Motor Learning in People with Multiple Sclerosis: A Systematic Review and Meta-analysis

Objective: To systematically review and quantitatively synthesize the existing evidence of motor learning in persons with multiple sclerosis (PwMS). Data Sources: PubMed, Cumulative Index to Nursing and Allied Health Literature, and Web of Science were searched using the following terms: multiple sclerosis, task learning, motor learning, skill learning, performance learning. Study Selection: Studies had to include PwMS with a main outcome being motor learning, be published in peer-reviewed journals, and be written in English. The search yielded 68 results, and the inclusion criteria were met by 17 studies. Data Extraction: Basic descriptors of each study, study protocol, and motor learning measures were extracted. The Grading of Recommendations Assessment, Development, and Evaluation approach revealed the quality of evidence was low with a high risk of bias. Meta-analysis was conducted to determine the difference in implicit and explicit learning in PwMS and controls without multiple sclerosis. Data Synthesis: Studies scored on average 15.9 of 18 for quality assessment. PwMS were able to learn functional mobility and upper limb manipulation motor skills as indicated by short-term acquisition, transfer, and retention. Implicit learning conditions from the meta-analysis showed that PwMS were able to learn at a similar rate to controls without multiple sclerosis (P<.001), yet explicit learning conditions did not display a significant rate of learning (P = .133). Conclusions: While this review indicated that PwMS are capable of motor learning, several knowledge gaps still exist. Future research should focus on using higher-quality evidence to understand motor learning in PwMS and translate the findings to rehabilitation and activities of daily living. (C) 2019 by the American Congress of Rehabilitation Medicine