Background: Lateral ankle sprains (LAS) are among the most common musculoskeletal injuries globally. Although international frameworks such as the Rehabilitation-Oriented Assessment Tool (ROAST) and Ankle-GO provide structured approaches for LAS assessment and return-to-sport (RTS) evaluation, their implementation in Sweden has not been investigated.
Methods: A cross-sectional online survey was distributed to registered Swedish physiotherapists managing patients with LAS. The survey assessed adherence to the original ROAST, as well as modified versions of the frameworks (ROASTmodified and Ankle-GOmodified). Additionally, physiotherapists' self-rated confidence in their methods was assessed to explore potential discrepancies between perceived competence and framework adherence. Descriptive and inferential statistics were used to analyse associations between reported assessment practices and physiotherapists' workplace location, educational level, and clinical experience.
Results: A total of 124 physiotherapists responded. Most (87.1%) reported using fewer than 50% of ROAST criteria, while 48.4% met at least 50% of ROASTmodified criteria. Adherence was significantly higher among those working in urban areas (p = 0.032), with no significant differences based on educational level or years of clinical experience. Regarding RTS, 36.7% of physiotherapists applied methods aligned with Ankle-GOmodified, but only 6.5% regularly used patient-reported outcome measures (PROMs) in this context. The most commonly used assessment domains were gait pattern, range of motion, and muscle strength, while PROMs and physical activity level were rarely included.
Conclusions: Adherence to international frameworks for LAS assessment was generally low among Swedish physiotherapists, but higher when modified versions were applied. Urban-based physiotherapists reported higher adherence compared to their rural counterparts, while educational level and experience had little influence. A discrepancy between perceived confidence and actual adherence suggests a gap between self-assessed competence and implementation.
Objective: Global aging has increased the risk of falls and functional dependence among elderly people. Aquatic exercise, with its low-impact and multimuscle group activation characteristics, provides a unique physiological stimulation environment for improving the physical functions of the elderly population. However, previous studies have insufficiently integrated multidimensional functional indicators and dose-effect relationships. In this study, a meta-analysis was conducted to systematically evaluate the effects of aquatic exercise on the multidimensional physical functions of elderly people and to determine the differential effects of different intervention programs.
Methods: Databases in both Chinese and English were searched up to April 2025, and 23 RCTs (1179 healthy elderly individuals aged ≥ 60 years) were included. The Cochrane tool was used to assess the risk of bias, and data on intervention programs (type, duration, frequency) and functional indicators were extracted. RevMan 5.4 was used to combine effect sizes (MD and 95% CI), and subgroup analysis was conducted to explore the sources of heterogeneity (I2 > 75%).
Results: (1) Balance ability: Static balance improved (single-leg standing time: MD = 3.05 s, P = 0.007); dynamic balance improved (TUG time reduced by 0.59 s, P = 0.028), with resistance training having the greatest effect (MD = -1.80 s, P = 0.006); and a higher frequency intervention (> 2 times/week) was more effective. (2) Muscle strength: Lower limb strength increased (30-s chair stand test increased by 2.77 times, P < 0.001), with combined resistance and aerobic training having the greatest effect (MD = 3.98 times, P < 0.001); upper limb strength increased (arm curl test increased by 3.17 times, P < 0.001). (3) Cardiopulmonary function: The 2MST increased 7.56 times (P < 0.001). (4) Flexibility: Lower limb flexibility improved by 3.21 cm (P = 0.024), whereas upper limb flexibility did not significantly improve. (5) Subgroup analysis revealed that long-term (> 12 weeks) and high-frequency (> 2 times/week) interventions were more effective for improving dynamic balance (MD = -0.87 vs. -0.34 s) and increasing lower limb strength (MD = 5.65 vs. 1.45 times); combined resistance and aerobic training had significant overall benefits.
Conclusion: Aquatic exercise can comprehensively improve the physical function of elderly people. High-frequency (> 2 times/week) and long-term (> 12 weeks) combined resistance and aerobic training programs are recommended. Clinically, task-oriented interventions should be designed on the basis of individual deficits, and future research should standardize exercise parameters and explore its psychological and social benefits.
Background: Patients with fibromyalgia syndrome (FMS) often exhibit poor health and reduced physical function. Exercise interventions can effectively alleviate symptoms and improve function. This study aims to systematically evaluate and compare the efficacy of different exercise interventions on the key clinical outcomes to identify the most effective modality and inform evidence-based exercise recommendations for patients with FMS.
Methods: This study conducted a systematic search of four databases: PubMed, Embase, the Cochrane Library, and Web of Science. The primary outcome measures included health status, pain intensity, the number of tender points (TP), and aerobic capacity. Stata 15.0 and R software were used for network meta-analysis (NMA), and the effect size and its 95% confidence interval were calculated using a random-effects model. The methodological quality of the included studies was assessed using the Cochrane RoB 2.0 tool and the TESTEX scale.
Results: Stretching combined with balance training resulted in the greatest improvement in health status (MD = - 25.13; 95% CI [- 33.81, - 16.44]). For other symptom-related outcomes, aerobic exercise (AE) combined with strength and stretching showed the highest probability of alleviating pain intensity (MD = - 3.61; 95% CI [- 4.40, - 2.82]). AE alone was most effective in reducing the number of tender points (MD = - 2.28; 95% CI [- 3.57, - 1.00]), while whole-body vibration (WBV) produced the largest enhancement in aerobic capacity (MD = 55.0; 95% CI [26.14, 83.75]).
Conclusions: Stretching combined with balance training was found to be most effective in improving health status. AE combined with strength training and stretching demonstrated the greatest efficacy in reducing pain intensity, while AE was most effective in decreasing the number of tender points. WBV appeared to provide the largest improvement in aerobic capacity in patients with FMS. These findings suggest that healthcare providers should combine AE, strength, stretching, balance, WBV, and other exercises based on the individual circumstances of patients with FMS, while further high-quality RCTs are warranted to confirm these results and to standardize exercise protocols.
Trial registration: CRD420251036473.
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