Physiotherapy and Walking Outcomes in Adults with Multiple Sclerosis: A Meta-Analysis

Background: The potential beneficial effect of physiotherapy interventions for improving walking in multiple sclerosis (MS) has not been systematically examined.

Objectives: This study aimed to quantify the overall effect of physiotherapy on walking in individuals with MS by conducting a meta-analysis of all the published randomised controlled trials in the literature.

Methods: We systematically reviewed a total of 381 potential articles that were identified through various search engines (i.e., PubMed, Science Direct, Scopus, SPORTDiscus and Web of Science). Twenty-two of those qualified to be included in the final meta-analysis. We computed an overall effect size (ES) based on a Hedge’s g. We further conducted subgroup analyses using type of exercise training and outcome assessment as potential moderator variables.

Results: The mean, overall ES was 0.26 (SE=0.08; 95% CI=0.11-0.42, z=3.23, p<.001), indicating a small, but statistically significant beneficial effect of physiotherapy compared with control conditions for improving walking in individuals with MS. There was significant heterogeneity (Q_b=56.33, df=21, p<.001), which justified undertaking of the subgroup analyses of various study variables. The results indicated that resistance training as an exercise type and the outcome assessment of walking endurance yielded the largest effects (p<.05).  

Conclusions: Based on the ¼ SD improvement observed in the current meta-analysis, we provide evidence that physiotherapy can be beneficial for improving walking in individuals with MS. We further indicate that resistance-based training and measuring walking endurance as an outcome yield the largest benefits. These findings have important practical implications for individuals with MS and physiotherapists working with this population.