The Effectiveness of Vestibular Rehabilitation on Balance Related Impairments among Multiple Sclerosis Patients: A Systematic Review

Background: Balance related dysfunction remains a debilitating clinical manifestation among people with Multiple Sclerosis (pwMS) causing significant morbidity and reduced quality of life. Imbalance is found to stem primarily from neurophysiological causes. Current management strategies have shown to have small but clinically insignificant results with little consideration towards vestibular sources of postural instability. Vestibular rehabilitation (VR) provides a promising treatment strategy to mediate balance dysfunction among people with pwMS.Design: Systematic Review, guided by PRISMA guidelines and presenting a best evidence synthesis.Data sources: 10 electronic databases were searched from inception until September 2019.Eligibility criteria for study selection: Article of original research, population of patients with multiple sclerosis aged over 18, interventions detailing VR protocols, measurement of outcomes pre-VR/post-VR.Results: Seven articles satisfied the eligibility criteria. 6/7 studies were rated as high quality and regarded as level one evidence. 5 studies consisted of standardised VR protocols while 2 studies consisted of customised VR. All studies identified improvements of mixed significance in balance, fatigue and dizziness outcomes post VR. Heterogeneity among VR prescription patterns limited optimal prescription guidelines.Conclusions: The available evidence shows promise that VR is a safe and ef- fective strategy to provide short term benefits in balance related dysfunction in pwMS. Recommendations of mixed strength are made based on the quality of current literature. Current evidence for optimal prescription and long-term effects of VR is limited. Further high-level studies evaluating the effects of VR in patients with multiple sclerosis with vestibular and/or balance dysfunction are required