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Joint Diseases and
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Original Article · Open access

Comparative efficacy of conventional rehabilitation, balance acupuncture combined with conventional rehabilitation and additional unconscious proprioception training for chronic ankle instability: A randomized-controlled clinical study

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Na Liu

Department of Rehabilitation Medicine, Xuzhou Central Hospital, Xuzhou, Jiangsu, China Department of Rehabilitation Medicine,Xuzhou Rehabilitation Hospital, Xuzhou, Jiangu, China

ORCID: 0009-0004-6595-4363

Mi Wang

Department of Rehabilitation Medicine, Xuzhou Central Hospital, Xuzhou, Jiangsu, China Department of Rehabilitation Medicine,Xuzhou Rehabilitation Hospital, Xuzhou, Jiangu, China

ORCID: 0009-0007-2155-4036

Qing Meng

Department of Rehabilitation Medicine,Xuzhou Rehabilitation Hospital, Xuzhou, Jiangu, China

ORCID: 0009-0005-4330-4092

Mingyu Wang

Department of Rehabilitation Medicine,Xuzhou Rehabilitation Hospital, Xuzhou, Jiangu, China

ORCID: 0009-0009-4016-5372

Kai Shang

Department of Rehabilitation Medicine, Xuzhou Central Hospital, Xuzhou, Jiangsu, China

ORCID: 0009-0000-4009-7482

Ying-Li Bi

Department of Rehabilitation Medicine,Xuzhou Rehabilitation Hospital, Xuzhou, Jiangu, China

ORCID: 0009-0002-9546-4045

Xiaowei Jiang

Department of Rehabilitation Medicine, Xuzhou Central Hospital, Xuzhou, Jiangsu, China Department of Rehabilitation Medicine,Xuzhou Rehabilitation Hospital, Xuzhou, Jiangu, China

ORCID: 0009-0004-2630-2338

Jin Li

Department of Rehabilitation Medicine,Xuzhou Rehabilitation Hospital, Xuzhou, Jiangu, China

ORCID: 0009-0001-9625-5096

Jiaojiao Chen

Department of Rehabilitation Medicine,Xuzhou Rehabilitation Hospital, Xuzhou, Jiangu, China

ORCID: 0009-0006-1854-4307

Shiming Feng

Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou, Jiangsu, China

ORCID: 0009-0008-1524-977X

Hongwei Zhai

Department of Rehabilitation Medicine, Xuzhou Central Hospital, Xuzhou, Jiangsu, China Department of Rehabilitation Medicine,Xuzhou Rehabilitation Hospital, Xuzhou, Jiangu, China

ORCID: 0009-0002-2545-8029

Abstract

Objectives: This study aims to compare the efficacy of conventional rehabilitation alone, conventional rehabilitation combined with balance acupuncture (BA) and conventional rehabilitation plus BA and unconscious proprioception training in chronic ankle instability (CAI) patients.

Patients and methods: This single-center, parallel-group, assessor-blinded randomized-controlled trial included a total of 120 CAI patients between October 2022 and October 2024. The patients were randomly assigned to control (n = 40), BA (n = 40), and combination therapy (CT, (n = 40) groups. All groups received six weeks of intervention (6 days/week): the control group received conventional rehabilitation, the BA group received conventional rehabilitation + BA and the CT group received conventional rehabilitation + BA + unconscious proprioception training. Unconscious proprioception training was defined as dual-task training using the MOTOmed system with cognitive distraction to shift focus away from conscious movement control. Assessments were conducted before and after treatment using a three-dimensional gait analysis system, a balance function testing and training system, and the Star Excursion Balance Test (SEBT).

Results: There was no statistically significant difference in age and sex among the groups (p > 0.05). In addition, disease duration and number of previous sprains were comparable among the groups (p > 0.05). Following the six-week intervention, all three groups showed significant improvements in gait parameters, balance function and SEBT scores compared to baseline (p < 0.05). The CT group exhibited significantly greater improvements in gait speed, cadence, movement length, movement ellipse area and SEBT scores than the BA group (p < 0.05), whereas the BA group outperformed the control group in all outcome measures (p < 0.05). No adverse reactions were reported in any group.

Conclusion: The integration of BA and unconscious proprioception training may offer additional benefits for improving gait and balance in CAI patients compared to conventional rehabilitation plus BA or conventional rehabilitation alone. Based on these preliminary findings, the combined approach shows potential clinical value for targeted populations with CAI.

* Na Liu and Mi Wang contributed equally to this study

Declarations

Author Contributions

L.N., W.M.Z.H.W.: Conception and design; M.Q.: Administrative support; W.M.Y., S.K.,B.Y.L.: Provision of study materials or patients; J.X.W., L.J.,C.J.J: Collection and assembly of data; F.S.M., Z.H.W.,L.N.: Data analysis and interpretation.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

This work was supported by Xuzhou Science and Technology Project (KC25082).

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

AI Disclosure

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

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