Targeted ankle proprioceptive training improves balance, gait, and functional mobility in chronic stroke survivors: a multicenter randomized controlled trial with longitudinal follow-up

BACKGROUND: One of the most common predictors of post-stroke balance and gait problems is ankle proprioceptive impairment. Previous cross-sectional studies have shown strong links, especially with inversion proprioception, but causality, progression over time, and effectiveness in severe cases has not been proven. OBJECTIVE: To determine the causal effects of ankle proprioceptive training on balance, gait, and mobility in moderate-to-severe and non-ambulatory chronic stroke survivors, and to examine the long-term impact of proprioception training across different stroke stages. METHODS: A total of 132 participants (mean age 58.4 ± 11.2 years; 18 to 72 months post stroke) completed the 12 weeks of intervention and immediate post-intervention assessments, (68 were randomly assigned to the intervention group(proprioceptive ankle training) while 64 to the control group(standard rehabilitation)).The primary outcome was weight-bearing ankle proprioception, assessed with the Active Movement Extent Discrimination Apparatus (AMEDA) while the secondary outcomes included the Berg Balance Scale (BBS), Timed Up and Go Test (TUG), 10-meter walk test (10-MWT), Fugl-Meyer Lower Extremity Test (FM-LE), and Functional Ambulation Category(FAC). An assessment from acute to chronic stages was conducted on a longitudinal subsample (n = 42). RESULTS: The intervention led to significant and clinically meaningful improvements in proprioception (inversion Δ = 0.21), balance(BBS + 12.4 points), gait speed (+ 0.32 m/s)(TUG), and mobility(10-MWT, FM-LE, FAC), which were sustained at 6-month follow-up (all p < 0.001). Benefits were evenly observed in severe/non-ambulatory individuals who experienced a stroke. This was supported by mediation analysis showing that 72% of the functional gains in severe/non-ambulatory chronic stroke participants were influenced by improved inversion proprioception. Longitudinal data indicated a progressive bilateral decline, with the earliest and steepest drop occurring in inversion. CONCLUSION: Targeted proprioceptive exercises are causally efficacious in enhancing functional recovery across all levels of severity in post stroke populations and it therefore compliments routine clinical practice. Trial registration This study was retrospectively registered at Clinical Trials.gov (Registration Number NCT07420608) on 18th February,2026.