The following is a summary of the “Mobility and balance rehabilitation in multiple sclerosis: A systematic review and dose-response meta-analysis,” published in the January 2023 issue of Multiple Sclerosis and Related Disorders by Corrini, et al.

Evaluation of the dose-response relationship and efficacy of neurological rehabilitation for improving MS patients’ gait and posture. In this review, researchers included papers that met the following criteria and examined the effects of neurological rehabilitation on mobility and balance: PwMS, the Multiple Sclerosis populace; Clinical measures of balance as an outcome of rehabilitation methods; Randomized controlled studies of balance-focused therapies vs those that do not include a control group. They used a one-stage linear mixed effects meta-regression to estimate dose-response curves and a random effects dose-response meta-analysis to evaluate linear trend estimations.

Among a total of 5,020 papers, researchers were able to retrieve 196 for full-text evaluation, with 71 of those studies ultimately being included (n participants = 3,306). In total, there were 70 randomised controlled trials and 1 cross-over study, with an average sample size of 46.5± 28.6 (mean±SD) participants, a mean age of 48.3 ±7.8 years, a mean duration of disease of 11.6± 6.1 years, and an EDSS of 4.4± 1.4 points. Balance was the major outcome in 29 research (40.8%), secondary in 42 (59.1%), and not specified in 7 studies (2%). Thirty-three trials (46.5% of total) used a passive control group, whereas 38 trials (53.5% of total) utilised an active control group.

A medium pooled effect size for balance therapies was found, with a standard mean difference of 0.41 (95% CIs: 0.22 to 0.59) based on data from 20 studies (n participants = 1,016). They also looked at 14 trials (n participants = 696) with balance as the primary outcome and BBS as the primary endpoint, and they found a mean difference of 3.58 points (95% CIs 1.79 to 5.38, P< 0.0001). Lastly, researchers did meta-regression on the 20 studies that found a correlation between improved outcomes and log of intensity measured in minutes per session (β=1.26; SEβ=0.51; P = 0.02) or task-oriented intervention (=0.38; SEβ=0.17; P = 0.05). In order to increase mobility, our analyses provide level 1 evidence on the effect of balancing intervention. More so, high-intensity, task-specific interventions are linked to higher treatment outcomes, as stated by the principles of neurological rehabilitation.