Is Physiotherapy Effective in Improving Balance and Gait in Patients with Multiple Sclerosis?: A Systematic Review

Abstract

Objective: The purpose of this systematic review was to determine whether physiotherapy was effective in improving balance and gait in patients with multiple sclerosis (MS). Material and Methods: Medically stable MS patients above the age of 18 years who were diagnosed by a neurologist and had balance and/or gait problems were included in this study. The studies involving all types of physiotherapy approaches (i.e. functional exercise, resistive exercise, treadmill training, physical therapy using training with equipment, electrotherapy) were incorporated and interpreted in this systematic review. Results: Nine randomized controlled trials (RCTs) met the inclusion criteria. Three studies included neurophysiological approaches, three studies performed resistive exercises, one study used treadmill training, one study used electrotherapy and one study used pressure splint application in their therapy protocols. Amongst the physiotherapy methods, strong evidence was suggested that neurophysiological approaches were effective in improving gait (functional and temporal-spatial gait parameters), as well as static balance and, moderate evidence was found for improving dynamic balance. Conflicting evidence was found for the effects of other physiotherapy methods (i.e. resistive exercises, treadmill training, whole-body vibration and pressure splint application) in the improvement of balance and gait in patients with MS. Conclusion: This systematic review revealed that physiotherapy interventions, particularly neurophysiological approaches and in some extend resistive exercises, treadmill training, whole-body vibration and pressure splint application can be effective in improving balance and gait in patients with MS. None of the RCTs included in this study defined any detrimental changes after physiotherapy interventions. However, currently the proofs are not convincing to draw an evidence-based program in the treatment of balance and gait problems in patients with MS.