{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T17:42:56Z","timestamp":1789494176152,"version":"build-2803163510"},"reference-count":49,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Mhealth Uhealth"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Functional rehabilitation is commonly used for patients with chronic ankle instability (CAI). Digital training (DT) systems have become increasingly popular in postoperative rehabilitation; however, their effectiveness for CAI patients after modified Brostrom surgery (MBS) is uncertain. Furthermore, specialized physiotherapy resources for CAI are limited in some regions, highlighting the need for effective digital home-based rehabilitation alternatives.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This trial aimed to evaluate whether individually tailored physiotherapeutic ankle-specific training (PAST) delivered via a DT system is noninferior to conventional face-to-face physiotherapy in clinical outcomes and to compare their cost-effectiveness in CAI patients following MBS in China.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a 2-arm, single-blinded (assessor), noninferiority randomized controlled trial at a tertiary hospital in Shanghai, China, from January 2022 to January 2024. A total of 84 postsurgery CAI patients were randomly assigned to a DT group (n=42), which received a 12-week individualized PAST program via a digital system, or a physiotherapy group (n=42), which received standard face-to-face physiotherapy for 12 weeks. Assessments were performed at baseline, 12 weeks, and 24 weeks postoperatively. The primary outcomes were 2 subscales of the Foot and Ankle Ability Measure, with a noninferiority margin of 8 points for Foot and Ankle Ability Measure\u2014Activities of Daily Living (FAAM-ADL) and 9 points for Foot and Ankle Ability Measure\u2014Sports (FAAM-S). Secondary outcomes included balance tests (time-in-balance, foot-lift, and star excursion balance), functional tests (ankle dorsiflexion range of motion, side-hop, and figure-8 hop), and quality of life (FAAM questionnaire). We also collected intervention costs to evaluate cost-effectiveness. Statistical analyses included between-group comparisons of outcomes and nonparametric bootstrapping to calculate incremental cost-effectiveness ratios.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Baseline characteristics were similar between groups (except for a difference in foot-lift test performance). By the 24-week follow-up, improvements in the primary outcomes were comparable between the DT and physiotherapy groups, with adjusted between-group differences of 0.36 (95% CI \u22121.01 to 1.72) for FAAM-ADL and 1.67 (95% CI \u22120.61 to 3.96) for FAAM-S. These differences fell within the predefined noninferiority margins, demonstrating noninferiority of the digital program. No significant between-group differences were observed in secondary outcomes (all\n P<\/jats:italic>\n >.05). The average cost per patient was lower in the DT group (CNY 53,551; an exchange rate of US $1=CNY 7 was applied) than in the physiotherapy group (CNY 59,372), yielding an incremental cost of CNY \u221214,451 in favor of the digital intervention. The bootstrapped incremental cost-effectiveness ratios were CNY \u221216,396 for FAAM-ADL and CNY \u2212114,131 for FAAM-S, indicating that DT was more cost-effective.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Individually tailored PAST delivered via a DT system was found to be clinically noninferior to conventional face-to-face physiotherapy and more cost-effective, supporting its use as a viable rehabilitation alternative for CAI patients after MBS.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/78307","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:09Z","timestamp":1762300809000},"page":"e78307-e78307","source":"Crossref","is-referenced-by-count":2,"title":["Digital Physiotherapeutic Ankle-Specific Training System for Patients With Chronic Ankle Instability Following Modified Brostrom Surgery: Noninferiority Randomized Controlled Trial at a Tertiary Grade A Trauma Center in China"],"prefix":"10.2196","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4094-2778","authenticated-orcid":false,"given":"Xiang","family":"Geng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5743-3943","authenticated-orcid":false,"given":"Yilin","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0114-8376","authenticated-orcid":false,"given":"Xu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1966-7318","authenticated-orcid":false,"given":"Xin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8526-0723","authenticated-orcid":false,"given":"Yiming","family":"Lyu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5313-2902","authenticated-orcid":false,"given":"Shengdi","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7860-2413","authenticated-orcid":false,"given":"Xin","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"issue":"2","key":"R1","first-page":"311","volume":"42","author":"Hootman","journal-title":"J Athl Train"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","DOI":"10.1186\/s13047-021-00480-w","article-title":"The epidemiology of chronic ankle instability with perceived ankle instability- a systematic review","volume":"14","author":"Lin","journal-title":"J Foot Ankle Res"},{"issue":"6","key":"R3","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1177\/1941738116659639","article-title":"Incidence and cost of ankle sprains in United States emergency departments","volume":"8","author":"Shah","journal-title":"Sports Health"},{"issue":"6","key":"R4","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1177\/036354658601400606","article-title":"Treatment of ankle sprains in young athletes","volume":"14","author":"Smith","journal-title":"Am J Sports Med"},{"issue":"4","key":"R5","first-page":"364","volume":"37","author":"Hertel","journal-title":"J Athl Train"},{"issue":"5","key":"R6","doi-asserted-by":"publisher","first-page":"361","DOI":"10.2165\/00007256-200029050-00005","article-title":"Functional instability following lateral ankle sprain","volume":"29","author":"Hertel","journal-title":"Sports Med"},{"issue":"4","key":"R7","first-page":"512","volume":"37","author":"Tropp","journal-title":"J Athl Train"},{"issue":"3","key":"R8","doi-asserted-by":"publisher","first-page":"343","DOI":"10.3113\/FAI.2007.0343","article-title":"Contributing factors to chronic ankle instability","volume":"28","author":"Hubbard","journal-title":"Foot Ankle Int"},{"issue":"3","key":"R9","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/j.fas.2020.11.001","article-title":"Lateral augmentation reconstruction system versus modified Brostrom-Gould procedure: a meta-analysis of RCTs","volume":"27","author":"Lei","journal-title":"Foot Ankle Surg"},{"key":"R10","unstructured":"China to promote rehabilitation and assistive products industry. The State Council of the People\u2019s Republic of China. Oct 27, 2016. URL: https:\/\/english.www.gov.cn\/policies\/latest_releases\/2016\/10\/27\/content_281475476503586.htm [Accessed 20-11-2025]"},{"issue":"1","key":"R11","doi-asserted-by":"publisher","DOI":"10.2196\/10342","article-title":"Feasibility and patient experience of a home-based rehabilitation program driven by a tablet app and mobility monitoring for patients after a total hip arthroplasty","volume":"7","author":"Hoogland","journal-title":"JMIR mHealth uHealth"},{"issue":"1","key":"R12","doi-asserted-by":"publisher","DOI":"10.2196\/14139","article-title":"Effectiveness of a home-based rehabilitation program after total hip arthroplasty driven by a tablet app and remote coaching: nonrandomized controlled trial combining a single-arm intervention cohort with historical controls","volume":"7","author":"Wijnen","journal-title":"JMIR Rehabil Assist Technol"},{"issue":"1","key":"R13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.31083\/jomh.2021.142","article-title":"The effect of center-based versus home-based training for rehabilitation of chronic ankle instability in recreational athletes","volume":"18","author":"Jiang","journal-title":"J Mens Health"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1016\/j.msksp.2025.103327","article-title":"The effect of tele-rehabilitation under a comprehensive exercise program on the function of patients with chronic ankle instability: a randomized controlled trial","volume":"78","author":"Yang","journal-title":"Musculoskelet Sci Pract"},{"issue":"14","key":"R15","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.2106\/JBJS.N.01066","article-title":"In-home telerehabilitation compared with face-to-face rehabilitation after total knee arthroplasty: a noninferiority randomized controlled trial","volume":"97","author":"Moffet","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"R16","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1053\/j.jfas.2012.10.004","article-title":"Outcomes of the modified Brostrom procedure using suture anchors for chronic lateral ankle instability--a prospective, randomized comparison between single and double suture anchors","volume":"52","author":"Cho","journal-title":"J Foot Ankle Surg"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1186\/1749-799X-4-41","article-title":"Treatment of chronic lateral ankle instability: a modified Brostr\u00f6m technique using three suture anchors","volume":"4","author":"Li","journal-title":"J Orthop Surg Res"},{"issue":"3","key":"R18","first-page":"235","volume":"51","author":"Shahrulazua","journal-title":"Singapore Med J"},{"issue":"11","key":"R19","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1177\/107110070502601113","article-title":"Evidence of validity for the Foot and Ankle Ability Measure (FAAM)","volume":"26","author":"Martin","journal-title":"Foot Ankle Int"},{"issue":"2","key":"R20","doi-asserted-by":"publisher","first-page":"179","DOI":"10.4085\/1062-6050-43.2.179","article-title":"Validity of the Foot and Ankle Ability Measure in athletes with chronic ankle instability","volume":"43","author":"Carcia","journal-title":"J Athl Train"},{"issue":"5","key":"R21","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1249\/MSS.0000000000000859","article-title":"Sensory-targeted ankle rehabilitation strategies for chronic ankle instability","volume":"48","author":"McKeon","journal-title":"Med Sci Sports Exerc"},{"issue":"1","key":"R22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1123\/jsr.2015-0045","article-title":"Effects of a 4-week biomechanical ankle platform system protocol on balance in high school athletes with chronic ankle instability","volume":"26","author":"Cain","journal-title":"J Sport Rehabil"},{"issue":"1","key":"R23","doi-asserted-by":"publisher","first-page":"15","DOI":"10.4085\/1062-6050-48.6.09","article-title":"Postural-stability tests that identify individuals with chronic ankle instability","volume":"49","author":"Linens","journal-title":"J Athl Train"},{"issue":"3","key":"R24","doi-asserted-by":"publisher","first-page":"339","DOI":"10.4085\/1062-6050-47.3.08","article-title":"Using the star excursion balance test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review","volume":"47","author":"Gribble","journal-title":"J Athl Train"},{"issue":"2","key":"R25","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1123\/jsr.9.2.104","article-title":"Intratester and intertester reliability during the star excursion balance tests","volume":"9","author":"Hertel","journal-title":"J Sport Rehabil"},{"issue":"3","key":"R26","doi-asserted-by":"publisher","first-page":"131","DOI":"10.2519\/jospt.2006.36.3.131","article-title":"Simplifying the star excursion balance test: analyses of subjects with and without chronic ankle instability","volume":"36","author":"Hertel","journal-title":"J Orthop Sports Phys Ther"},{"issue":"3","key":"R27","first-page":"279","volume":"7","author":"Konor","journal-title":"Int J Sports Phys Ther"},{"issue":"1","key":"R28","first-page":"30","volume":"40","author":"Docherty","journal-title":"J Athl Train"},{"issue":"6","key":"R29","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1016\/j.jval.2015.05.009","article-title":"The iMTA productivity cost questionnaire: a standardized instrument for measuring and valuing health-related productivity losses","volume":"18","author":"Bouwmans","journal-title":"Value Health"},{"issue":"10","key":"R30","doi-asserted-by":"publisher","first-page":"1152","DOI":"10.1001\/jama.295.10.1152","article-title":"Reporting of noninferiority and equivalence randomized trials: an extension of the CONSORT statement","volume":"295","author":"Piaggio","journal-title":"JAMA"},{"issue":"5","key":"R31","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1093\/ptj\/pzx021","article-title":"Telephone-delivered exercise advice and behavior change support by physical therapists for people with knee osteoarthritis: protocol for the TELECARE randomized controlled trial","volume":"97","author":"Hinman","journal-title":"Phys Ther"},{"issue":"7048","key":"R32","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1136\/bmj.313.7048.36","article-title":"Trials to assess equivalence: the importance of rigorous methods","volume":"313","author":"Jones","journal-title":"BMJ"},{"issue":"1","key":"R33","doi-asserted-by":"publisher","first-page":"39","DOI":"10.3109\/17453674.2013.867782","article-title":"Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty (THA) patients 1 year postoperatively","volume":"85","author":"Paulsen","journal-title":"Acta Orthop"},{"key":"R34","unstructured":"Circular on the average wages of employed persons in full-caliber urban units in the city in 2022 [article in chinese]. Shanghai Municipal Bureau of Human Resources and Social Security; 2022. URL: https:\/\/m12333.cn\/policy\/mpzsa.html [Accessed 20-11-2025]"},{"issue":"4","key":"R35","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1016\/s0891-8422(02)00023-x","article-title":"Diagnosis and treatment of ankle pain with the use of arthroscopy","volume":"19","author":"Seeber","journal-title":"Clin Podiatr Med Surg"},{"issue":"2","key":"R36","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1136\/bjsm.35.2.103","article-title":"Ankle injuries in basketball: injury rate and risk factors","volume":"35","author":"McKay","journal-title":"Br J Sports Med"},{"issue":"3","key":"R37","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1177\/0363546504268137","article-title":"Intrinsic risk factors for inversion ankle sprains in male subjects: a prospective study","volume":"33","author":"Willems","journal-title":"Am J Sports Med"},{"issue":"5","key":"R38","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1111\/j.1600-0838.2004.00428.x","article-title":"Intrinsic risk factors for inversion ankle sprains in females \u2013 a prospective study","volume":"15","author":"Willems","journal-title":"Scandinavian Med Sci Sports"},{"issue":"3","key":"R39","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1590\/S1413-35552006000300005","article-title":"N\u00edvel de atividade f\u00edsica, dor e edema e suas rela\u00e7\u00f5es com a disfun\u00e7\u00e3o muscular do joelho de idosos com osteoartrite [Article in Portuguese]","volume":"10","author":"Zacaron","journal-title":"Rev bras fisioter"},{"issue":"6","key":"R40","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1093\/geront\/46.6.801","article-title":"Long-term impact of Fit and Strong! on older adults with osteoarthritis","volume":"46","author":"Hughes","journal-title":"Gerontologist"},{"issue":"2","key":"R41","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1002\/acr.20642","article-title":"Long-term outcomes and costs of an integrated rehabilitation program for chronic knee pain: a pragmatic, cluster randomized, controlled trial","volume":"64","author":"Hurley","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"1","key":"R42","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-41671-8","article-title":"Technology-based balance performance assessment can eliminate floor and ceiling effects","volume":"13","author":"Forero","journal-title":"Sci Rep"},{"issue":"2","key":"R43","doi-asserted-by":"publisher","first-page":"404","DOI":"10.26603\/001c.21150","article-title":"The impact of dance-specific neuromuscular conditioning and injury prevention training on motor control, stability, balance, function and injury in professional ballet dancers: a mixed-methods quasi-experimental study","volume":"16","author":"Long","journal-title":"Int J Sports Phys Ther"},{"issue":"6","key":"R44","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.86664","article-title":"Optimizing ankle sprain management in primary care: a randomized trial of telerehabilitation added to usual care","volume":"17","author":"Figueroa-Garc\u00eda","journal-title":"Cureus"},{"issue":"1","key":"R45","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1089\/tmr.2025.0010","article-title":"Cost-effectiveness analysis of adding telerehabilitation to standard care for ankle sprains compared with standard care alone","volume":"6","author":"Figueroa-Garc\u00eda","journal-title":"Telemed Rep"},{"issue":"3","key":"R46","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1002\/acr.22164","article-title":"Expert consensus on best practices for post-acute rehabilitation after total hip and knee arthroplasty: a Canada and United States Delphi study","volume":"66","author":"Westby","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"1","key":"R47","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1093\/rheumatology\/keh399","article-title":"Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee--the MOVE consensus","volume":"44","author":"Roddy","journal-title":"Rheumatology (Oxford)"},{"issue":"2","key":"R48","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/s0004-9514(14)60205-1","article-title":"Hospital stay and discharge outcomes after knee arthroplasty: implications for physiotherapy practice","volume":"48","author":"Oldmeadow","journal-title":"Aust J Physiother"},{"key":"R49","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007099","article-title":"Post-acute physiotherapy for primary total knee arthroplasty","author":"Westby","journal-title":"Cochrane Database Syst Rev"}],"container-title":["JMIR mHealth and uHealth"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/mhealth.jmir.org\/2025\/1\/e78307","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:10:52Z","timestamp":1782843052000},"score":1,"resource":{"primary":{"URL":"https:\/\/mhealth.jmir.org\/2025\/1\/e78307"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,18]]},"references-count":49,"URL":"https:\/\/doi.org\/10.2196\/78307","relation":{},"ISSN":["2291-5222"],"issn-type":[{"value":"2291-5222","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,18]]},"article-number":"v13i2e78307"}}