EFFECTS OF PHYSIOTHERAPY INTERVENTIONS ON BALANCE IN MULTIPLE SCLEROSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Objective: To determine the effects of physiotherapy interventions on balance in people with multiple sclerosis. Data sources: A systematic literature search was conducted in Medline, Cinahl, Embase, PEDro, both electronically and by manual search up to March 2011. Study selection: Randomized controlled trials of physiotherapy interventions in people with multiple sclerosis, with an outcome measure linked to the International Classification of Functioning, Disability and Health (ICE) category of "Changing and maintaining body position", were included. Data extraction: The quality of studies was determined by the van Tulder criteria. Meta-analyses were performed in subgroups according to the intervention. Data synthesis: After screening 233 full-text papers, 11 studies were included in a qualitative analysis and 7 in a metaanalysis. The methodological quality of the studies ranged from poor to moderate. Low evidence was found for the efficacy of specific balance exercises, physical therapy based on an individualized problem-solving approach, and resistance and aerobic exercises on improving balance among ambulatory people with multiple sclerosis. Conclusion: These findings indicate small, but significant, effects of physiotherapy on balance in people with multiple sclerosis who have a mild to moderate level of disability. However, evidence for severely disabled people is lacking, and further research is needed.