The effectiveness of physical therapy interventions in reducing falls among people with multiple sclerosis: A systematic review and meta-analysis

Background: Falls are common among People with Multiple Sclerosis (PwMS) and can result in significant consequences. Summary of the evidence of effectiveness of Physical Therapy (PT) to manage fall risks is needed. Objective: To investigate the effectiveness of PT interventions to reduce fall related outcomes in PwMS. Methods: Electronic databases of PubMed, PEDro, Web of Science, Scopus, SportDiscuss and CINAHL were searched. Randomized Controlled Trials (RCTs) and pre-post studies that examined the effectiveness of any PT interventions to target falls in PwMS were included. Two independent reviewers extracted the data. The Cochrane risk of bias assessment tool and the quality assessment tool for before-after studies were used for RCTs and pre-post studies, respectively. The Grading Recommendations, Assessment, Development and Evaluation- GRADE was used to rate the overall quality of evidence. Results: Twenty articles with 819 participants were included in the review and 16 articles in meta-analysis. Only home-based exercise was found to significantly reduce the number of ambulatory fallers (risk ratio = 0.53, 95% CI 0.31 to 0.91, P = 0.02) with Multiple Sclerosis. Limited evidence exists on PT interventions to reduce falls among non-ambulatory PwMS. Conclusion: The overall very low to moderate quality of evidence presented showed the effectiveness of PT interventions to reduce fall outcomes in PwMS is limited. However, home-based exercise showed potential to reduce fall outcomes in ambulatory PwMS. There is a need to develop PT interventions to reduce fall outcomes in non-ambulatory PwMS due to a scarcity of evidence in this population. Registration: The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD 42020150297)