Gait-training interventions for individuals with chronic ankle instability: a systematic review and meta-analysis

Background Chronic ankle instability (CAI) is a condition known to negatively affect lower extremity gait biomechanics during walking. Gait-training interventions have been proposed as a potential strategy to improve faulty movement patterns associated with CAI. Objective To determine if gait-training interventions influence lower extremity biomechanics during walking in individuals with CAI. Design Systematic review and meta-analysis. Data Sources Literature searches were conducted in PubMed, CINAHL, SPORTDiscus, and MEDLINE from database inception through September 15, 2022. Study Selection Eligible studies were published in English and included randomized controlled trials, studies with a repeated-measures design, and descriptive laboratory studies in which authors measured the biomechanical outcomes (kinematics, kinetics, and electromyography) of a gait-training intervention during walking in individuals with CAI. Data Extraction One author extracted study design, participant characteristics, sample size, intervention type (device and biofeedback), intervention length, and biomechanical outcome measures (kinematics, kinetics, and electromyography). Data Synthesis Gait-training interventions were broadly categorized into device (destabilization and novel gait-training devices) and biofeedback (visual, auditory, and haptic delivery modes). When appropriate, meta-analyses were conducted using a random-effects model to compare mean differences and SDs before and after the gait-training intervention. Results Thirteen studies were included. Meta-analyses were conducted only for single-session gait-training studies. Authors of 11 studies reported kinetic outcomes. Meta-analyses showed the location of center of pressure was shifted medially from 0% to 90% of stance (effect size [ES] range, −0.35 to −0.82), contact time was decreased in the medial forefoot (ES = −0.43), peak pressure was decreased for the lateral midfoot (ES = −1.18) and increased for the hallux (ES = 0.59), and the pressure time integral was decreased for the lateral heel (ES = −0.33) and the lateral midfoot (ES = −1.22) and increased for the hallux (ES = 0.63). Authors of 3 studies reported kinematic outcomes. Authors of 7 studies reported electromyography outcomes. Meta-analyses revealed increased activity for 200 milliseconds after initial contact for the fibularis longus muscle (ES = 0.83). Conclusions Gait-training protocols improved some lower extremity biomechanical outcomes in individuals with CAI. Plantar-pressure outcome measures seemed to be most affected by gait-training programs, with improvements including decreasing the lateral pressure associated with increased risk for lateral ankle sprains. Gait training increased electromyographic activity after initial contact for the fibularis longus muscle. Authors of few studies have assessed the effect of multisession gait training on biomechanical outcome measures. Targeted gait training should be considered when treating patients with CAI.