Changes in Dorsiflexion and Dynamic Postural Control After Mobilizations in Individuals With Chronic Ankle Instability: A Systematic Review and Meta-Analysis

Abstract

Objective: To conduct a systematic review with meta-analysis assessing the effectiveness of joint mobilizations for improving dorsiflexion range of motion (DFROM) and dynamic postural control in individuals with chronic ankle instability.

Data sources: Electronic databases (PubMed, MEDLINE, CINAHL, and SPORTDiscus) were searched from inception to January 2017.

Study selection: Included studies examined the isolated effects of joint mobilizations to enhance DFROM and dynamic postural control in individuals with chronic ankle instability and provided adequate data to calculate effect sizes (ESs) and 95% confidence intervals (CIs).

Data extraction: Two investigators independently assessed the methodologic quality, level of evidence, and strength of recommendation using the Physiotherapy Evidence Database scale and the Strength of Recommendation Taxonomy. We extracted the sample sizes, means, and standard deviations for DFROM and dynamic postural control and filtered the data based on control-to-intervention and preintervention-to-postintervention (pre-post) comparisons.

Data synthesis: We included 7 level 1 and 3 level 2 studies that had a median Physiotherapy Evidence Database score of 60% (range = 40%-80%). The magnitudes of control-to-intervention and pre-post differences were examined using bias-corrected Hedges g ESs. Random-effects meta-analyses were conducted for each outcome measure and comparison. Positive ESs indicated better outcome scores in the intervention group than in the control group and at postintervention than at preintervention. The α level was set at .05. Meta-analysis revealed weak and moderate ESs for overall control-to-intervention (ES = 0.41; 95% CI = 0.14, 0.68; P = .003) and pre-post (ES = 0.34; 95% CI = 0.20, 0.48; P < .001) DFROM analyses. Overall, dynamic postural control meta-analysis revealed moderate control-to-intervention (ES = 0.42; 95% CI = -0.14, 0.98; P = .14) and weak and moderate ESs for pre-post (ES = 0.37; 95% CI = -0.12, 0.87; P = .14) analyses.

Conclusions: We observed grade A evidence that joint mobilizations can mildly improve DFROM among individuals with chronic ankle instability compared with controls and preintervention. We observed grade B evidence that indicated conflicting effects of joint mobilizations on dynamic postural control compared with controls and preintervention.

Keywords: Maitland mobilization; Mulligan mobilization; Star Excursion Balance Test; weight-bearing lunge test.

Figure 1

Flow chart of literature review.

Figure 2

Summary of Hedges g effect sizes and 95% confidence intervals for the overall analyses. A, Dorsiflexion preintervention-to-postintervention comparison. B, Dorsiflexion control-to-intervention comparison. C, Dynamic postural control preintervention-to-postintervention comparison. D, Dynamic postural control control-to-intervention comparison. Continued on next page.

Figure 2

Continued from previous page.

Figure 3

Summary of Hedges g effect sizes and 95% confidence intervals for the subanalyses. A, Mobilization type. B, Treatment length. C, Measurement time. D, Reach direction. Abbreviation: MWM, mobilizations with movement.

Figure 4

Funnel plot analyses for publication bias of overall analyses. A, Dorsiflexion range-of-motion control-to-intervention comparison. B, Dorsiflexion range-of-motion preintervention-to-postintervention comparison. C, Dynamic postural control control-to-intervention comparison. D, Dynamic postural control preintervention-to-postintervention comparison.