Do Physiotherapy Interventions on the Ankle have an Impact on the Balance of the Olders adults? A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Abstract

Background and purpose: Falling and its disastrous consequences in the aging population are a public health issue in terms of both morbidity and mortality. Several authors put forward the hypothesis that increasing the range of motion or the muscular strength of the ankle could improve balance in this population. The purpose of this systematic review and meta-analysis is to gather data to evaluate the effect of those two entities on static and dynamic balance.

Methods: Databases as well as grey literature were systematically searched from inception until May 2023. A level of evidence and the corresponding GRADE approach were attributed. Meta-analysis included subgroup analyses to determine the effect of techniques that aim to improve ankle ROM and techniques to strengthen ankle muscles 

Results: Among the 884 studies collected, 10 randomized trials were included for the qualitative analysis and 8 for the meta-analysis. The mean PEDro score was 4.8/10 [3-6]. The GRADE approach revealed low to moderate certainty for static balance in relation to ankle ROM interventions, moderate for static balance in relation to ankles trengthening interventions and low to moderate for dynamic balance in relation to ankle ROM interventions. The meta-analysis points out an improvement for staticbalance with grade III and IV ankle mobilization (pooled SMD = 2.06; 95% CI = 0.15 to3.97; P = 0.03). 

Conclusion: Among the different techniques used on the ankle, only passive mobilizations seems to improve static balance. All of the results have to be considered with caution on account of high heterogeneity.