Investigating the effects of core stability training on balance and gait in people with multiple sclerosis: A systematic review and meta-analysis

Background and objectives: Balance disorders are a common concern in people with multiple sclerosis (PwMS). Core stability exercises are recommended as one of the treatment principles of rehabilitation in patients with balance disorders. This systematic review and meta-analysis investigate the effects of core stabilization exercises (CSE) on balance in PwMS. Methods: Online databases were searched from 1980 to December 15, 2022, including PubMed/Medline, Scopus, Web of Science, CINAHL, PEDro, Embase, and ProQuest to identify randomized controlled trials (RCTs) investigating the effects of CSE on balance in PwMS. The methodological qualities of the included studies were assessed using the modified Cochrane risk bias tool for randomized trials. Random-effect meta-analyzes were performed on the Berg balance test and Biodex balance system outcomes. Results: Seven RCTs were included in this study. A total of 379 patients (EDSS <6) were enrolled in the included studies. All researchers had applied CSE within six to ten weeks with the frequency of two to three sessions/week. According to qualitative results, core stability exercise significantly changes the most balanced outcomes. The meta-analyses illustrated that allocated participants to experimental groups had statistically significantly higher Berg balance test scores (standardized mean difference: 1.1; 95 % CI: [0.1, 2.11) and insignificant lower Biodex score (standardized mean difference: -0.59; 95 % CI: [-1.09, -0.091) compared to the control groups. Conclusion: Six to ten weeks of CSEs is an effective therapeutic strategy for balance improvement in PwMS that can help improve balance, especially in patients with moderate disability levels (EDSS3.5 -6). Further randomized clinical trials are needed to compare the efficacy of CSEs and routine balance training in PwMS.