The effect of adherence to functional stability training on lower-limb injury prevention: A meta-analysis based on intervention type and training dose.

OBJECTIVES

To quantify the effect of functional stability training on lower-limb injury risk in athletes and assess whether programme composition, programme type, weekly frequency, and adherence modify effectiveness.

DESIGN

Systematic review and meta-analysis of randomised and cluster-randomised controlled trials.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and registration in the International Prospective Register of Systematic Reviews (CRD420251166935), we searched PubMed, Web of Science, Scopus, the Cochrane Library, and Embase to June 2025. Eligible trials compared functional stability training with control conditions in athletes. Risk of bias was assessed with the Cochrane Risk of Bias 2.0 tool and certainty with the Grading of Recommendations Assessment, Development and Evaluation approach. Random-effects models pooled risk ratios with 95% confidence intervals. Prespecified subgroup analyses and meta-regression examined effect modification.

RESULTS

Thirty-seven trials (36,385 participants) were included. Functional stability training reduced lower-limb injury risk (risk ratio 0.70, 95% confidence interval 0.63 to 0.78; p < 0.001; I2 = 73%; 95% prediction interval 0.42 to 1.18). Each 10% increase in adherence was associated with a 10% reduction in injury risk. Multicomponent programmes were more effective than single-component programmes (risk ratio 0.67 versus 0.85; p = 0.03), and programmes delivered at least twice weekly were more effective than once weekly. FIFA 11+ and non-FIFA 11+ programmes did not differ. After trim-and-fill adjustment, the pooled effect remained significant. Certainty of evidence was low.

CONCLUSIONS

Functional stability training reduces lower-limb injury risk in athletes, with greater benefit as adherence improves. Multicomponent programmes delivered at least twice weekly appear most effective.