ReviewPostural control deficits in people with Multiple Sclerosis: A systematic review and meta-analysis
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.
References (71)
- et al.
The changing demographic pattern of multiple sclerosis epidemiology
Lancet Neurol.
(2010) - et al.
Multiple sclerosis
Lancet
(2002) - et al.
Gait deficits in people with multiple sclerosis: a systematic review and meta-analysis
Gait Posture
(2017) - et al.
Injurious falls among middle aged and older adults with multiple sclerosis
Arch. Phys. Med. Rehabil.
(2008) - et al.
Physical fitness, walking performance, and gait in multiple sclerosis
J. Neurol. Sci.
(2013) - et al.
Anticipatory and compensatory postural adjustments in individuals with multiple sclerosis in response to external perturbations
Neurosci. Lett.
(2015) - et al.
Multiscale entropy identifies differences in complexity in postural control in women with multiple sclerosis
Gait Posture
(2016) - et al.
We-Measure. Toward a low-cost portable posturography for patients with multiple sclerosis using the commercial Wii balance board
J. Neurol. Sci.
(2015) - et al.
Functional connectivity underlying postural motor adaptation in people with multiple sclerosis
Neuroimage Clin.
(2015) - et al.
Clinical tests of standing balance: performance of persons with multiple sclerosis
Arch. Phys. Med. Rehabil.
(2000)
Postural control strategy during standing is altered in patients with multiple sclerosis
Neurosci. Lett.
Frequency analysis approach to study balance control in individuals with multiple sclerosis
J. Neurosci. Methods
Feedforward postural control in individuals with multiple sclerosis during load release
Gait Posture
Anticipatory postural adjustments in individuals with multiple sclerosis
Neurosci. Lett.
The effects of cognitive loading on balance control in patients with multiple sclerosis
Gait Posture
Nonlinear dynamical structure of sway path during standing in patients with multiple sclerosis and in healthy controls is affected by changes in sensory input and cognitive load
Neurosci. Lett.
Characterization of compensatory stepping in people with multiple sclerosis
Arch. Phys. Med. Rehabil.
Investigating the phenomenon of cognitive-motor interference in multiple sclerosis by means of dual-task posturography
Gait Posture
Multiple sclerosis and postural control: the role of spasticity
Arch. Phys. Med. Rehabil.
Body-worn motion sensors detect balance and gait deficits in people with multiple sclerosis who have normal walking speed
Gait Posture
Postural control in women with multiple sclerosis: effects of task, vision and symptomatic fatigue
Gait Posture
Objectification of psychogenic postural instability by trunk sway analysis
J. Neurol. Sci.
Relationship between muscular strength, gait and postural parameters in multiple sclerosis
Ann. Phys. Rehabil. Med.
Neuropsychological, balance, and mobility risk factors for falls in people with multiple sclerosis: a prospective cohort study
Arch. Phys. Med. Rehabil.
A prospective evaluation of balance, gait, and strength to predict falling in women with multiple sclerosis
Arch. Phys. Med. Rehabil.
Systematic review the effectiveness of interventions to reduce falls and improve balance in adults with multiple sclerosis
Archives of Phys. Med. Rehabil.
Multiple sclerosis: an immune or neurodegenerative disorder
Annu. Rev. Neurosci.
A systematic review of factors associated with accidental falls in people with multiple sclerosis: a meta-analytic approach
Clin. Rehabil.
Falls in people with MS-an individual data meta-analysis from studies from Australia, Sweden, United Kingdom and the United States
Multiple Sclerosis J.
Identification of risk factors for falls in multiple sclerosis: a systematic review and meta-analysis
Phys. Ther.
An exploration of fall-related, psychosocial variables in people with multiple sclerosis who have fallen
Br. J. Occup. Ther.
Understanding falls in multiple sclerosis: association of mobility status, concerns about falling, and accumulated impairments
Phys. Ther.
Reducing falls and improving mobility in multiple sclerosis
Expert Rev. Neurother.
What is balance
Clin. Rehabil.
Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls
Age Ageing
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