Article

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.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS