The Effects of Visual Training on Balance and Functional Recovery After Lower Extremity Injuries: A Systematic Review and Meta-analysis.

Abstract

Context: Visual training (VT) is used increasingly in sports rehabilitation to enhance visuomotor integration after lower extremity injuries. However, its effectiveness in improving balance and functional recovery remains unclear, with inconsistent findings across studies.

Objective: To determine whether VT improves balance control and functional recovery in people with lower extremity injuries compared with standard rehabilitation or other active controls.

Data sources: Eight databases (PubMed, Web of Science, Embase, Scopus, MEDLINE, CINAHL, SPORTDiscus, and Cochrane Library) were searched from inception to September 17, 2025.

Study selection: Randomized controlled trials (RCTs) evaluating VT as the primary intervention and reporting balance- or function-related outcomes were included. Of 1186 records screened, 18 RCTs (n = 707) met eligibility criteria.

Study design: Systematic review and meta-analysis of RCTs.

Level of evidence: Level 1.

Data extraction: Data on participant characteristics, intervention protocols, balance outcomes (static and dynamic), and functional outcomes (subjective function, physical function, sport performance) were extracted.

Results: VT improved static balance significantly (standardized mean difference [SMD] = 0.46; 95% CI, 0.10-0.81; P = 0.01) and dynamic balance (SMD = 0.88; 95% CI, 0.31-1.44; P = 0.002). No significant effects were found for subjective functional recovery, physical function, or sport performance. Larger effects were observed in men, chronic ankle instability populations, and with stroboscopic VT.

Conclusion: VT may provide meaningful benefits for balance rehabilitation after lower extremity injuries, especially for dynamic balance. However, it does not enhance subjective function, physical function, or sport performance significantly. Despite its potential as an adjunct to rehabilitation, overall certainty of evidence is very low, highlighting the need for high-quality RCTs with standardized protocols.