Study Design Meta-Analysis.

Objectives Examine the effectiveness of ankle sprain rehabilitation; subgroup rehabilitation programmes based on training volume and training emphasis and highlight key components associated with clinical effect.

Background Ankle sprains commonly occur in sports and have a high re-injury rate. Rehabilitation exercise is often used to prevent recurrence but its effectiveness remains equivocal; this may be because rehabilitation programmes differ significantly in their exercise content and training volume.

Methods and Measures A computerised literature search, citation tracking, and hand searching were carried out up to January 2017. Eligible studies were randomized-controlled trials describing acute ankle sprain treated exercise based rehabilitation, with comparisons to standard care (PRICE). The PEDro scale was used to assess methodological quality. Key outcomes were re-injury, function, ankle instability, pain (at 3, 6, 12 months). Total rehabilitation time (TRT) and the training emphasis were extracted. Meta-analysis was undertaken using RevMan.

Results Eight trials were included (n=1439). The median PEDro score was 7/10 (range 1–8). Pooled data (n=4 RCTs) revealed a significant reduction in re-injury at 12 months in favour of the rehabilitation (OR 0.53 95%Cis 0.38 to 0.73) when compared to standard care alone. Data pooling was not feasible for other outcomes however results from individual studies were conflicting for pain, functional recovery and stability outcomes. TRT was highly variable across studies (median 9 hour, range 1–21 hour). The training emphasis varied between programmes, however most focused on balance or strength training. Studies provided insufficient data to quantify training intensity and subgroup analysis was not possible.

Conclusion Rehabilitation exercises prevent re-injury after ankle sprain (absolute risk reduction=13%, NNT=8). The majority of rehabilitation programmes comprised mostly balance or strength training exercises, but there is no consensus on optimal dose or exercise content. Future research in this field must explicitly report all details of exercise prescription.