Do exercise therapies restore the deficits of joint position sense in patients with chronic ankle instability? A systematic review and meta-analysis

To determine whether existing exercise therapies can restore the joint position sense (JPS) deficits of patients with chronic ankle instability (CAI) when compared with controlled non-training patients. Seven databases were searched using ankle, injury, proprioception, and exercise-therapy-related terms. Peer-reviewed human studies in English that used the absolute errors score of joint position reproduction (JPR) test to compare the JPS of injured ankles in CAI patients before and after exercise therapy and non-training controls were included and analyzed. Demographic information, sample size, description of exercise therapies, methodological details of the JPR test, and absolute error scores were extracted by two researchers independently. Meta-analysis of the differences in JPS changes (i.e., absolute errors after treatment minus the baseline) between the exercise therapies and non-training controls was performed with the weighted mean difference (WMD) and 95% confidence interval (CI). Seven studies were finally included. Meta-analyses revealed significantly higher improvements in passive JPS during inversion with, WMD ​= ​−1.54° and eversion, of, WMD ​= ​−1.80°, after exercise therapies when compared with non-training controls. However, no significant changes in the impaired side active JPS were observed with regard to inversion and eversion. Existing exercise therapies may have a positive effect on passive JPS during inversion and eversion, but do not restore the active JPS deficits of injured ankles in patients with CAI when compared with non-training controls. Updated exercise components with a longer duration that focus on active JPS with longer duration are needed to supplement the existing content of exercise therapies.