.84, 95% CI: 0.50 to 1.19, I² = 78%) or 6 weeks (MD = 1.21, 95% CI: 0.91 to 1.51, I² = 71%), and a frequency of 3 sessions per week (MD = 1.14, 95% CI: 0.89 to 1.38, I² = 57%).
Why it matters
This review identifies a specific, optimal dosage protocol for balance training in chronic ankle instability: 20 to 30 minutes per session, 3 times per week, for 4 to 6 weeks.
Limits
High statistical heterogeneity was present across all primary dynamic balance measures and functional scores (I² between 55% and 84%). Average sample size per included study was relatively small (approximately 34 participants), and the abstract does not report long-term follow-up or recurrent sprain incidence.