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Azizian M, Yalfani A, Gholami-Borujeni B. Comparing the Effect of Combined and Conventional Rehabilitation Protocols on Psychological Indicators in People With Chronic Ankle Instability: A Systematic Review. PTJ 2025; 15 (4) :255-264
URL: http://ptj.uswr.ac.ir/article-1-675-fa.html

Purpose: Lateral ankle sprains (LAS) have been documented to be one of the most common types of musculoskeletal injuries. Approximately 40% of individuals with LAS are susceptible to reinjuries, which can cause chronic ankle instability (CAI). CAI causes a decrease in physical activity levels and psychological indicators, which are crucial aspects of rehabilitation. Some rehabilitation protocols have been approved to improve this factor; however, the effectiveness of these protocols in improving psychological indicators requires further investigation. The present study aimed to systematically review the impact of different rehabilitation protocols on psychological indicators in patients with CAI. 
Methods: This systematic review was conducted according to the guidelines provided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. The PICOS framework (participant, intervention, comparator, outcome, and study design) was applied to include or exclude the studies. The 11-item PEDro scale was utilized to measure the quality of the selected studies. Seven studies were selected for review. 
Results: Seven studies were included out of the initial 388 manuscripts retrieved, comparing four studies that combined data and three studies that followed the conventional protocol. The results of the present study showed that multimodal, or combined, rehabilitation is more effective than conventional rehabilitation protocols for improving the physical and psychological indicators of CAI patients. 
Conclusion: Conventional programs (e.g. balance, strength, and proprioceptive training) may not be sufficient to improve physical and psychological indicators. Rehabilitation specialists are advised to add psychological exercises to the conventional protocol to simultaneously involve the CNS and musculoskeletal system in the rehabilitation program for CAI patients.