Comparison Of The Effects Of Different Non-surgical Treatments For The Ability Of Foot And Ankle And Dynamic Balance In Patients With Chronic Ankle Instability: A Network Meta-analysis

BACKGROUND: Despite the variety of non-surgical treatments for chronic ankle instability (CAI), the most effective non-surgical treatments are currently unclear due to the continuous introduction of new therapeutic measures. This study aimed to comprehensively review the existing literature and assess the efficacy of different non-surgical treatment measures on foot and ankle ability and dynamic balance in patients with CAI using a network meta-analysis. METHODS: The PubMed, Embase, Cochrane, and Web of Science databases were searched for the search period up to February 2023. Quality assessment was performed according to the Cochrane Collaboration's risk of bias guidelines. Standardized mean difference (SMD) and 95% confidence interval (95% CI) were used as effect sizes for analysis. RESULTS: A total of 22 eligible studies were analyzed in this network meta-analysis. The results of the network meta-analysis showed that the most effective treatment to improve the scores of Foot and Ankle Ability Measure in daily living (FAAM-A) was National Academy of Sports Medicine corrective exercise program (SMD = -1.61; 95% CI, -2.34 to -0.89; SUCRA = 91.9%), the most effective treatment to improve the scores of Foot and Ankle Ability Measure in sports (SMD = -2.67; 95% CI, -3.40 to -1.95; SUCRA = 93.5%) and the Star Excursion Balance Test for the posteromedial direction(SMD = -1.78; 95% CI, -2.78 to -0.78; SUCRA = 87.4%) was Balance Training +Stroboscopic Glasses, the most effective treatment to improve the Star Excursion Balance Test for the anterior direction (SMD = -0.67; 95% CI, -1.94 to 0.72; SUCRA = 88.4%) and the scores of Cumberland ankle instability tool (SMD = -3.53; 95% CI, -5.17 to -1.90; SUCRA = 88.7%) was Joint Mobilizations Training, CrossFit Training + Self-Mobilization (CFT + SM) was the most effective treatment (SMD = -1.66; 95% CI, -3.21 to -0.11; SUCRA = 74.6%) to improve the Star Excursion Balance Test for the posterolateral direction (SEBT-PL). CONCLUSION: Nonoperative therapies could improve foot and ankle ability and dynamic balance in patients with CAI. However, the effectiveness of these treatments may vary. In the future, when treating chronic ankle instability, the appropriate treatment should be chosen based on the patient's condition and needs.