Abstract
Objectives
To evaluate the effectiveness of interventions in reducing falls and/or improving
balance as a falls risk in multiple sclerosis (MS).
Data Sources
Computer-based and manual searches included the following medical subject heading
keywords: “Multiple Sclerosis AND accidental falls” OR “Multiple Sclerosis AND postural
balance” OR “Multiple Sclerosis AND exercise” OR “Multiple Sclerosis AND physical/physio
therapy” NOT animals. All literature published to November 2014 with available full-text
details were included.
Study Selection
Studies were reviewed against the PICO (participants, interventions, comparisons,
outcomes) selection criteria: P, adults with MS; I, falls management/balance rehabilitation
interventions; C, randomized/quasi-randomized studies comparing intervention with
usual care or placebo control; O, falls outcomes and measures of balance. Fifteen
articles of the original 529 search results were included.
Data Extraction
Two reviewers independently extracted data and assessed methodological quality using
the Cochrane Risk of Bias tool.
Data Synthesis
Random-effects meta-analysis indicated a small decrease in falls risk (risk ratio,
.74), although the 95% confidence interval (CI) crossed 1 (95% CI, .12–4.38). The
pooled standardized mean difference (SMD) for balance outcomes was .55 (95% CI, .35–.74).
SMD varied significantly between exercise subgroupings; gait, balance, and functional
training interventions yielded the greatest pooled effect size (ES) (SMD=.82; 95%
CI, 0.55–1.10). There was a moderate positive correlation between program volume (min/wk)
and ES (Cohen's d) (r=.70, P=.009), and a moderate negative correlation between program duration in weeks and
ES (r=−.62, P=.03). Variations in interventions and outcomes and methodological limitations mean
that results must be viewed with caution.
Conclusions
This review suggests that balance may improve through exercise interventions, but
that the magnitude of the improvements achieved in existing programs may not be sufficient
to impact falls outcomes. Supporting participants to achieve an appropriate intensity
of practice of highly challenging balance activities appears to be critical to maximizing
effectiveness.
Keywords
List of abbreviations:
ACSM (American College of Sports Medicine), BBS (Berg Balance Scale), CI (confidence interval), EDSS (Expanded Disability Status Scale), MS (multiple sclerosis), RR (risk ratio), SMD (standardized mean difference)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 09, 2015
Footnotes
Supported by the Multiple Sclerosis Society in the UK (grant no. 990).
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
