The Effectiveness of Physiotherapy Interventions for Mobility in Severe Multiple Sclerosis: A Systematic Review and Meta-Analysis

Abstract

Background. People with Multiple Sclerosis (pwMS) prioritise gait as the most valuable function to be affected by MS. Physiotherapy plays a key role in managing gait impairment in MS. There is little evidence on the effectiveness of physiotherapy for severe MS. Objective. To undertake a systematic review and meta-analysis of the literature to identify evidence for the effectiveness of physiotherapy for gait impairment in severe MS. Methods. The available literature was systematically searched, using a predetermined protocol, to identify research studies investigating a physiotherapy intervention for mobility in people with severe MS ( EDSS ≥ 6.0 ). Data on mobility related endpoints was extracted. Meta-analysis was performed where a given mobility end point was reported in at least 3 studies. Results. 37 relevant papers were identified, which included 788 pwMS. Seven mobility-related endpoints were meta-analysed. Robot-Assisted Gait Training (RAGT) was found to improve performance on the 6-minute walk test, 10-metre walk test, fatigue severity scale, and Berg Balance Scale. Neither body weight supported training nor conventional walking training significantly improved any mobility-related outcomes. Conclusion. Physiotherapy interventions are feasible for mobility in severe MS. There is some evidence for the effectiveness of RAGT.

Can Robotic Gait Training with End Effectors Improve Lower-Limb Functions in Patients Affected by Multiple Sclerosis? Results from a Retrospective Case–Control Study

“…Thus, repetitive movements can serve as a foundational element in the acquisition of motor skills, promoting muscle memory and improving motor coordination. Repetition allows patients to hone specific movements, promoting greater efficiency and precision over time [ 16 ]. This approach is particularly useful in activities that require precise and consistent motor control, such as gait training or fine motor skill development.…”

“…This approach is particularly useful in activities that require precise and consistent motor control, such as gait training or fine motor skill development. Furthermore, the incorporation of strategies during training, such as the presence of obstacles and the diversification of paths, introduces elements of complexity and adaptability to therapeutic sessions [ 16 , 35 ]. These strategies mimic real-world challenges, encouraging patients to engage in problem solving and adapt their movements accordingly.…”

“…Conventional rehabilitation training includes physical exercise, which is a well-known approach to improving cardiorespiratory fitness, muscle strength, flexibility, and balance [ 15 ]. Physiotherapy treatments emphasizing gait training have consistently demonstrated their effectiveness in enhancing gait and mobility, while also mitigating the risk of falls [ 16 ]. However, when patients with MS experience increased difficulties in walking and decreased levels of independence, clinicians must adopt other rehabilitation strategies.…”

Influence of Transcranial Direct Current Stimulation and Exercise on Physical Capacity and Gait in Multiple Sclerosis: A Cross-Over Pilot Study

“…Therefore, a future line of research in MS would be to further study the combination of these therapies to determine whether tDCS can improve the efficacy of treatment. Another difficulty we encounter is the disability of the subjects, so another challenge is to adapt the treatments and clinical recommendations to the different degrees of disability [10,[48][49][50].…”