Efficacy of conservative intervention for kinesiophobia in individuals with a history of ankle sprain: A systematic review.

Only five trials met the criteria, and each used a different intervention and comparison, so no finding could be checked against a second study. Both positive results come from single trials. No trial was at low risk of bias. Three had some concerns and two were at high risk, both high-risk trials because of the way patients were assigned to groups, and every trial raised concerns about whether the results reported matched what had been planned. Blinding is not realistic for exercise or hands-on treatment, which the authors say contributed to the risk of bias. Nobody has worked out how much change on these fear scales matters to patients with a previous ankle sprain or chronic ankle instability, so it is unclear whether the improvements that were found are clinically meaningful. Interventions varied in type and length, so the review could not tell whether longer programmes work better. Only articles published in English were included, which the authors say may have skewed the picture. The trials were in young adults, with mean ages between 20.6 and 24.8 years, so this says nothing about older patients.

The review was funded by a Japanese government research grant through the Japan Society for the Promotion of Science (Grant Number 23K10511). The authors declared no competing interests. The paper does not say whether the funder had any role in the review.

Do not read this as evidence that either intervention works. Each positive result came from a single trial, no trial in the review was free of the problems that bias results, the studies were too different to combine, and no one has established how much change on these fear scales matters to patients. Note too that the largest trial, which supplied most of the 616 patients, measured fear of injury rather than the Tampa Scale or the FABQ.