Included studies.

Objective
The efficacy of tuina in treating chronic ankle instability (CAI) arouses controversy. Therefore, the present study adopted the meta-analysis to evaluate the effectiveness and safety of tuina in treating CAI and aims to provide high-quality evidence for this promising treatment.
Methods
We searched eight databases from inception to April 1st, 2024 for randomized controlled trials (RCTs) of tuina treatment for CAI, including PubMed, Web of Science, Embase, Cochrane Library, Wanfang database, China National Knowledge Infrastructure database, and VIP Chinese Science and Technique Journals database. Information was independently extracted and bias risks were evaluated by two researchers. To assess the quality of the studies, we utilized Cochrane Collaboration’s tool and the GRADE evaluation system. Meta-analysis was performed using the RevMan5.4 software.
Results
Thirteen RCTs involving 984 patients were included in this study. The overall methodological quality of the studies was low. The meta-analysis revealed the followings: (1) the clinical effective rate was higher in the treatment group compared to the control group (OR = 6.51, 95% CI [3.76, 11.28]); (2) the treatment group performed better in reducing the Visual Analogue Scale score (MD = −1.59, 95% CI [−2.59, −0.59]); (3) the Baird-Jackson Ankle Score was superior in the treatment group (MD = 8.20, 95% CI [6.37, 10.04]); (4) the improvement in the AOFAS Ankle Hindfoot Scale was greater in the treatment group (MD = 14.52, 95% CI [9.81, 19.23]). All differences were statistically significant. Regarding adverse events, there were no significant differences in incidence rates between the groups.
Conclusions
Tuina is an effective and safe treatment option for CAI, the conclusions are limited by the methodological quality of the included trials. Further high-quality research is needed to confirm these findings and guide clinical practice.