Effects of Balance Exercise Interventions on Balance-Related Performance in People With Multiple Sclerosis: A Systematic Review and a Meta-Analysis of Randomized Controlled Trials

Background Balance training covers a range of different modalities and complexity levels for people with multiple sclerosis (MS). When evaluating the effects of balance training across different kinds of interventions, determination of the specific intervention content that predict effects are neede...

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Published in:Neurorehabilitation and Neural Repair 2024-10, Vol.38 (10), p.775-790
Main Authors: Wallin, Andreas, Johansson, Sverker, Brincks, John, Dalgas, Ulrik, Franzén, Erika, Callesen, Jacob
Format: Article
Language:English
Subjects:
Exercise Therapy - methods
Humans
Multiple Sclerosis - physiopathology
Multiple Sclerosis - rehabilitation
Outcome Assessment, Health Care
Postural Balance - physiology
Randomized Controlled Trials as Topic
Review
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container_issue 10
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container_title Neurorehabilitation and Neural Repair
container_volume 38
creator Wallin, Andreas
Johansson, Sverker
Brincks, John
Dalgas, Ulrik
Franzén, Erika
Callesen, Jacob
description Background Balance training covers a range of different modalities and complexity levels for people with multiple sclerosis (MS). When evaluating the effects of balance training across different kinds of interventions, determination of the specific intervention content that predict effects are needed. Objective To investigate the effects of balance training on gait and dynamic balance outcomes. Methods Four databases were systematically searched. Randomized controlled trials involving people with MS (Expanded Disability Status Scale [EDSS] score ≤7.5) where at least 50% of the intervention targeted balance control were included. Interventions were categorized based on training types. Risk-of-bias was assessed using the Tool for the Assessment of Study Quality and Reporting in Exercise (TESTEX). Results A total of 18 included studies involved 902 people with MS (EDSS range from 0 to 7.5). Interventions evaluated with a balance composite score or a mobility test showed a moderate effect size (ES = 0.46 [95% confidence interval (CI) = 0.18 to 0.74]; p 
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When evaluating the effects of balance training across different kinds of interventions, determination of the specific intervention content that predict effects are needed. Objective To investigate the effects of balance training on gait and dynamic balance outcomes. Methods Four databases were systematically searched. Randomized controlled trials involving people with MS (Expanded Disability Status Scale [EDSS] score ≤7.5) where at least 50% of the intervention targeted balance control were included. Interventions were categorized based on training types. Risk-of-bias was assessed using the Tool for the Assessment of Study Quality and Reporting in Exercise (TESTEX). Results A total of 18 included studies involved 902 people with MS (EDSS range from 0 to 7.5). Interventions evaluated with a balance composite score or a mobility test showed a moderate effect size (ES = 0.46 [95% confidence interval (CI) = 0.18 to 0.74]; p &lt; .01) and a small overall ES (ES = 0.19 [95% CI = 0.01–0.36]; p = .04), respectively, across different training types. Stepping and gait speed outcomes showed no effect. Cognitive dual-task training showed a significant effect (ES = 0.81 [95% CI = 0.24 to 1.37]) on subgroup level, when evaluated with a mobility outcome measure. The median TESTEX score on study quality and reporting was 11 (maximum score = 15). Conclusions Improvements of balance were found across interventions when measured by balance composite scores and mobility tests, but not when measured by stepping or gait speed outcomes. Large training volume was positively associated with effect on balance. A definition of intensity in balance training is needed for evaluation of its impact on the effect of balance interventions.</description><identifier>ISSN: 1545-9683</identifier><identifier>ISSN: 1552-6844</identifier><identifier>EISSN: 1552-6844</identifier><identifier>DOI: 10.1177/15459683241273402</identifier><identifier>PMID: 39162296</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Exercise Therapy - methods ; Humans ; Multiple Sclerosis - physiopathology ; Multiple Sclerosis - rehabilitation ; Outcome Assessment, Health Care ; Postural Balance - physiology ; Randomized Controlled Trials as Topic ; Review</subject><ispartof>Neurorehabilitation and Neural Repair, 2024-10, Vol.38 (10), p.775-790</ispartof><rights>The Author(s) 2024</rights><rights>The Author(s) 2024 2024 American Society of Neurorehabilitation</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c359t-f01de5630bcfd799d048cb6f516eb8f08b5974a0a92724fb4fc98b17514426533</cites><orcidid>0000-0002-8788-1669 ; 0000-0002-0202-0633 ; 0000-0001-5520-544X ; 0000-0003-4132-2789</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,313,314,777,781,789,882,27903,27905,27906,79113</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39162296$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:159324484$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Wallin, Andreas</creatorcontrib><creatorcontrib>Johansson, Sverker</creatorcontrib><creatorcontrib>Brincks, John</creatorcontrib><creatorcontrib>Dalgas, Ulrik</creatorcontrib><creatorcontrib>Franzén, Erika</creatorcontrib><creatorcontrib>Callesen, Jacob</creatorcontrib><title>Effects of Balance Exercise Interventions on Balance-Related Performance in People With Multiple Sclerosis: A Systematic Review and a Meta-Analysis of Randomized Controlled Trials</title><title>Neurorehabilitation and Neural Repair</title><addtitle>Neurorehabil Neural Repair</addtitle><description>Background Balance training covers a range of different modalities and complexity levels for people with multiple sclerosis (MS). When evaluating the effects of balance training across different kinds of interventions, determination of the specific intervention content that predict effects are needed. Objective To investigate the effects of balance training on gait and dynamic balance outcomes. Methods Four databases were systematically searched. Randomized controlled trials involving people with MS (Expanded Disability Status Scale [EDSS] score ≤7.5) where at least 50% of the intervention targeted balance control were included. Interventions were categorized based on training types. Risk-of-bias was assessed using the Tool for the Assessment of Study Quality and Reporting in Exercise (TESTEX). Results A total of 18 included studies involved 902 people with MS (EDSS range from 0 to 7.5). Interventions evaluated with a balance composite score or a mobility test showed a moderate effect size (ES = 0.46 [95% confidence interval (CI) = 0.18 to 0.74]; p &lt; .01) and a small overall ES (ES = 0.19 [95% CI = 0.01–0.36]; p = .04), respectively, across different training types. Stepping and gait speed outcomes showed no effect. Cognitive dual-task training showed a significant effect (ES = 0.81 [95% CI = 0.24 to 1.37]) on subgroup level, when evaluated with a mobility outcome measure. The median TESTEX score on study quality and reporting was 11 (maximum score = 15). Conclusions Improvements of balance were found across interventions when measured by balance composite scores and mobility tests, but not when measured by stepping or gait speed outcomes. Large training volume was positively associated with effect on balance. A definition of intensity in balance training is needed for evaluation of its impact on the effect of balance interventions.</description><subject>Exercise Therapy - methods</subject><subject>Humans</subject><subject>Multiple Sclerosis - physiopathology</subject><subject>Multiple Sclerosis - rehabilitation</subject><subject>Outcome Assessment, Health Care</subject><subject>Postural Balance - physiology</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Review</subject><issn>1545-9683</issn><issn>1552-6844</issn><issn>1552-6844</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>AFRWT</sourceid><recordid>eNp9Uk1v1DAQjRCIlsIP4IJ85JJiO3YSc0HLaoFKrUDbIo6W44xbFyfe2t4ty9_iD-Kw24oKidN8vfdmPJ6ieEnwMSFN84ZwxkXdVpQR2lQM00fFIeGclnXL2OPJZ7ycAAfFsxivMaZVK_DT4qASpKZU1IfFr4UxoFNE3qD3yqlRA1r8gKBtBHQyJggbGJP1Y0aMd4hyCU4l6NEXCMaH4Q_Ljjn0Kwfom01X6Gztkp2ic-0g-GjjWzRD59uYYFDJarSEjYVbpMYeKXQGSZWzUbltBk6zLHPeD_ZnbjL3YwreuexeBKtcfF48MdnAi709Kr5-WFzMP5Wnnz-ezGenpa64SKXBpAdeV7jTpm-E6DFrdVcbTmroWoPbjouGKawEbSgzHTNatB1pOGGM1ryqjopypxtvYbXu5CrYQYWt9MrKfep79kC2LeaCZ_y7HT5XBuh1XlxQ7gHtYWW0V_LSbyQhTGDc4Kzweq8Q_M0aYpKDjRpc3jr4dZQVFqylDamnZmQH1Xm5MYC570OwnK5D_nMdmfPq7wHvGXfnkAHH-xerS5DXfh3yl8T_KP4GjvHGRg</recordid><startdate>20241001</startdate><enddate>20241001</enddate><creator>Wallin, Andreas</creator><creator>Johansson, Sverker</creator><creator>Brincks, John</creator><creator>Dalgas, Ulrik</creator><creator>Franzén, Erika</creator><creator>Callesen, Jacob</creator><general>SAGE Publications</general><scope>AFRWT</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0002-8788-1669</orcidid><orcidid>https://orcid.org/0000-0002-0202-0633</orcidid><orcidid>https://orcid.org/0000-0001-5520-544X</orcidid><orcidid>https://orcid.org/0000-0003-4132-2789</orcidid></search><sort><creationdate>20241001</creationdate><title>Effects of Balance Exercise Interventions on Balance-Related Performance in People With Multiple Sclerosis: A Systematic Review and a Meta-Analysis of Randomized Controlled Trials</title><author>Wallin, Andreas ; Johansson, Sverker ; Brincks, John ; Dalgas, Ulrik ; Franzén, Erika ; Callesen, Jacob</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-f01de5630bcfd799d048cb6f516eb8f08b5974a0a92724fb4fc98b17514426533</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Exercise Therapy - methods</topic><topic>Humans</topic><topic>Multiple Sclerosis - physiopathology</topic><topic>Multiple Sclerosis - rehabilitation</topic><topic>Outcome Assessment, Health Care</topic><topic>Postural Balance - physiology</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wallin, Andreas</creatorcontrib><creatorcontrib>Johansson, Sverker</creatorcontrib><creatorcontrib>Brincks, John</creatorcontrib><creatorcontrib>Dalgas, Ulrik</creatorcontrib><creatorcontrib>Franzén, Erika</creatorcontrib><creatorcontrib>Callesen, Jacob</creatorcontrib><collection>Sage Journals GOLD Open Access 2024</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>Neurorehabilitation and Neural Repair</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wallin, Andreas</au><au>Johansson, Sverker</au><au>Brincks, John</au><au>Dalgas, Ulrik</au><au>Franzén, Erika</au><au>Callesen, Jacob</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of Balance Exercise Interventions on Balance-Related Performance in People With Multiple Sclerosis: A Systematic Review and a Meta-Analysis of Randomized Controlled Trials</atitle><jtitle>Neurorehabilitation and Neural Repair</jtitle><addtitle>Neurorehabil Neural Repair</addtitle><date>2024-10-01</date><risdate>2024</risdate><volume>38</volume><issue>10</issue><spage>775</spage><epage>790</epage><pages>775-790</pages><issn>1545-9683</issn><issn>1552-6844</issn><eissn>1552-6844</eissn><abstract>Background Balance training covers a range of different modalities and complexity levels for people with multiple sclerosis (MS). When evaluating the effects of balance training across different kinds of interventions, determination of the specific intervention content that predict effects are needed. Objective To investigate the effects of balance training on gait and dynamic balance outcomes. Methods Four databases were systematically searched. Randomized controlled trials involving people with MS (Expanded Disability Status Scale [EDSS] score ≤7.5) where at least 50% of the intervention targeted balance control were included. Interventions were categorized based on training types. Risk-of-bias was assessed using the Tool for the Assessment of Study Quality and Reporting in Exercise (TESTEX). Results A total of 18 included studies involved 902 people with MS (EDSS range from 0 to 7.5). Interventions evaluated with a balance composite score or a mobility test showed a moderate effect size (ES = 0.46 [95% confidence interval (CI) = 0.18 to 0.74]; p &lt; .01) and a small overall ES (ES = 0.19 [95% CI = 0.01–0.36]; p = .04), respectively, across different training types. Stepping and gait speed outcomes showed no effect. Cognitive dual-task training showed a significant effect (ES = 0.81 [95% CI = 0.24 to 1.37]) on subgroup level, when evaluated with a mobility outcome measure. The median TESTEX score on study quality and reporting was 11 (maximum score = 15). Conclusions Improvements of balance were found across interventions when measured by balance composite scores and mobility tests, but not when measured by stepping or gait speed outcomes. Large training volume was positively associated with effect on balance. 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subjects Exercise Therapy - methods
Humans
Multiple Sclerosis - physiopathology
Multiple Sclerosis - rehabilitation
Outcome Assessment, Health Care
Postural Balance - physiology
Randomized Controlled Trials as Topic
Review
title Effects of Balance Exercise Interventions on Balance-Related Performance in People With Multiple Sclerosis: A Systematic Review and a Meta-Analysis of Randomized Controlled Trials
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