Elsevier

Gait & Posture

Volume 61, March 2018, Pages 445-452
Gait & Posture

Review
Postural control deficits in people with Multiple Sclerosis: A systematic review and meta-analysis

https://doi.org/10.1016/j.gaitpost.2018.02.018Get rights and content

Highlights

  • People with MS have deficits in postural control compared to healthy controls.

  • These deficits are considerable regardless of task complexity or sensory condition.

  • A lack of standardisation of reporting exists for assessment of postural control.

Abstract

Background

Multiple sclerosis (MS) is a neurological condition that can affect the postural stability of the individual and predispose falls in this population.

Methods

A systematic literature search identified case-control studies investigating differences in postural control across a diversity of task conditions, with the exception of gait, between people with MS and healthy controls. Meta-analysis was conducted where a variable was presented by four or more studies.

Results

Forty-three studies of people with a mean Expanded Disability Status Scale (EDSS) of 1.0 to 6.0 were included. Seven conditions of assessment and 105 individual measurement variables relating to postural control were included. Quiet stance was the only condition (11 studies) possessing sufficient data to contribute to meta-analysis in terms of centre of pressure path length (SMD = 1.04, 95% CI {0.86–1.22}, p < 0.001), medio-lateral velocity (SMD = 1.35, 95% CI {0.77–1.92}, p < 0.001) and 95% confidence ellipse (SMD = 0.83 95% CI {0.59–1.08}, p < 0.001).

Results

indicate that regardless of task complexity or sensory condition, people with MS display considerable deficits in postural control in comparison to healthy controls.

Conclusions

The large number of variables and lack of standardisation of reporting makes data synthesis challenging, however, people with MS display considerable deficits in postural control compared to healthy controls regardless of task condition or complexity.

Introduction

Multiple Sclerosis (MS) is a chronic, inflammatory-mediated disease resulting in demyelination of the central nervous system which is often progressive in nature [1]. Currently it is estimated that the global prevalence of MS is 33 per 100,000 with a total of 2.3 million people with MS (pwMS) worldwide and a notably high incidence in young adults [2]. The heterogeneous pathological and clinical presentation of MS predisposes deterioration of motor, sensory and/or cognitive function [3]. Such impairments lead to symptoms such as gait deficits [4], postural instability [5] and predispose falls in this population.

Falls are increasingly being recognised as a significant consequence of MS with 56% of individuals experiencing a fall in any three-month period [6]. Much like the clinical presentation of the disease itself, risk factors for falls in pwMS are diverse [7]. The potential physical [8], psychological [9] and social [10] impact associated with falls in pwMS have led to falls prevention becoming a rapidly developing research area in rehabilitation for pwMS [11].

Postural control is an encompassing term referring to the ability of the body to pre-empt or react to conditions threatening stability and maintain or adjust body position to prevent a fall [12]. Rather than an automatic response, the ability to maintain or change posture is a complex process embodying a diversity of sensorimotor processes [13]. Notably, the disease pathology associated with diseases such as MS predispose postural instability and falls [5]. The identification and quantification of postural control deficiencies in pwMS is pertinent to the development of theory based interventions for falls. A recent meta-analysis quantified the deficits in postural control during gait in pwMS in comparison to healthy counterparts [4], to date no such comparison has been conducted for stationary or reactive postural control conditions. These forms of postural control are crucial for the maintenance of stability and the prevention of falls across functional and compensatory tasks.

As such, this systematic review and meta-analysis aimed to identify and quantify deficits in postural control across task conditions for pwMS in comparison to healthy controls to inform the development of falls prevention interventions for this population.

Section snippets

Study design

This study is a systematic review and meta-analysis of case-control studies. The recommendations of the Meta-analysis of Observational Studies in Epidemiology (MOOSE) group statement [14] were followed throughout this study to strengthen and standardise the conduct and reporting.

Search strategy

A literature search was conducted during May 2016 by the primary author (LC) through the following databases; Ebsco (Academic Search Complete, AMED, CINAHL, Medline, PsychArticles, PsychInfo, SportDiscus, Biomedical

Study identification

Fig. 1. provides detailed information relating to study identification and selection for inclusion. A total of 31,624 articles were generated through the initial search of relevant databases. Following the removal of duplicates, the titles and abstracts of 23,883 articles were screened for eligibility. The full texts of 153 articles were examined for eligibility by the authors. One hundred and nine studies did not meet the predefined criteria for inclusion. Sandroff et al. [[18], [19]] reported

Discussion

This systematic review and meta-analysis aimed to identify and quantify the effects of MS on postural control. The methodological quality of the 43 included studies was varied. The key findings of this research highlight that, irrespective of sensory state or task complexity, pwMS display large deficits in postural control compared to their healthy counterparts. Despite relative homogeneity between studies in terms of apparatus, conditions and protocols, the diversity of measurement variables

Conclusion

PwMS display considerable deficits in postural control compared to healthy controls regardless of task condition or complexity. A significant lack of standardisation exists regarding the reporting of variables measuring postural control for pwMS and there is a timely need for agreement in terms of core measurements for extraction and reporting.

Conflict of interest

The authors declare no conflict of interest.

Funding

LC is a PhD candidate funded by the Multiple Sclerosis Society of Ireland through the Ireland Fund.

Acknowledgements

The authors wish to thank Bláthín Casey, Gillian Quinn and the members of the MS Research Team at the University of Limerick for their assistance and feedback in the preparation of this manuscript.

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