Effects of Physical Therapy on Proprioception in Individuals with Chronic Ankle Instability: A systematic review with pairwise and network meta-analyses.

Abstract

To compare the effects of various physical therapy interventions on proprioception in individuals with chronic ankle instability (CAI) and to provide an evidence-based medical basis for choosing the best physical therapy. Six electronic databases were systematically searched. From the time the database was created until March 1, 2025. Randomized controlled trials evaluating the efficacy of physical therapy for joint position sense were included. A total of 24 randomized controlled trials including 949 individuals with CAI were included. Seven physical therapy methods were used. Network meta-analysis revealed that balance training (standardized mean difference [SMD]=0.66, 95% confidence interval [CI]: 0.26-1.05), strength training (SMD=0.97, 95% CI: 0.53-1.41), balance combined with strength training (SMD=0.94, 95% CI: 0.50-1.37), cognitive motor training (SMD=0.77, 95% CI: 0.08-1.45), electroacupuncture (SMD=0.84, 95% CI: 0.03-1.65), and whole-body vibration training (SMD=1.00, 95% CI: 0.45-1.55) significantly reduced ankle joint position error. Although whole-body vibration training had the highest ranking (75.4%), it was not significantly better than other therapies. With the exception of electrophysical agents, all six physical therapy treatments significantly improved ankle proprioception and yielded similar results. However, interventions should be chosen carefully, as the certainty of evidence is very low.