Table 2. .
Methodologic Summary of the Included Studies Continued on Next Page
| Author and Design |
Sample Size/Group |
Participant Characteristics |
Intervention |
Intervention Frequency |
Outcome Measures |
Results |
| Hale et al24 (2007), randomized controlled trial | 29 CAI, 19 healthy CAI control = 12/13, CAI rehabilitation = 13/16, healthy = 17/19 | Unilateral CAI, history of ankle sprain, chronic weakness or pain, and episodes of giving way in last 6 mo | Home-exercise program and supervised rehabilitation: gastrocnemius and soleus stretching, ankle strengthening, single-limb balance training Supervised rehabilitation: box hops, carioca, figure of 8 | 4 wk, 6 supervised sessions, home-exercise program 5 per week Wks 1 and 2 = 2 sessions/wk, wks 3 and 4 = 1 session/wk | FADI (%) FADI–Sport (%) | Rehabilitation had greater FADI and FADI–Sport change scores compared with control and healthy groups. |
| McKeon et al28 (2008), randomized controlled trial | 31 CAI Balance training = 16/16 and control = 15/15 | History of more than 1 ankle sprain, giving way, and ≥4 yes responses on Ankle Instability Instrument | Progressive dynamic balance training: hop to stabilization, hop to stabilization and reach, unanticipated hop to stabilization, single-limb stance with eyes open and closed (20 min/session) | 4 wk, 12 supervised sessions (20 min) | FADI (%) FADI–Sport (%) | Balance training had greater postintervention scores compared with preintervention and control postintervention scores. |
| Beazell et al17 (2012), randomized controlled trial | 43 CAI Proximal tibiofibular joint manipulations = 15/15, distal tibiofibular joint manipulations = 14/15, and control = 13/13 | History of ankle sprain, episodes of giving way, <85% on FAAM–Sport or ≥3 yes responses on modified Ankle Instability Instrument, and 5° dorsiflexion deficit compared bilaterally | Proximal tibiofibular joint manipulations: 1–2 thrusts per session Distal tibiofibular joint manipulations: 1–2 thrusts per session | 3 wk, 4 supervised sessions | FAAM–Sport (%) | No changes in FAAM–Sport scores over time or compared with control participants in the proximal and distal tibiofibular joint manipulation groups. |
| Hilgendorf et al25 (2012), randomized controlled trial | 16 CAI Balance training = 8/8, vestibular-ocular reflex training = 8/8 | History of ≥2 ankle sprains and ≥1 episode of giving way in last 6 mo | Progressive dynamic balance training with and without vestibular-ocular reflex training | 4 wk, 12 supervised sessions | FAAM–ADL (%) FAAM–Sport (%) | FAAM–ADL and FAAM–Sport improved from preintervention to postintervention for both groups. No differences between groups were found. |
| Hoch et al26 (2012), prospective cohort study | 12 CAI | History of ankle sprain, ≥2 episodes of giving way in past 3 mo, ≥4 yes responses on Ankle Instability Instrument, ≤90% on the FAAM–ADL, and ≤80% on the FAAM–Sport | Maitland grade II talocrural joint traction (2 sets of 2 min) and Maitland grade III anterior-to-posterior talocrural joint traction (4 sets of 2 min) | 2 wk, 6 mobilization sessions | FAAM–ADL (%) FAAM–Sport (%) | FAAM–ADL and FAAM–Sport improved at postintervention and 1-wk follow-up compared with preintervention. |
| Schaefer and Sandrey30 (2012), randomized controlled trial | 36 CAI Balance training and Graston instrument-assisted soft tissue mobilization = 13/15, balance training and sham = 12/15, and balance training and control = 11/15 | History of inversion ankle sprain, repeated injury, and perception of giving way | Dynamic flex-band stretching warm-up (10 min), progressive dynamic balance training, and Graston instrument-assisted soft tissue mobilization | 4 wk, 8 supervised sessions (45 min) | FAAM–ADL (%) FAAM–Sport (%) | FAAM–ADL and FAAM–Sport improved from preintevention to postintevention for all groups. |
| Gilbreath et al22 (2014), prospective cohort study | 11 CAI | History of ankle sprain, ≥1 episode of giving way in past 3 mo, ≤25 on the CAIT, and participation in physical activity 20 min/d 3 times/wk | Weight-bearing talocrural mobilizations with movement (2 sets of 4 repetitions with 30-s holds) | 2 wk, 3 mobilization sessions | FAAM–ADL (%) FAAM–Sport (%) | FAAM–Sport improved. FAAM–ADL did not change. |
| Collins et al18 (2014), nonrandomized controlled trial | 36 CAI Strain-counterstrain = 13/13 and sham = 14/14 | History of ankle sprain at least 3 mo before study and ≥3 episodes of giving way in past year | Strain-counterstrain of tender points of the pelvis and lower extremity (90-s holds) and home-exercise program of strengthening and proprioceptive training | 4 wk, 4 strain-counterstrain or sham sessions and 12 d of home-exercise program | FAAM–ADL (%) FAAM–Sport (%) | Strain-counterstrain and sham groups both had greater FAAM–ADL and FAAM–Sport scores postintervention than preintervention. |
| Hale et al23 (2014), nonrandomized controlled trial | 34 CAI Balance training = 13/17 and control = 14/17 | History of >1 ankle sprain and reported feeling of giving way | Progressive balance- training program: dynamic and static single-limb stance activities; program completed on stable ankle only | 4 wk, 8 supervised sessions (30 min) | FADI–ADL (%) FADI–Sport (%) | Balance training improved scores from preintervention to postintervention on the FADI–Sport. FADI–ADL did not change. |
| Kim et al27 (2014), randomized controlled trial | 30 CAI Strength = 10/10, strength/proprioceptive exercises = 10/10, and control = 10/10 | Episodes of giving way due to previous ankle sprain and ≤24 on the CAIT | TheraBanda ankle- strengthening (10 min) and proprioceptive exercises involving single-limb balance and marching in place (10 min) | 4 wk, 12 supervised sessions | CAIT (score) | CAIT scores improved with strength and strength/proprioceptive exercises versus control. Strength/proprioceptive exercises improved scores compared with strength alone. |
| Cruz-Díaz et al20 (2015), randomized controlled trial | 70 CAI Balance training = 35/35 and control = 35/35 | History of ankle sprain ≥6 mo before study with subjective feeling of instability and <27 on the CAIT | Individually tailored balance training: static single-limb or double-limb stance tasks; control group completed general lower extremity strengthening program | 6 wk, 18 supervised sessions | CAIT (score) | Both groups improved CAIT scores. Balance training resulted in greater change score than control group. |
| Cruz-Díaz et al19 (2015), randomized controlled trial | 90 CAI Mobilizations with movement = 29/30, sham = 28/31, and control = 21/29 | History of ankle sprain, ≥2 sprains on same side in last 2 y, feeling of giving way, >2 cm weight-bearing–lunge test asymmetry, and no ankle sprain on contralateral side | Weight-bearing mobilizations with movement according to the Mulligan “no-pain rule” (2 sets of 10 repetitions); sham consisted of a fixed ankle while knee was flexed and extended (2 sets of 10 repetitions) | 3 wk, 6 supervised sessions | CAIT (score) | Differences in the CAIT were found for mobilizations with movement compared with control and sham after treatment and at 6-mo follow-up. |
| De Ridder et al21 (2015), case-control study | 39 CAI and 31 healthy Balance training = 33/39 and healthy = 31/31 | History of ≥2 ankle sprains, 1 ankle sprain associated with 3 wk of activity restriction, sensation of giving way, decreased functional participation, and physically active | Progressive balance- training program: single-limb and some double-limb tasks; tasks progressed by changing upper extremity position, visual status, and surface | 8 wk, 24 home balance sessions | FADI (%) FADI–Sport (%) | Individuals with CAIT had higher FADI and FADI–Sport scores after than before balance training. |
| Salom-Moreno et al29 (2015), randomized controlled trial | 27 CAI Balance training and strength = 13/13 and balance training, strength, and dry needling = 14/14 | History of ankle sprain, ≥1 episode of giving way in past 6 mo, pain >3 points on 11-point scale, and <26 on CAIT | Progressive TheraBanda ankle-strengthening and balance-training tasks; trigger-point dry needling to lateral peroneus muscle | 8 wk, 16 supervised sessions, with dry needling completed over first 4 wk (8 sessions) | FAAM–ADL (%) FAAM–Sport (%) | Both groups increased FAAM scores from baseline, with balance training, strength, and dry needling increasing scores more. |
| McKeon and Wikstrom31 (2016), randomized controlled trial | 80 CAI Mobilization = 19/20, massage = 19/20, stretching = 18/20, and control = 19/20 | History of ≥2 episodes of giving way in past 6 mo, ≥5 on the Ankle Instability Instrument, ≤90% FAAM, and ≤80% FAAM–Sport | Maitland grade III anterior-to-posterior talocrural joint mobilizations (2 sets of 2 min), petrissage and effleurage plantar massage (2 sets of 2 min), and heel cord stretching with knee slightly bent (3 sets of 30 s) | 2 wk, 6 supervised sessions | FAAM–ADL (%) FAAM–Sport (%) | FAAM–ADL improvements after massage and stretching. FAAM–Sport improvements after massage and mobilizations. |
Abbreviations: CAI, chronic ankle instability; CAIT, Cumberland Ankle Instability Tool; FAAM, Foot and Ankle Ability Measure; FADI, Foot and Ankle Disability Index; FADI–ADL, FADI activities of daily living subscale; FADI–Sport, FADI Sport subscale.
a
The Hygenic Corporation, Akron, OH.