The Effect of Visual Feedback on Balance Rehabilitation in People with Impaired Ankle Instability: A Systematic Review and Meta-Analysis

Abstract Aim: The aim of this systematic review and meta-analysis was to(1) comprehensively assess the possible effects of visual feedback on balance exercise in a population with ankle instability;(2) Quantify the effects of visual feedback on balance in a population with ankle instability. Methods: A total of 10 studies were included in this systematic evaluation and Meta-analysis. This review was performed by the PERSiST (implementing Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science) guidance. Four databases were searched and the research had to be written in English and involve the provision of visual feedback during balanced rehabilitation. Results: Visual feedback improves balance rehabilitation effects. Improvement of static balance, dynamic balance, and balance perception during balance exercise. The provision of visual feedback simultaneously increased subjective motivation to train and increased satisfaction and enjoyment of rehabilitation training. The results demonstrated that visual feedback improved the Foot and Ankle Ability Measure by approximately 17%(g=2.42,95%CI=0.72-4.12,I2[total]=0%).Also by providing visual feedback during the training cycle, the star excursion balance test(SEBT) may be positively affected(g=4.83,95%CI=3.09-6.56,I2[total]=21%). Also the biodex system's performance on measures of balance will be highly improved(g=0.14,95%CI=0.01-0.28,I2[total]=24%). Conclusion: Providing visual feedback in balance rehabilitation can produce beneficial adaptations to balance in individuals with ankle instability. The research included in our analysis demonstrates the positive impact of visual feedback, with almost all results showing better outcomes than when visual feedback is not provided.Visual feedback can be used as an "additive" or alternative to traditional rehabilitation for people with ankle instability.研究目的：本系统综述与荟萃分析的研究目标为：(1) 全面评估视觉反馈(Visual feedback)对踝关节不稳人群平衡训练的潜在效应；(2) 量化视觉反馈对踝关节不稳人群平衡能力的影响效应。 研究方法：本系统评价与荟萃分析共纳入10项研究，严格遵循PERSiST（运动、康复、运动医学及运动科学领域的PRISMA实施指南）规范开展研究。本次研究检索了4个数据库，纳入文献需为英文撰写且涉及平衡康复训练中提供视觉反馈的相关内容。 研究结果：视觉反馈可改善平衡康复效果，具体表现为平衡训练过程中静态平衡、动态平衡及平衡感知能力的提升。提供视觉反馈同时可提升受试者的训练主观动机，并增强其对康复训练的满意度与参与乐趣。研究结果显示，视觉反馈可使足踝功能评分量表(Foot and Ankle Ability Measure)得分提升约17%（g=2.42，95%CI=0.72-4.12，I²[总]=0%）。此外，在训练周期中加入视觉反馈，可对星式平衡试验(Star Excursion Balance Test, SEBT)结果产生积极影响（g=4.83，95%CI=3.09-6.56，I²[总]=21%）。同时，Biodex平衡系统(Biodex system)的平衡测评表现也将得到显著提升（g=0.14，95%CI=0.01-0.28，I²[总]=24%）。 研究结论：在踝关节不稳人群的平衡康复中提供视觉反馈，可对其平衡能力产生有益的适应性改善。本分析纳入的研究均证实了视觉反馈的积极作用，几乎所有结果均优于未提供视觉反馈的对照组。视觉反馈可作为踝关节不稳患者传统康复训练的“附加手段”或替代方案。