Objective: To summarise the available evidence for the efficacy of neuromuscular training in enhancing\r\nsensorimotor and functional deficits in subjects with chronic ankle instability (CAI).\r\nDesign: Systematic review with best evidence synthesis.\r\nData Sources: An electronic search was conducted through December 2009, limited to studies published in the\r\nEnglish language, using the Pubmed, CINAHL, Embase, and SPORTDiscus databases. Reference screening of all\r\nincluded articles was also undertaken.\r\nMethods: Studies were selected if the design was a RCT, quasi RCT, or a CCT; the patients were adolescents or\r\nadults with confirmed CAI; and one of the treatment options consisted of a neuromuscular training programme.\r\nThe primary investigator independently assessed the risk of study bias and extracted relevant data. Due to clinical\r\nheterogeneity, data was analysed using a best-evidence synthesis.\r\nResults: Fourteen studies were included in the review. Meta-analysis with statistical pooling of data was not\r\npossible, as the studies were considered too heterogeneous. Instead a best evidence synthesis was undertaken.\r\nThere is limited to moderate evidence to support improvements in dynamic postural stability, and patient\r\nperceived functional stability through neuromuscular training in subjects with CAI. There is limited evidence of\r\neffectiveness for neuromuscular training for improving static postural stability, active and passive joint position\r\nsense (JPS), isometric strength, muscle onset latencies, shank/rearfoot coupling, and a reduction in injury recurrence\r\nrates. There is limited evidence of no effectiveness for improvements in muscle fatigue following neuromuscular\r\nintervention.\r\nConclusion: There is limited to moderate evidence of effectiveness in favour of neuromuscular training for various\r\nmeasures of static and dynamic postural stability, active and passive JPS, isometric strength, muscle onset latencies,\r\nshank/rearfoot coupling and injury recurrence rates. Strong evidence of effectiveness was lacking for all outcome\r\nmeasures. All but one of the studies included in the review were deemed to have a high risk of bias, and most\r\nstudies were lacking sufficient power. Therefore, in future we recommend conducting higher quality RCTs using\r\nappropriate outcomes to assess for the effectiveness of neuromuscular training in overcoming sensorimotor deficits\r\nin subjects with CAI.
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