Exercise-based rehabilitation reduces reinjury following acute lateral ankle sprain: A systematic review update with meta-analysis

Jente Wagemans, C M Bleakley, Jan Taeymans, Alexander Schurz, Kevin Kuppens, Heiner Baur, Dirk Vissers

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
35 Downloads (Pure)


Research questions
1) Do exercise-based rehabilitation programs reduce re-injury following acute ankle sprain?; 2) Is rehabilitation effectiveness moderated by the exercise’s therapeutic quality, content and volume?

This systematic review with meta-analysis (PROSPERO: CRD42020210858) included randomized controlled trials in which adults who sustained an acute ankle sprain received exercise-based rehabilitation as an intervention. Databases CINAHL, Web of Science, SPORTDiscus, Cochrane Central Register of Controlled Trials, PEDro and Google Scholar were searched for eligible articles (last search: March 2021). ROB II screening tool by Cochrane was used to assess risk of bias and the i-CONTENT tool was used to assess quality of interventions. Both qualitative analysis and quantitative data synthesis were performed.

Fourteen randomized controlled trials comprising 2182 participants were included. Five studies were judged overall low risk of bias and i-CONTENT assessment showed poor to moderate therapeutic quality of exercise across all included articles. Pooled data found significant reductions in re-injury prevalence at 12 months, in favour of the exercise-based rehabilitation group vs usual care (OR: 0.60; 95%CI: 0.36 to 0.99). Pooled data for re-injury incidence showed not-significant results (MD: 0.027; 95%CI: -2.14 to 2.19). Meta-regression displayed no statistically significant association between training volume and odds of re-injury (r = -0.00086; SD: 0.00057; 95%CI: -0.00197 to 0.00025). Results from patient-reported outcomes and clinical outcomes were inconclusive at 1 month, 3–6 months and 7–12 months of follow up.

Exercise-based rehabilitation reduces the risk of recurrent ankle sprain compared to usual care, but there is insufficient data to determine the optimal content of exercise-based interventions. Training volume varied considerably across studies but did not affect the odds of sustaining a re-injury. Effects on patient-reported outcomes and clinical outcomes are equivocal. Future research should compare different exercise contents, training volumes and intensities after ankle sprain.
Original languageEnglish
Article numbere0262023
Pages (from-to)1-20
Number of pages20
JournalPLoS ONE
Issue number2
Publication statusPublished (in print/issue) - 8 Feb 2022

Bibliographical note

Funding: The author(s) received no specific funding for this work.

Publisher Copyright:
Copyright: © 2022 Wagemans et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


  • Ankle
  • Humans
  • Ankle Injuries
  • Range of Motion, Articular
  • Treatment Outcome
  • Exercise
  • Incidence
  • Odds Ratio
  • Databases, Factual
  • Reinjuries


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