Effects of physiotherapy interventions on balance in multiple sclerosis: A systematic review and meta-analysis of randomized controlled trials

Abstract

Objective: to determine the effects of physiotherapy inter ventions on balance in people with multiple sclerosis. Data sources: A systematic literature search was conducted in Medline, cinahl, embase, PeDro, both electronically and by manual search up to March 2011. Study selection: Randomized controlled trials of physiothe rapy interventions in people with multiple sclerosis, with an outcome measure linked to the International Classifica tion of Functioning, Disability and Health (icF) category of "changing and maintaining body position", were included. Data extraction: the quality of studies was determined by the van tulder criteria. Metaanalyses were performed in subgroups according to the intervention. Data synthesis: After screening 233 fulltext papers, 11 stud ies were included in a qualitative analysis and 7 in a meta analysis. the methodological quality of the studies ranged from poor to moderate. Low evidence was found for the effi cacy of specific balance exercises, physical therapy based on an individualized problemsolving approach, and resistance and aerobic exercises on improving balance among ambula tory people with multiple sclerosis. Conclusion: These findings indicate small, but significant, effects of physiotherapy on balance in people with multiple sclerosis who have a mild to moderate level of disability. However, evidence for severely disabled people is lacking, and further research is needed.

Do Physical Therapy Interventions Affect Urinary Incontinence and Quality of Life in People with Multiple Sclerosis?

“…13 The rationale is to increase voluntary contraction of the PFMs before events such as coughing to reduce urinary leakage. 11,12 Strengthening of the PFMs is also thought to help prevent adverse perineal movement during intraabdominal pressure changes. 26,27 A possible disadvantage of overtraining the PFMs is an increase in voiding disorders.…”

“…29 Actual evidence of changes in UI for people with MS is needed before advocating PT interventions widely. 11,12 The cost of this condition, financially and in QOL, 3,25 highlights the need for a safe, well-tolerated, and effective long-term treatment that may preclude the need for surgical intervention in people with MS.…”

“…Physical therapy (PT) has proved to be effective in reducing the effects of UI in non-MS populations, but literature is scarce in MS. 11,12 The purpose of this study was to review the existing literature regarding the effectiveness of PT in reducing UI and increasing quality of life (QOL) in people with MS.…”

Exercise Approaches to Ameliorate Fatigue in People with Multiple Sclerosis

“…Among them are approaches that focused on improving balance [64,65]. Indeed, some researches argued that fatigue could be resolved as a result of exercise activities focused on improvement of balance in individuals with MS. For example, it was suggested that when balance is improved, less energy will be spent on maintaining balance to perform various activities, which in turn would help in dealing with fatigue [62].…”

Innovative Physiotherapy and Continuity of Care in People with Multiple Sclerosis: A Randomized Controlled Trial and a Qualitative Study

“…People with multiple sclerosis (MS) frequently present balance and walking disturbances [1], even when disability is minimal [2,3]. Dynamic stability of the trunk, commonly termed "core stability", is one of the fundamental bases for balance and walking [4,5].…”