A Cochrane review [Abstract] 1 included 10 studies with a total of 388 subjects. Neuromuscular training compared with no training resulted in better ankle function scores at the end of four weeks training (Ankle Joint Functional Assessment Tool: MD 3.00, 95% CI 0.3 to 5.70; 1 trial, n=19; Foot and Ankle Disability Index: MD 8.83, 95% CI 4.46 to 13.20; 2 trials, n=56). Another trial (n=19) found no significant difference in the functional outcome after six weeks training programme on a cyclo-ergometer with a bi-directional compared with a traditional uni-directional pedal. Longer-term follow-up data were not available for these four trials.Four studies compared surgical procedures for chronic ankle instability. There were more nerve injuries after tenodesis than anatomical reconstruction (RR 5.50, 95% CI 1.39 to 21.71; 1 trial, n=40). Dynamic tenodesis resulted in higher numbers of people with unsatisfactory function (RR 8.62, 95% CI 1.97 to 37.77; 1 trial, n=82). Early functional mobilisation after surgery led to earlier return to work compared with immobilisation (MD -2.00 weeks, 95% CI -3.06 to -0.94; 1 trial) and to sports (MD -3.00 weeks, 95% CI -4.49 to -1.51; 1 trial)..
Comment: The quality of evidence is downgraded by limitations in study quality (limitations in the design, conduct and reporting, unclear or high risk of bias assessments relating to allocation concealment, assessor blinding, incomplete and selective outcome reporting) and imprecise results (limited study size for each comparison).
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