The Use of Therapeutic Interventions for Improving Balance and Gait in People with Multiple Sclerosis: A Systematic Review of Studies Conducted in Turkey

Yıl 2023, Cilt: 7 Sayı: 3, 235 - 251, 24.12.2023

Meryem Koçaslan Toran , İsmail Toyğar , Gizem Yağmur Yalçın

Öz

This systematic review aimed to evaluate the effectiveness of therapeutic interventions used in the treatment of balance and gait in multiple sclerosis by reviewing studies conducted in Turkey. Studies were included according to the following eligibility criteria: Population, Multiple Sclerosis patients; Intervention, non-pharmacological therapeutic interventions for balance and gait; Comparison, usual intervention and no intervention/no special balance intervention; Outcome, balance and gait clinical scales; Study design, randomized controlled trials. A literature search was conducted in CENTRAL, MEDLINE/PubMed, EMBASE, ClinicalTrials.gov, TR Index for studies published between January 2013 and August 2023. The methodological quality of the included studies was assessed by the Quality Checklist for Randomized Controlled Trials published by the Joanna Briggs Institute. A total of 1023 participants (n) were included in this review. The average sample size per study was 37.88± 16.73. While 78% of the studies reported that the interventions they applied had a positive effect on walking and recovery outcomes in MS, 22% of the studies reported no significant superiority in balance and walking outcomes. The evidence showed that although a wide range of therapeutic interventions are available for balance and gait in people with MS, there is a serious lack of high-quality evidence demonstrating the effectiveness of these modalities.

Anahtar Kelimeler

gait, multiple sclerosis, Postural balance, Therapeutic

Multipl Sklerozlu Kişilerde Denge ve Yürüyüşü İyileştirmek İçin Terapötik Müdahalelerin Kullanımı: Türkiye'de Yapılan Çalışmaların Sistematik Derlemesi

Öz

Bu sistematik derleme, Türkiye'de yapılan çalışmaları gözden geçirerek multipl sklerozda denge ve yürüme tedavisinde kullanılan terapötik müdahalelerin etkinliğini değerlendirmeyi amaçlamaktadır. Çalışmalar aşağıdaki uygunluk kriterlerine göre dahil edilmiştir: Popülasyon, Multipl Skleroz hastaları; Müdahale, denge ve yürüyüş için farmakolojik olmayan terapötik müdahaleler; Karşılaştırma, olağan müdahale ve müdahale yok/özel denge müdahalesi yok; Sonuç, denge ve yürüyüş klinik ölçekleri; Çalışma tasarımı, randomize kontrollü çalışmalar. Ocak 2013 ile Ağustos 2023 tarihleri arasında yayınlanan çalışmalar için CENTRAL, MEDLINE/PubMed, EMBASE, ClinicalTrials.gov, TR Dizin'de literatür taraması yapılmıştır. Dahil edilen çalışmaların metodolojik kalitesi Joanna Briggs Enstitüsü tarafından yayınlanan Randomize Kontrollü Çalışmalar için Kalite Kontrol Listesi ile değerlendirilmiştir. Bu incelemeye toplam 1023 katılımcı (n) dahil edilmiştir. Çalışma başına ortalama örneklem büyüklüğü 37.88± 16.73'tür. Çalışmaların %78'i uyguladıkları müdahalelerin MS'te yürüme ve iyileşme sonuçlarına olumlu etkisinin olduğunu bildirirken, çalışmaların %22'si ise denge ve yürüme sonuçlarında anlamlı bir üstünlük olmadığını bildirmiştir. Bu inceleme sonucunda bulunan kanıtlar, MS'li kişilerde denge ve yürüme için çok çeşitli terapötik müdahalelerin mevcut olmasına rağmen, bu yöntemlerin etkinliğini gösteren yüksek kaliteli kanıtların ciddi şekilde eksik olduğunu göstermiştir.

Anahtar Kelimeler

Duruş dengesi, yürüyüş biçimi, multipl skleroz, tedavi ediciler

Etik Beyan

The current review is a systematic review. Ethics committee is not necessary.

Destekleyen Kurum

This study has not been financed by any institutional organization.

Kaynakça

• Abasıyanık, Z., Ertekin, Ö., Kahraman, T., Yiğit, P., & Özakbaş, S. (2020). The effects of clinical pilates training on walking, balance, fall risk, respiratory, and cognitive functions in persons with multiple sclerosis: A randomized controlled trial. Explore, 16(1), 12–20. https://doi.org/10.1016/j.explore.2019.07.010
• Arık, M. I., Kiloatar, H., & Saraçoğlu, I. (2022). Do Pilates exercises improve balance in patients with multiple sclerosis? A systematic review and meta-analysis. Multiple Sclerosis and Related Disorders, 57(1), 103410. https://doi.org/10.1016/j.msard.2021.103410
• Aydın, T., Akif Sarıyıldız, M., Güler, M., Çelebi, A., Seyithanoğlu, H., Mirzayev, I., Peru, C., Sezer, E., & Batmaz, I. (2014). Evaluation of the effectiveness of home based or hospital based calisthenic exercises in patients with multiple sclerosis. European Review for Medical and Pharmacological Sciences, 18(8), 1189–1198
• Ayvat, F., Özçakar, L., Ayvat, E., Aksu Yıldırım, S., & Kılınç, M. (2021). Effects of low vs. high frequency local vibration on mild-moderate muscle spasticity: Ultrasonographical and functional evaluation in patients with multiple sclerosis. Multiple Sclerosis and Related Disorders, 51(6), 102930. https://doi.org/10.1016/j.msard.2021.102930
• Barker, T. H., Stone, J. C., Sears, K., Klugar, M., Tufanaru, C., Leonardi-Bee, J., Aromataris, E., & Munn, Z. (2023). The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evidence Synthesis, 21(3), 494–506. https://doi.org/10.11124/JBIES-22-00430
• Bilek, F., Bahçecioğlu-Turan, G., & Özer, Z. (2023). The effect of self-acupressure on quality of life, physical and cognitive function in relapsing remitting multiple sclerosis patients: A randomized controlled study. Explore, 19(1), 84–90. https://doi.org/10.1016/j.explore.2022.03.002
• Bulguroğlu, I., Güçlü-Gündüz, A., Yazıcı, G., Özkul, C., İrkeç, C., Nazlıel, B., & Batur-Çaglayan, H. Z. (2017). The effects of mat pilates and reformer pilates in patients with multiple sclerosis: A randomized controlled study. NeuroRehabilitation, 41(2), 413–422. https://doi.org/10.3233/NRE-162121
• Cameron, M. H., & Nilsagard, Y. (2018). Balance, gait, and falls in multiple sclerosis. Handbook of Clinical Neurology, 159, 237–250. https://doi.org/10.1016/B978-0-444-63916-5.00015-X
• Cattaneo, D., Marazzini, F., Crippa, A., & Cardini, R. (2002). Do static or dynamic AFOs improve balance? Clinical Rehabilitation, 16(8), 894-899.
• Centonze, D., Leocani, L., & Feys, P. (2020). Advances in physical rehabilitation of multiple sclerosis. Current Opinion in Neurology, 33(3), 255–261. https://doi.org/10.1097/WCO.0000000000000816
• Chee, J. N., Ye, B., Gregor, S., Berbrayer, D., Mihailidis, A., & Patterson, K. K. (2021). Influence of multiple sclerosis on spatiotemporal gait parameters: A systematic review and meta-regression. Archives Of Physical Medicine and Rehabilitation, 102(9), 1801–1815. https://doi.org/10.1016/j.apmr.2020.12.013
• Dijkers, M. P., Hart, T., Tsaousides, T., Whyte, J., & Zanca, J. M. (2014). Treatment taxonomy for rehabilitation: past, present, and prospects. Archives of Physical Medicine and Rehabilitation, 95(1 Suppl), S6–S16. https://doi.org/10.1016/j.apmr.2013.03.032
• Doğan, M., Ayvat, E., & Kılınç, M. (2023). Telerehabilitation versus virtual reality supported task-oriented circuit therapy on upper limbs and trunk functions in patients with multiple sclerosis: A randomized controlled study. Multiple Sclerosis and Related Disorders, 71(2), 104558. https://doi.org/10.1016/j.msard.2023.104558
• Eldemir, K., Güçlü-Gündüz, A., Eldemir, S., Saygılı, F., Özkul, C., & İrkeç, C. (2023). Effects of pilates-based telerehabilitation on physical performance and quality of life in patients with multiple sclerosis. Disability and Rehabilitation, 45(1), 1–8. https://doi.org/10.1080/09638288.2023.2205174
• Glinsky, J., Harvey, L., & Van Es, P. (2007). Efficacy of electrical stimulation to increase muscle strength in people with neurological conditions: A systematic review. Physiotherapy Research International, 12(3), 175–194. https://doi.org/10.1002/pri.375
• Gunn, H., Markevics, S., Haas, B., Marsden, J., & Freeman, J. (2015). Systematic review: the effectiveness of interventions to reduce falls and ımprove balance in adults with multiple sclerosis. Archives of Physical Medicine and Rehabilitation, 96(10), 1898–1912. https://doi.org/10.1016/j.apmr.2015.05.018
• Gürpınar, B., Kara, B., & İdiman, E. (2020). Effects of aquatic exercises on postural control and hand function in multiple sclerosis: Halliwick versus aquatic plyometric exercises: A randomised trial. Journal of Musculoskeletal and Neuronal İnteractions, 20(2), 249–255.
• Güngör, F., Tarakcı, E., Özdemir-Acar, Z., & Soysal, A. (2022). The effects of supervised versus home pilates-based core stability training on lower extremity muscle strength and postural sway in people with multiple sclerosis. Multiple Sclerosis (Houndmills, Basingstoke, England) Journal, 28(2), 269–279. https://doi.org/10.1177/13524585211012202
• Haselkorn, J. K., Hughes, C., Rae-Grant, A., Henson, L. J., Bever, C. T., Lo, A. C., Brown, T. R., Kraft, G. H., Getchius, T., Gronseth, G., Armstrong, M. J., & Narayanaswami, P. (2015). Summary of comprehensive systematic review: Rehabilitation in multiple sclerosis: Report of the guideline development, dissemination, and ımplementation subcommittee of the American Academy of Neurology. Neurology, 85(21), 1896–1903. https://doi.org/10.1212/WNL.0000000000002146
• Kahraman, T., Savcı, S., Özdoğar, A. T., Gedik, Z., & İdiman, E. (2020). Physical, cognitive and psychosocial effects of telerehabilitation-based motor imagery training in people with multiple sclerosis: A randomized controlled pilot trial. Journal of Telemedicine and Telecare, 26(5), 251–260. https://doi.org/10.1177/1357633X18822355
• Kantele, S., Karinkanta, S., & Sievänen, H. (2015). Effects of long-term whole-body vibration training on mobility in patients with multiple sclerosis: A meta-analysis of randomized controlled trials. Journal of The Neurological Sciences, 358(1-2), 31–37. https://doi.org/10.1016/j.jns.2015.09.357
• Kırmacı, Z. İ., Fırat, T., Sağlam, M., Neyal, A., Neyal A. M., & Ergun, N.(2021). A comparison of the effects of eccentric and concentric exercise training on hemodynamic response, functional capacity, and fatigue in patients with multiple sclerosis. Turkish Journal of Physiotherapy and Rehabilitation, 32(1), 10-19.
• Khan, F., Amatya, B., Galea, M. P., Gonzenbach, R., & Kesselring, J. (2017). Neurorehabilitation: applied neuroplasticity. Journal of Neurology, 264, 603-615.
• Küçük, F., Kara, B., Poyraz, E. Ç., & İdiman, E. (2016). Improvements in cognition, quality of life, and physical performance with clinical pilates in multiple sclerosis: A randomized controlled trial. Journal of Physical Therapy Science, 28(3), 761-768.
• Motl, R. W., Mowry, E. M., Ehde, D. M., LaRocca, N. G., Smith, K. E., Costello, K., Shinto, L., Ng, A. V., Sullivan, A. B., Giesser, B., McCully, K. K., Fernhall, B., Bishop, M., Plow, M., Casaccia, P., & Chiaravalloti, N. D. (2018). Wellness and multiple sclerosis: The National MS Society establishes a Wellness Research Working Group and research priorities. Multiple Sclerosis (Houndmills, Basingstoke, England), 24(3), 262–267. https://doi.org/10.1177/1352458516687404
• Özdoğar, A. T., Ertekin, O., Kahraman, T., Yiğit, P., & Özakbaş, S. (2020). Effect of video-based exergaming on arm and cognitive function in persons with multiple sclerosis: A randomized controlled trial. Multiple Sclerosis and Related Disorders, 40(1), 101966. https://doi.org/10.1016/j.msard.2020.101966
• Özkul, C., Eldemir, K., Apaydın, Y., Gülşen, C., İrkeç, C., & Güçlü-Gündüz, A. (2023). Effects of multi-task training on motor and cognitive performances in multiple sclerosis patients without clinical disability: A single-blinded randomized controlled trial. Acta Neurologica Belgica, 123(4), 1301–1312. https://doi.org/10.1007/s13760-023-02172-7.
• Özkul, C., Güçlü-Gündüz, A., Eldemir, K., Apaydın, Y., Gülşen, C., Yazıcı, G., Söke, F., & İrkeç, C. (2020c). Effect of task-oriented circuit training on motor and cognitive performance in patients with multiple sclerosis: A single-blinded randomized controlled trial. NeuroRehabilitation, 46(3), 343–353. https://doi.org/10.3233/NRE-203029
• Özkul, C., Güçlü-Gündüz, A., Eldemir, K., Apaydın, Y., Yazıcı, G., & İrkeç, C. (2020b). Combined exercise training improves cognitive functions in multiple sclerosis patients with cognitive impairment: A single-blinded randomized controlled trial. Multiple Sclerosis and Related Disorders, 45(7), 102419. https://doi.org/10.1016/j.msard.2020.102419
• Özkul, C., Güçlü-Gündüz, A., İrkeç, C., Fidan, I., Aydın, Y., Özkan, T., & Yazıcı, G. (2018). Effect of combined exercise training on serum brain-derived neurotrophic factor, suppressors of cytokine signaling 1 and 3 in patients with multiple sclerosis. Journal of Neuroimmunology, 316(1), 121–129. https://doi.org/10.1016/j.jneuroim.2018.01.002
• Özkul, C., Güçlü-Gündüz, A., Yazıcı G., Güzel, N. A., & İrkeç, C. (2020a). Effect of immersive virtual reality on balance, mobility, and fatigue in patients with multiple sclerosis: A single-blinded randomized controlled trial. European Journal of Integrative Medicine, 35(3), 101092.
• Özsoy-Ünübol, T., Ata, E., Cavlak, M., Demir, S., Candan, Z., & Yılmaz, F. (2022). Effects of robot-assisted gait training in patients with multiple sclerosis: A single-blinded randomized controlled study. American Journal of Physical Medicine and Rehabilitation, 101(8), 768–774. https://doi.org/10.1097/PHM.0000000000001913
• Özkan, T., & Ünlüer, N. Ö. (2022). Investigation of the effects of trunk stabilization training combined with aerobic training on balance, lower limb muscle strength, and core stability in patients with Multiple Sclerosis: a randomized controlled study. Journal of Exercise Therapy and Rehabilitation, 9(1), 20-29.
• Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. British Medical Journal, 372, 71. https://doi.org/10.1136/bmj.n71
• Paltamaa, J., Sjögren, T., Peurala, S. H., & Heinonen, A. (2012). Effects of physiotherapy interventions on balance in multiple sclerosis: A systematic review and meta-analysis of randomized controlled trials. Journal of Rehabilitation Medicine, 44(10), 811–823. https://doi.org/10.2340/16501977-1047
• Pearson, M., Dieberg, G., & Smart, N. (2015). Exercise as a therapy for improvement of walking ability in adults with multiple sclerosis: A meta-analysis. Archives of Physical Medicine and Rehabilitation, 96(7), 1339–1348.e7. https://doi.org/10.1016/j.apmr.2015.02.011
• Pilutti, L. A., Platta, M. E., Motl, R. W., & Latimer-Cheung, A. E. (2014). The safety of exercise training in multiple sclerosis: A systematic review. Journal of The Neurological Sciences, 343(1-2), 3–7. https://doi.org/10.1016/j.jns.2014.05.016
• Rodríguez-Fuentes, G., Silveira-Pereira, L., Ferradáns-Rodríguez, P., & Campo-Prieto, P. (2022). Therapeutic effects of the pilates method in patients with multiple sclerosis: A systematic review. Journal of Clinical Medicine, 11(3), 683. https://doi.org/10.3390/jcm11030683
• Salbaş, E., & Karahan, A. Y. (2022). Effects of hippotherapy simulation exercise vs. conventional home exercises on muscle strength and balance in people with multiple sclerosis: A randomized controlled trial. Multiple Sclerosis and Related Disorders, 68(12), 104111. https://doi.org/10.1016/j.msard.2022.104111
• Salcı, Y., Fil, A., Armutlu, K., Yıldız, F. G., Kurne, A., Aksoy, S., Nurlu, G., & Karabudak, R. (2017). Effects of different exercise modalities on ataxia in multiple sclerosis patients: a randomized controlled study. Disability and Rehabilitation, 39(26), 2626–2632. https://doi.org/10.1080/09638288.2016.1236411
• Sherrington, C., Fairhall, N. J., Wallbank, G. K., Tiedemann, A., Michaleff, Z. A., Howard, K., ... & Lamb, S. E. (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 1(1), CD012424. doi: 10.1002/14651858.CD012424.pub2.
• Tomruk, M.S, Uz, M. Z., Kara, B., & İdiman, E. (2016). Effects of Pilates exercises on sensory interaction, postural control and fatigue in patients with multiple sclerosis. Multiple Sclerosis and Related Disorders, 7(12), 70–73. https://doi.org/10.1016/j.msard.2016.03.008
• Tarakçı, E., Tarakçı, D., Hajebrahimi, F., & Budak, M. (2021). Supervised exercises versus telerehabilitation: Benefits for persons with multiple sclerosis. Acta Neurologica Scandinavica, 144(3), 303–311. https://doi.org/10.1111/ane.13448
• Tarakçı, E., Yeldan, I., Hüseyinsinoğlu, B. E., Zenginler, Y., & Eraksoy, M. (2013). Group exercise training for balance, functional status, spasticity, fatigue and quality of life in multiple sclerosis: A randomized controlled trial. Clinical Rehabilitation, 27(9), 813–822. https://doi.org/10.1177/0269215513481047
• Walton, C., King, R., Rechtman, L., Kaye, W., Leray, E., Marrie, R. A., Robertson, N., La Rocca, N., Uitdehaag, B., Vander Mei, I., Wallin, M., Helme, A., Angood Napier, C., Rijke, N., & Baneke, P. (2020). Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition. Multiple Sclerosis (Houndmills, Basingstoke, England) Journal, 26(14), 1816–1821. https://doi.org/10.1177/1352458520970841
• Yaşa, M. E., Özkan, T., Ünlüer, N. Ö., Çelenay, Ş. T., & Anlar, Ö. (2022). Core stability-based balance training and kinesio taping for balance, trunk control, fear of falling and walking capacity in patients with multiple sclerosis: A randomized single-blinded study. Multiple Sclerosis and Related Disorders, 68(12), 104178. https://doi.org/10.1016/j.msard.2022.104178
• Yazgan, Y. Z., Tarakçı, E., Tarakçı, D., Özdinçler, A. R., & Kürtüncü, M. (2020). Comparison of the effects of two different exergaming systems on balance, functionality, fatigue, and quality of life in people with multiple sclerosis: A randomized controlled trial. Multiple Sclerosis and Related Disorders, 39(4), 101902. https://doi.org/10.1016/j.msard.2019.101902
• Yeni, K., Tülek, Z., & Terzi, M. (2022). Effect of self-acupressure on fatigue in patients with multiple sclerosis. Complementary Therapies in Clinical Practice, 47(5), 101572. https://doi.org/10.1016/j.ctcp.2022.101572
• Zurawski, J., & Stankiewicz, J. (2018). Multiple sclerosis re-examined: Essential and emerging clinical concepts. The American Journal of Medicine, 131(5), 464–472. https://doi.org/10.1016/j.amjmed.2017.11.044