Effectiveness of Vestibular Training for Balance and Dizziness Rehabilitation in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis

Cristina García-Muñoz, María-Dolores Cortés-Vega, Alberto Marcos Heredia-Rizo, Rocío Martín-Valero, María-Isabel García-Bernal, María Jesús Casuso-Holgado, Cristina García-Muñoz, María-Dolores Cortés-Vega, Alberto Marcos Heredia-Rizo, Rocío Martín-Valero, María-Isabel García-Bernal, María Jesús Casuso-Holgado

Abstract

Postural instability and dizziness are commonly observed in people with multiple sclerosis (PwMS). The aim of this systematic review was to evaluate the evidence for the use of vestibular rehabilitation, in comparison with other exercise interventions or no intervention, to treat balance impairments and dizziness in PwMS. An electronic search was conducted by two independent reviewers in the following databases: MEDLINE (Pubmed), Scopus, the Physiotherapy Evidence Database (PEDro), Web of Science (WOS), Lilacs, CINHAL and the Cochrane Database of Systematic Reviews (CDSR). A quality assessment was performed using the PEDro scale and the Cochrane Risk of Bias Tool. When possible, the data were pooled in a meta-analysis (95%CI). This systematic review followed the PRISMA guideline statement and was registered in the PROSPERO database (CRD42019134230). Seven studies were included, with a total of 321 participants analysed. Compared with no intervention, vestibular rehabilitation was more effective for balance development (SMD = 2.12; 95% CI = 0.49, 3.75; p = 0.01; I2 = 89%) and dizziness symptoms improvement (SMD = -17.43; 95% CI = -29.99, -4.87; p= 0.007; I2= 66%). Compared with other exercise interventions, improvements in favour of the experimental group were observed, but statistical significance for the differences between groups was not reached.

Keywords: dizziness; fatigue; multiple sclerosis; physical therapy modalities; postural balance; vestibular diseases.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of trial selection based on PRISMA guidelines.
Figure 2
Figure 2
Cochrane risk of bias tool summary.
Figure 3
Figure 3
Forest plot of the meta-analysis of postural control (vestibular rehabilitation versus no intervention).
Figure 4
Figure 4
Forest plot of the meta-analysis of Berg Balance Scale (vestibular rehabilitation versus other exercises).
Figure 5
Figure 5
Forest plot of the meta-analysis of dizziness (vestibular rehabilitation versus no intervention).
Figure 6
Figure 6
Forest plot of the meta-analysis of fatigue (vestibular rehabilitation versus no intervention).
Figure 7
Figure 7
Forest plot of the meta-analysis of fatigue (vestibular rehabilitation versus other exercises).

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