Comparison the Effect of Neuromuscular Exercises with Other Training Modalities on Balance and Motor Function in People with Chronic Ankle Instability: A Systematic Review and Meta-Analysis

Background and aim. Identifying the factors affecting the reduction of ankle sprain complications as well as rapid recovery and prevention of re-injury after ankle sprain occurs are considered as the essentials. Therefore, the present meta- analysis investigate the challenge that which training modalities have a better effect on the balance and motor function of people with chronic ankle instability. Method. Articles by searching 8 databases MEDLINE / PubMed, EMBASE / SCOPUS, LILACS, CINAHL, CENTRAL (Cochrane Central Register of Controlled Trials), Web of Science, PEDro and Google Scholar, Were identified. This work was also done in Persian databases MAGIRAN, IRANDOC, IranMedex, MedLib, SID, equivalent to English keywords searched from 8 databases. After collecting the search results, first the title and then the abstracts of the articles were read. If the articles met the inclusion and exclusion criteria; the results were used in the review study and otherwise discarded. The search period covered the years from the beginning to December 2021. In addition, a manual search and full review of article sources was performed. Exclusion criteria were: articles whose statistical population was people other than people with chronic ankle instability, published articles other than English and Persian, articles that examined the effect of exercise programs on factors other than balance and motor function had paid. Hedges's effect size (ratio of the mean difference between the two groups to the mixed weight standard deviation) was used for meta-analysis. Heterogeneity between studies was assessed using the I2 index. If the heterogeneity is above 50%, the random effects model method is used, and if it is below 50%, the fixed-effects model method is used. The bias of publication studies was assessed using Egger's test. Comprehensive Meta-Analysis version 2.0 software was used to analyze the data. Results. After reviewing the full text of the articles, 21 articles using 24 training protocols were selected. The final articles were divided into two categories for analysis: articles comparing neuromuscular exercises with other exercises and articles comparing new and combined balance exercises with other exercises with traditional balance exercises. By a superficial qualitative review of articles with the PEDro tool, the average scores that articles received from this scale were higher than a score of 7; which shows that the articles used for meta-analysis of this study are of high quality and the results of these studies are reliable. Conclusion. The results of studies showed that neuromuscular training has a better effect on static and dynamic balance in people with chronic ankle instability than other training protocols; but there was no significant difference in motor performance between the two types of training groups. The results of studies also showed that balance-combination exercises as well as new methods of balance exercises compared to traditional balance exercises, have a more significant effect on static balance and motor function of people with chronic ankle instability. However, no significant difference was observed in the dynamic balance between the two types of training groups; however, the effect of new combined-balance exercises on dynamic balance was better than traditional balance exercises. It seems that the usefulness of balance-combination exercises and performing balance exercises with new methods is more useful than other training protocols on balance and postural control of people with chronic ankle instability.