Mobility and balance rehabilitation in multiple sclerosis: A systematic review and dose-response meta-analysis

Corrini, Chiara; Gervasoni, Elisa; Perini, Gloria; Cosentino, Carola; Putzolu, Martina; Montesano, Angelo; Pelosin, Elisa; Prosperini, Luca; Cattaneo, Davide

doi:10.1016/j.msard.2022.104424

Cited by 18 publications

(21 citation statements)

References 111 publications

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“…In addition, we expected that a greater number of available sessions would influence the physiotherapist's decision to select a restorative approach, as the time spent in rehabilitation should result in an increased therapy dosage (31,32). The lack of association between the number of sessions and the restorative approach may be due to a lack of strong evidence supporting a dose-response effect in PwNDs (33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

Factors influencing physiotherapy decisions between restorative and compensatory gait rehabilitation: an Italian multicenter study

Mestanza Mattos,

Bowman,

Marazzini

et al. 2024

Front. Neurol.

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Background and purposeThis study aimed to investigate the factors that influence physiotherapists’ decision in choosing restorative or compensatory rehabilitation during gait training in people with neurological disorders (PwNDs) and the different treatments used in the approaches.MethodsThis cross-sectional analysis used the baseline data from an observational cohort study. We analyzed data from 83 PwNDs (65 people after stroke, 5 with multiple sclerosis, and 13 with Parkinson’s disease) who underwent at least 10 sessions of physiotherapy (PT) focusing on gait function. Performance was quantified using the modified Dynamic Gait Index (MDGI), three impairment domains of Fugl–Meyer Assessment for lower extremity (mFM-LL), Activities-specific Balance Confidence (ABC), modified Barthel Index (mBI), Mini-Mental State Examination (MMSE), and Motivational Index (MI). Forty-three physiotherapists completed a treatment report form categorizing the rehabilitation approach and specifying treatments used (e.g., resistance training and proprioceptive exercises).ResultsFifty-six subjects underwent restorative rehabilitation approach. The univariate predictors of restorative approach were being in the subacute phase with a disease onset of less than 180 days, (odds ratio [95%CI]; 3.27[1.19–9.24]), mFM-LL (1.25[1.11–1.44]), MMSE (0.85[0.67–1.00]), and number of sessions (1.03[1–1.01]). The backward stepwise analysis revealed an association between restorative and subacute phase (36.32[4.11–545.50]), mFM-LL (3.11[1.55–9.73]), mBI (1.79[1.08–3.77]), MMSE (0.46[0.25–0.71]), and the interaction between mFM-LL and mBI (0.99[0.98–1.00]). No statistically significant association between treatments used and approach was found (p = 0.46).Discussion and conclusionThe restorative approach was more commonly used to improve gait. The main variables associated with this approach were: being in the subacute phase of the disease, a low level of impairment, and a high level of functional independence at baseline. However, few differences were found between the treatments used for the restorative or compensatory approaches, as similar PT treatments were used for both.

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Section: Discussionmentioning

confidence: 99%

Factors influencing physiotherapy decisions between restorative and compensatory gait rehabilitation: an Italian multicenter study

Mestanza Mattos,

Bowman,

Marazzini

et al. 2024

Front. Neurol.

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“…Systematic reviews of conventional balance rehabilitation regimens have documented balance and gait performance improvement in older adults [5] and individuals with stroke [6], Parkinson's disease [7], traumatic brain injury [8], and multiple sclerosis [9]. Conventional balance rehabilitation regimens, however, often limit or prevent an individual's full participation due to the unavailability of physical therapists, limited access to clinical facilities, reduced accountability, and cost [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review of the Effects of Interactive Telerehabilitation with Remote Monitoring and Guidance on Balance and Gait Performance in Older Adults and Individuals with Neurological Conditions

Park,

Lee

2024

Bioengineering

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Recognizing the growing interests and benefits of technology-assisted interactive telerehabilitation in various populations, the aim of this review is to systematically review the effects of interactive telerehabilitation with remote monitoring and guidance for improving balance and gait performance in older adults and individuals with neurological conditions. The study protocol for this systematic review was registered with the international prospective register of systematic reviews (PROSPERO) with the unique identifier CRD42024509646. Studies written in English published from January 2014 to February 2024 in Web of Science, Pubmed, Scopus, and Google Scholar were examined. Of the 247 identified, 17 were selected after initial and eligibility screening, and their methodological quality was assessed with the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. All 17 studies demonstrated balance and gait performance improvement in older adults and in individuals with stroke, Parkinson’s disease, and multiple sclerosis following 4 or more weeks of interactive telerehabilitation via virtual reality, smartphone or tablet apps, or videoconferencing. The findings of this systematic review can inform the future design and implementation of interactive telerehabilitation technology and improve balance and gait training exercise regimens for older adults and individuals with neurological conditions.

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“…The goal of rehabilitation is to minimize motor impairments while facilitating the activation of new neural pathways. Exercise is considered one of the most effective tools in traditional treatment for loss of balance [ 4 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of transcranial direct current stimulation on balance and gait in patients with multiple sclerosis: systematic review and meta-analysis of randomized clinical trials

Nombela-Cabrera,

Pérez-Nombela,

Avendaño-Coy

et al. 2023

J NeuroEngineering Rehabil

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Background Motor impairments are very common in neurological diseases such as multiple sclerosis. Noninvasive brain stimulation could influence the motor function of patients. Objective The aim of this meta-analysis was to evaluate the effectiveness of transcranial direct current stimulation (tDCS) on balance and gait ability in patients with multiple sclerosis. Additionally, a secondary aim was to compare the influence of the stimulation location of tDCS on current effectiveness. Methods A search was conducted for randomized controlled trials published up to May 2023 comparing the application of tDCS versus a sham or control group. The primary outcome variables were balance and gait ability. Results Eleven studies were included in the qualitative analysis, and ten were included in the quantitative analysis, which included 230 patients with multiple sclerosis. The average effect of tDCS on gait functionality was superior to that of the control group (SMD = -0.71; 95% CI, -1.05 to -0.37). However, the overall results of the tDCS vs. sham effect on static balance did not show significant differences between groups (MD = 1.26, 95% CI, -1.31 to 3.82). No significant differences were found when different locations of tDCS were compared. Conclusions These results reveal that tDCS is an effective treatment for improving gait ability with a low quality of evidence. However, the application of tDCS has no effect on static balance in patients with multiple sclerosis with very low quality of evidence. Similarly, there seems to be no difference regarding the stimulation area with tDCS.

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Mobility and balance rehabilitation in multiple sclerosis: A systematic review and dose-response meta-analysis

Cited by 18 publications

References 111 publications

Factors influencing physiotherapy decisions between restorative and compensatory gait rehabilitation: an Italian multicenter study

Factors influencing physiotherapy decisions between restorative and compensatory gait rehabilitation: an Italian multicenter study

A Systematic Review of the Effects of Interactive Telerehabilitation with Remote Monitoring and Guidance on Balance and Gait Performance in Older Adults and Individuals with Neurological Conditions

Effectiveness of transcranial direct current stimulation on balance and gait in patients with multiple sclerosis: systematic review and meta-analysis of randomized clinical trials

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