This review concluded that evidence for an effect of sensorimotor training on ankle morphological, neurophysiological and functional characteristics in people with a previous ankle sprain was limited. These cautious conclusions seem appropriate based on the evidence presented, but a lack of detail about some of the review methods make it difficult to judge its reliability.

To review the effect of sensorimotor training on the morphological, neurophysiological and functional characteristics of the ankle in people with a previous ankle sprain.

MEDLINE and CINAHL were searched between January 1980 and December 2007 for published studies. Search terms were reported. Reference lists of relevant studies were searched.

Studies that compared sensorimotor training to a control in people with a history of ankle sprain that measured biomechanical, neurophysiological or functional insufficiency outcomes were eligible for inclusion. Included studies assessed different types of sensorimotor training, such as: agility, strength or balance training; high-intensity aerobic training; or coordination training with or without stochastic resonance stimulation. Training was between once and five times a week for up to four weeks or four months. Subjects had previous ankle sprain or functional, mechanical or chronic ankle instability.

The authors did not report how many reviewers performed the study selection.

Validity was assessed using a scale that covered: randomisation; comparability of intervention and control groups; definition of history of injury; testing procedures described in sufficient detail; intervention procedures described in sufficient detail; and appropriate research design and statistical analysis. The highest possible score was 11. Only studies that scored 7 or more were included in the review.

Validity was assessed by two reviewers independently.

The results were extracted as they were reported by the primary studies.

The authors did not report how many reviewers performed data extraction.

Results were presented as a narrative synthesis.

Twelve studies were included (n=421, range 19 to 92). All were considered to be good quality and scored 8 to 11 out of 11. The most common problem was non-comparability of treatment groups at baseline.

Neurophysiological changes: Three studies assessed the effect of sensorimotor training on joint angles or joint position sense. One found that training had no effect on position sense compared with controls after six weeks or four months or between injured and non-injured ankles. Another study found no statistically significant between-group differences, but both training and control groups had significant improvements in position sense after six weeks. The third study did not find any differences between the groups, but found an improved position sense in a group of athletes with chronic ankle instability after sensorimotor training (20 intervention and 10 control subjects).

Morphological changes: Three studies assessed the effect of sensorimotor training on strength using peak torques measured by an isokinetic dynamometer. Two studies found that training had no effect on strength. The third study in 19 people with chronic ankle stability found that after sensorimotor training the intervention group had increased peak eversion torque and the control group did not.

Functional changes: Ten studies assessed the effect of sensorimotor training on static postural sway and one measured dynamic postural stability. Some studies found improved reach distances and postural stability after six weeks of dura disc and mini-trampoline training. Most studies found no statistically significant differences between the training and control groups; some saw greater improvement in the training group. Most studies were small (sample sizes of 30 or less).

Evidence for an effect of sensorimotor training on neurophysiological, morphological and functional characteristics in people with a previous ankle sprain was limited. The pathway through which sensorimotor training can reduce the risk of re-injury remained unclear.

This review specified study inclusion criteria for participants, interventions and outcomes. Only two databases and reference lists were searched. It was not reported whether there were any language restrictions, so language bias was a possibility. Study validity was thoroughly assessed and results were reported for each study; however, studies had to meet certain criteria for inclusion and seven out of 19 studies were excluded. Reliance on a total score was less helpful than considering which aspects of validity were most important. Validity was assessed by two reviewers independently; it was not reported whether study selection and data extraction were performed in the same way.

The authors' cautious conclusions seem appropriate based on the evidence presented, but a lack of detail about some of the review methods make it difficult to judge its reliability.

Practice: The authors did not state any recommendations for practice.

Research: The authors stated that future research should use a multidisciplinary team approach and preferably conduct randomised controlled trials with a suitably large sample size and follow-up greater than six weeks. Studies should differentiate between morphological, physiological and functional changes, ensure correspondence between training and test method and use measures other than postural sway.

Not stated.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.