Abstract：
OBJECTIVE: This review aimed to determine if gait training interventions influence lower extremity biomechanics during walking in individuals with chronic ankle instability (CAI).
METHODS: A literature search was conducted in PubMed, CINAHL, SPORTDiscus, and MEDLINE to identify English-language studies from inception through September 2022. Eligible studies included randomized control trials, repeated measures design, and descriptive laboratory studies measuring the effects during or following a gait training intervention on biomechanical outcomes (kinematics, kinetics, electromyography) during walking in individuals with CAI. Gait training interventions were broadly categorized into devices (destabilization devices, novel gait training device) and biofeedback (visual, auditory, and haptic delivery modes). Meta-analyses were conducted when appropriate using random-effects to compare pre-and post- gait training intervention mean differences and standard deviations.
RESULTS: Thirteen studies were included. Meta-analyses were conducted for single session gait training studies only. Eleven studies reported kinetic outcomes. Our meta-analyses showed location of center of pressure (COP) was shifted medially from 0-90% (Effect Size [ES] range=0.35-0.82) of stance, contact time was decreased in medial forefoot (ES=0.43), peak pressure was decreased for lateral midfoot (ES=1.18) and increased for hallux (ES=0.59), pressure time integral was decreased for lateral heel (ES=0.33) and lateral midfoot (ES=1.22) and increased for hallux (ES=0.63). Three studies reported kinematic outcomes. Seven studies reported electromyography outcomes. Our meta-analyses revealed increased activity following initial contact (IC) for fibularis longus (ES=0.83).
CONCLUSIONS: Gait training protocols improved some lower extremity biomechanical outcomes in individuals with CAI. Plantar pressure outcome measures seem to be most impacted by gait training programs with improvements in decreasing lateral pressure associated with increased risk for lateral ankle sprains. Gait training increased EMG activity post-IC for the fibularis longus. Few studies have assessed the impact of multi-session gait training on biomechanical outcome measures. Targeted gait trainning should be considered when treating patients with CAI.
METHODS: A literature search was conducted in PubMed, CINAHL, SPORTDiscus, and MEDLINE to identify English-language studies from inception through September 2022. Eligible studies included randomized control trials, repeated measures design, and descriptive laboratory studies measuring the effects during or following a gait training intervention on biomechanical outcomes (kinematics, kinetics, electromyography) during walking in individuals with CAI. Gait training interventions were broadly categorized into devices (destabilization devices, novel gait training device) and biofeedback (visual, auditory, and haptic delivery modes). Meta-analyses were conducted when appropriate using random-effects to compare pre-and post- gait training intervention mean differences and standard deviations.
RESULTS: Thirteen studies were included. Meta-analyses were conducted for single session gait training studies only. Eleven studies reported kinetic outcomes. Our meta-analyses showed location of center of pressure (COP) was shifted medially from 0-90% (Effect Size [ES] range=0.35-0.82) of stance, contact time was decreased in medial forefoot (ES=0.43), peak pressure was decreased for lateral midfoot (ES=1.18) and increased for hallux (ES=0.59), pressure time integral was decreased for lateral heel (ES=0.33) and lateral midfoot (ES=1.22) and increased for hallux (ES=0.63). Three studies reported kinematic outcomes. Seven studies reported electromyography outcomes. Our meta-analyses revealed increased activity following initial contact (IC) for fibularis longus (ES=0.83).
CONCLUSIONS: Gait training protocols improved some lower extremity biomechanical outcomes in individuals with CAI. Plantar pressure outcome measures seem to be most impacted by gait training programs with improvements in decreasing lateral pressure associated with increased risk for lateral ankle sprains. Gait training increased EMG activity post-IC for the fibularis longus. Few studies have assessed the impact of multi-session gait training on biomechanical outcome measures. Targeted gait trainning should be considered when treating patients with CAI.
摘要：
目的：本综述旨在确定步态训练干预措施是否会影响慢性踝关节不稳（CAI）患者行走过程中的下肢生物力学。
方法：在PubMed，CINAHL,SPORTDiscus,和MEDLINE确定从开始到2022年9月的英语学习。符合条件的研究包括随机对照试验，重复措施设计，和描述性实验室研究，测量步态训练干预期间或之后对生物力学结果的影响(运动学，动力学,肌电图）在CAI个体行走期间。步态训练干预措施大致分为设备(失稳设备，新型步态训练装置)和生物反馈(视觉，听觉,和触觉传递模式)。适当时使用随机效应进行荟萃分析,以比较步态训练干预前后的平均差异和标准偏差。
结果：共纳入13项研究。仅对单次步态训练研究进行荟萃分析。11项研究报告了动力学结果。我们的荟萃分析显示，压力中心（COP）的位置从姿势的0-90％（效应大小[ES]范围=0.35-0.82）向内移动，足前内侧接触时间减少（ES=0.43），足中外侧的峰值压力降低（ES=1.18），并增加（ES=0.59），外侧足跟（ES=0.33）和外侧足中（ES=1.22）的压力时间积分降低，而外侧足跟（ES=0.63）的压力时间积分升高。三项研究报告了运动学结果。7项研究报告了肌电图结果。我们的荟萃分析显示，初次接触（IC）后长腓骨的活动增加（ES=0.83）。
结论：步态训练方案改善了CAI患者的一些下肢生物力学结果。足底压力结果测量似乎受步态训练计划的影响最大，与外侧踝关节扭伤风险增加相关的外侧压力降低的改善。步态训练增加了腓骨长肌IC后的EMG活性。很少有研究评估多阶段步态训练对生物力学结果指标的影响。在治疗CAI患者时，应考虑有针对性的步态训练。
方法：在PubMed，CINAHL,SPORTDiscus,和MEDLINE确定从开始到2022年9月的英语学习。符合条件的研究包括随机对照试验，重复措施设计，和描述性实验室研究，测量步态训练干预期间或之后对生物力学结果的影响(运动学，动力学,肌电图）在CAI个体行走期间。步态训练干预措施大致分为设备(失稳设备，新型步态训练装置)和生物反馈(视觉，听觉,和触觉传递模式)。适当时使用随机效应进行荟萃分析,以比较步态训练干预前后的平均差异和标准偏差。
结果：共纳入13项研究。仅对单次步态训练研究进行荟萃分析。11项研究报告了动力学结果。我们的荟萃分析显示，压力中心（COP）的位置从姿势的0-90％（效应大小[ES]范围=0.35-0.82）向内移动，足前内侧接触时间减少（ES=0.43），足中外侧的峰值压力降低（ES=1.18），并增加（ES=0.59），外侧足跟（ES=0.33）和外侧足中（ES=1.22）的压力时间积分降低，而外侧足跟（ES=0.63）的压力时间积分升高。三项研究报告了运动学结果。7项研究报告了肌电图结果。我们的荟萃分析显示，初次接触（IC）后长腓骨的活动增加（ES=0.83）。
结论：步态训练方案改善了CAI患者的一些下肢生物力学结果。足底压力结果测量似乎受步态训练计划的影响最大，与外侧踝关节扭伤风险增加相关的外侧压力降低的改善。步态训练增加了腓骨长肌IC后的EMG活性。很少有研究评估多阶段步态训练对生物力学结果指标的影响。在治疗CAI患者时，应考虑有针对性的步态训练。
