Factors Contributing to Chronic Ankle Instability: A Systematic Review and Meta-Analysis of Systematic Reviews
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Many factors are thought to contribute to chronic ankle instability (CAI). Multiple systematic reviews have synthesised the available evidence to identify the primary contributing factors. However, readers are now faced with several systematic reviews that present conflicting findings.
The aim of this systematic review and meta-analysis was to establish the statistical significance and effect size of primary factors contributing to CAI and to identify likely reasons for inconsistencies in the literature.
Relevant health databases were searched: CINAHL, MEDLINE, PubMed, Scopus and SPORTDiscus. Systematic reviews were included if they answered a focused research question, clearly defined the search strategy criteria and study selection/inclusion and completed a comprehensive search of the literature. Included reviews needed to be published in a peer-reviewed journal and needed to review observational studies of factors and/or characteristics of persons with CAI, with or without meta-analysis. There was no language restriction. Studies using a non-systematic review methodology (e.g. primary studies and narrative reviews) were excluded. Methodological quality of systematic reviews was assessed using the modified R-AMSTAR tool. Meta-analysis on included primary studies was performed.
Only 17% of primary studies measured a clearly defined CAI population. There is strong evidence to support the contribution of dynamic balance, peroneal reaction time and eversion strength deficits and moderate evidence for proprioception and static balance deficits to non-specific ankle instability.
Evidence from previous systematic reviews does not accurately reflect the CAI population. For treatment of non-specific ankle instability, clinicians should focus on dynamic balance, reaction time and strength deficits; however, these findings may not be translated to the CAI population. Research should be updated with an adequately controlled CAI population.
Systematic review registration
PROSPERO 2016, CRD42016032592.
Cassandra Thompson was responsible for the conception of the review question and the acquisition, analysis and interpretation of the data. Siobhan Schabrun assisted in review design, interpretation and revision and drafting of the manuscript. Rick Romero assisted with data acquisition. Paul Marshall, Andrea Bialocerkowski and Jaap van Dieen contributed to the revision of the manuscript.
Compliance with Ethical Standards
Cassandra Thompson is supported by a Western Sydney University Post-Graduate Research Award. Siobhan Schabrun is supported by a Career Development Fellowship from The National Health and Medical Research Council of Australia (1105040). No other sources of funding were used to assist in the conduct of this research or the preparation of this article.
Conflict of interest
Cassandra Thompson, Siobhan Schabrun, Rick Romero, Andrea Bialocerkowski, Jaap van Dieen and Paul Marshall declare that they have no conflicts of interest relevant to the content of this review.
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