Effects of Balance Training Combined With Either Transcranial Direct Current Stimulation or Stroboscopic Vision Training on Balance Performance in Individuals With Chronic Ankle Instability: A Systematic Review and Meta-Analysis.

Abstract

Introduction: Despite the benefits of balance training, persistent postural deficits remain common in individuals with Chronic Ankle Instability (CAI). The aim of this study investigates the efficacy of Stroboscopic Vision Training (SVT) and transcranial Direct Current Stimulation (tDCS) as adjunct modalities to improve balance in this population.

Methods: This review was developed in accordance with the PRISMA checklist. Five electronic databases (Web of Science, Scopus, PubMed, EBSCO, and Embase) along with three supporting search platforms and libraries (ScienceDirect, Cochrane Library, and Google Scholar) were searched from inception to June 20, 2026. Study quality was assessed using the PEDro scale, risk of bias with the RoB 2 tool, and the overall quality of evidence with GRADE. A meta-analysis of the review was conducted using Comprehensive Meta-Analysis v.3.0 software.

Results: Ten studies including 353 participants were included in this review. The meta-analytic results indicated that the effect sizes were 0.326 for static balance (tDCS = 0.303, SVT = 2.131) and 0.364 for dynamic balance (tDCS = 0.252, SVT = 1.086). The quality of the studies was high in the tDCS group and moderate in the SVT group. The risk of bias was higher in the SVT studies. The overall quality of the evidence was moderate in static balance and low in dynamic balance.

Conclusions: Although both interventions show promise, the higher risk of bias in SVT studies suggests that tDCS is the preferred approach for rehabilitation when conditions are comparable. Nonetheless, clinical decisions should remain personalized.

Trial registration: PROSPERO with the number CRD420251260339.