Physiotherapy and walking outcomes in adults with multiple sclerosis: systematic review and meta-analysis

Abstract

Background: Physiotherapy treatment may result in improved walking performance among persons with multiple sclerosis (MS). The existing literature is unclear as to what type of physiotherapy treatment has a larger effect on walking performance. It is further unclear regarding which domain of walking performance is improved with physiotherapy.

Objective: To systematically review and quantify the effect of physiotherapy on walking performance compared with usual care in MS.

Methods: A literature search of five databases was undertaken to identify randomised controlled trials of physiotherapy treatments that targeted walking outcomes. There were 21 studies that met our inclusion criteria and yielded data for effect size (ES) generation. An overall ES was calculated using a random effects model and expressed as Hedge’s g.

Major findings: Physiotherapy treatments yielded a small, but statistically significant overall improvement in walking outcomes compared with usual care in persons with MS (ES = 0.25; 95% CI = 0.09–0.41; p < .05). Moderator analyses provided no significant evidence that different types of physiotherapy treatment, or different domains of walking performance, yield larger improvements in walking outcomes in persons with MS.

Conclusion: This evidence indicates that overall there is a significant improvement in walking performance following physiotherapy in persons with MS.

Keywords:

• Physiotherapy
• Physical therapy
• Walking
• Multiple sclerosis
• Meta-analysis
• Review