Effects and dosage of exercise therapy on functional outcomes in chronic ankle instability: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the effects of exercise therapy on patient-oriented function among individuals with chronic ankle instability (CAI) and analyze the influence of exercise dosage characteristics on these outcomes. METHODS: Literature searches were conducted in multiple databases, including PubMed, Embase, Cochrane Library, Web of Science, EBSCO (MEDLINE, SPORTDiscus), Physiotherapy Evidence Database, CNKI, WANFANG, and VIP, from the earliest available time until May 22, 2025. The Cochrane Risk of Bias 2.0 tool was used to assess the risk of bias. Meta-analysis, sensitivity analysis, and publication bias analysis were conducted using RevMan 5.3.0 and Stata 14.0 software. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was applied to evaluate the quality of evidence. Main outcomes were assessed using the Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure-Activities of Daily Living (FAAM-A), Foot and Ankle Ability Measure-Sports (FAAM-S), Foot and Ankle Disability Index-Activities of Daily Living (FADI-A), and Foot and Ankle Disability Index-Sports (FADI-S). RESULTS: Twenty-six randomized controlled trials (1,032 participants) were included. Exercise therapy significantly improved patient-oriented function compared to non-trial intervention control group, as measured by CAIT (14 studies, MD = 4.59, 95% CI: 4.16-5.03, p < 0.001, I²=45.5%), FAAM-A (13 studies, MD = 7.71, 95% CI: 6.36-9.05, p < 0.001, I²=42.5%), FAAM-S (14 studies, MD = 11.86, 95% CI: 7.86-15.85, p < 0.001, I²=83.4%), FADI-A (2 studies, MD = 8.65, 95% CI: 3.11-14.19, p = 0.002, I²=0%), and FADI-S (3 studies, MD = 13.88, 95% CI: 11.97-15.78, p < 0.001, I²=0%). Subgroup analyses suggested that manual therapy, delivered 1-2 times per week for ≤ 4 weeks, yielded the greatest improvements in CAIT, whereas multimodal training, performed 1-2 times weekly over 5-8 weeks, demonstrated superior effects for FAAM-A and FAAM-S. CONCLUSIONS: This meta-analysis provides very low to moderate certainty evidence that exercise therapy improves patient-oriented function among individuals with CAI compared to comparator controls. Manual therapy of shorter duration may optimize CAIT outcomes, while longer multimodal training programs appear most effective for enhancing FAAM-A and FAAM-S scores.