Orthopedics · Medical Literature
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.
Abstract
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. 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). 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. 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.
Clinical relevance
In patients with chronic ankle instability (CAI), does adding balance acupuncture (BA) and/or unconscious proprioception training (dual-task MOTOmed-based cognitive distraction) to conventional rehabilitation produce superior improvements in gait kinematics, balance function, and Star Excursion Balance Test performance compared with conventional rehabilitation alone? __SNAPSHOT__ {"studyDesign":"Single-center, parallel-group, assessor-blinded randomized controlled trial (three-arm)","setting":"Single center; country not specified in the abstract","sampleSize":"n = 120 (control: n = 40; balance acupuncture + conventional rehabilitation [BA group]: n = 40; combination therapy [CT: conventional rehabilitation + BA + unconscious proprioception training]: n = 40)","population":"Patients with chronic ankle instability (CAI) enrolled between October 2022 and October 2024; additional inclusion/exclusion criteria not reported in the abstract","intervention":"BA group: conventional rehabilitation plus balance acupuncture (BA). CT group: conventional rehabilitation plus BA plus unconscious proprioception training, defined as dual-task training using the MOTOmed system with cognitive distraction to shift focus away from conscious movement control. All interventions delivered over six weeks at six days per week.","comparator":"Control group: conventional rehabilitation alone (six weeks, six days per week)","primaryOutcome":"Not explicitly designated in the abstract; outcomes assessed included three-dimensional gait analysis parameters, balance function (measured by a balance function testing and training system), and the Star Excursion Balance Test (SEBT). The primary endpoint is not formally labeled.","followUp":"Six weeks (intervention duration); no post-intervention follow-up period reported","fundingSource":"Not reported"}
Key findings
The abstract is truncated after the phrase 'There was no stati—' and no outcome data, effect sizes, confidence intervals, p-values, or between-group comparisons are available from the provided text. All three groups received assessments before and after treatment using three-dimensional gait analysis, a balance function testing and training system, and the SEBT. Whether the sentence beginning 'There was no stati—' was leading to a statement of no statistically significant difference between specific groups, no statistically significant difference between all groups, or a statement about a specific subgroup comparison cannot be determined from the truncated text. No numerical results, NNT/NNH, or adverse event data can be reported. All findings are therefore: not reported.
Practice implications
IMPORTANT LIMITATION: Only a truncated abstract is available; the manuscript's results, discussion, and conclusions are inaccessible. The study was designed to evaluate whether layering balance acupuncture and then unconscious proprioception training (via cognitive dual-task on the MOTOmed system) onto conventional rehabilitation provides incremental benefit for CAI — a clinically meaningful question, since CAI rehabilitation outcomes are often limited by persistent neuromuscular and proprioceptive deficits. The concept of 'unconscious proprioception training' through cognitive distraction during motor tasks is mechanistically plausible, targeting automatic neuromuscular control rather than consciously attended movement. However, no conclusions about efficacy, clinical importance, or applicability to specific patient populations can be drawn from the available information. The truncated concluding sentence ('There was no stati—') raises the possibility — but does not confirm — that one or more group comparisons may not have reached statistical significance, which would be a clinically meaningful finding. Findings cannot be generalized pending access to full results. The population studied (CAI patients from a single center over approximately two years) may not be broadly representative without knowing age, activity level, CAI severity, or diagnostic criteria used. __LIMITATIONS__ 1. Abstract truncation: outcome data, statistical results, and conclusions are entirely absent, making evidence appraisal impossible. 2. Single-center design limits generalizability. 3. Assessor-blinded but not participant- or therapist-blinded, introducing performance and detection bias risk; full blinding is not feasible for this intervention type but should be acknowledged. 4. Short follow-up of six weeks with no post-intervention period; durability of any effect is unknown. 5. High treatment frequency (six days per week) may limit real-world applicability in settings where daily supervised rehabilitation is not available. 6. The primary outcome is not formally pre-specified in the abstract, raising concerns about outcome hierarchy and multiplicity. 7. Multiple assessment tools (3D gait, balance system, SEBT) without a single designated primary endpoint increases risk of selective outcome reporting. 8. Inclusion/exclusion criteria, CAI diagnostic definition, and patient demographics are not described in the abstract, precluding assessment of internal and external validity. 9. Funding source is not reported, and potential conflicts of interest cannot be assessed. 10. The MOTOmed-based unconscious proprioception training protocol is novel and not standardized, limiting reproducibility. __BOTTOM_LINE_CATEGORY__ not_ready_for_clinical_application __BOTTOM_LINE__ This three-arm RCT examined whether adding balance acupuncture and/or unconscious proprioception training (dual-task MOTOmed protocol) to conventional rehabilitation improves gait, balance, and SEBT outcomes in CAI, but the abstract is truncated and no results are available for clinical appraisal. Clinicians should await publication of the full manuscript before drawing any conclusions about incremental benefit of these adjuncts. The study design and novel proprioception training approach are of interest to orthopedic rehabilitation practice, but current evidence from this trial cannot inform or change practice.