Effect of biofeedback on plantar pressure in individuals with chronic ankle instability: a systematic review and meta-analysis

Biofeedback may alter the plantar pressure in patients with chronic ankle instability (CAI). To systematically review the literature on the effect of gait-training and biofeedback on plantar pressure in individuals with CAI and conduct a meta-analysis. In this ystematic review and Meta-analysis four databases including PubMed, Web of Science, Scopus and Embase were searched from inception to ۳۰th June ۲۰۲۲. Two reviewers screened studies to identify studies reporting the effect of biofeedback on plantar pressure in individuals with CAI. The PEDro and Downs and Black appraisal scale were applied to assess quality of included studies. A meta-analysis was conducted provided that at least two studies with similar methodology reported the same factor. Thirteen studies with a total of ۲۲۶ participants were included. The study design of included studies were ۲ experimental studies and ۵ observational studies. The PEDRO score was fair for ۶ studies and high for ۱ RCT. The results showed that biofeedback was capable of shifting lateral plantar pressure medially and reducing peak pressure and pressure time integral in the lateral midfoot and forefoot. The meta-analyses revealed the evidence that visual biofeedback reduces peak pressure in lateral midfoot and pressure time integral at lateral and medial heel and increases under hallux. Biofeedback can alter plantar pressure in individuals with CAI. Auditory biofeedback had better impact on modifying plantar pressure in individuals with CAI. Further studies are required to assess the prolonged effect and clinical consequences of biofeedback or a combination of feedbacks in different age groups. Moreover, invention of a low-cost and user-friendly device, which effectiveness is evaluated in high quality RCTs, seems essential, before this intervention can be implemented in the clinical setting.