2022, Vol. 26 ›› Issue (33): 5407-5412

Joint mobilization treatment for chronic ankle instability function recovery: a meta-analysis

Yin Yikun1, Wang Jialin2, Wu Chaoming3, Sun Junzhi4   

Abstract: OBJECTIVE: The characteristics of chronic ankle instability are often manifested as varying degrees of decreased balance and stability, proprioception, and limited dorsiflexion range of motion. Joint mobilization can effectively improve the range of joint motion and stimulate the recovery of proprioception. This article systematically analyzed the effect of joint mobilization on the functional recovery of patients with chronic ankle instability.
METHODS: Electronic databases such as CNKI, PubMed, EBSCO, Web of Science, and Cochrane Library were searched. Randomized controlled trials on joint mobilization intervention for chronic ankle instability were collected. The key words were “mobilization with movement, joint mobilization, Maitland, Mulligan’s, chronic ankle instability, CAI, ankle instability” in Chinese and English. The search time was from the establishment of the database to June 2021. According to the “Bias Risk Assessment” tool in the Cochrane Intervention System Evaluation Manual, the risk assessment of the selected literature was carried out, and the RevMan 5.3 software was used for meta-analysis.
RESULTS: (1) Nine randomized controlled trials involving 336 subjects were finally included. (2) Meta-analysis results showed that joint mobilization could effectively improve the Cumberland ankle instability tool score of chronic ankle instability patients [MD=5.79, 95%CI(4.95, 6.62), P < 0.000 01]. After a single joint mobilization intervention, there was no significant improvement in the ankle dorsiflexion range of motion measured in weight bearing lunge test [MD=0.93, 95%CI(-0.53, 2.38), P=0.21] or non-weight bearing inclinometer test [MD=1.53, 95%CI(-1.69, 4.76), P=0.35]. After six joint mobilization interventions, the ankle dorsiflexion range of motion measured by weight bearing lunge test had been significantly improved [MD=4.45, 95%CI(0.41, 8.49), P=0.03]. Joint mobilization surgery had a better improvement in balance (star excursion balance test) intervention [MD=6.17, 95%CI(3.12, 9.23), P < 0.000 01], especially the forward and backward inward improvement was the most obvious (P < 0.05). However, joint mobilization surgery failed to effectively improve the pain of chronic ankle instability [MD=-0.74, 95%CI(-2.01, 0.53), P=0.25]. (3) A subgroup analysis based on different intervention methods found that dynamic joint mobilization was better than joint mobilization in improving ankle dorsiflexion range of motion (weight bearing lunge test).
CONCLUSION: (1) Joint mobilization can effectively improve the range of motion and balance of the ankle joint, but the effect of improving pain is not obvious, and further research should be done. (2) Mobilization with movement improves ankle dorsiflexion range of motion (weight bearing lunge test) better than joint mobilization.
Key words: joint mobilization, chronic ankle instability, ankle dorsiflexion range of motion, balance, meta-analysis