Exploring the effectiveness of circuit training rehabilitation on balance, gait, and fatigue in multiple sclerosis: a systematic review and meta-analysis

IF 3.1 3区医学 Q1 REHABILITATION

Physiotherapy Pub Date : 2024-07-20 DOI:10.1016/j.physio.2024.101413

Rebecca Cardini , Chiara Corrini , Rita Bertoni , Denise Anastasi , Davide Cattaneo , Elisa Gervasoni

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引用次数: 0

Abstract

Background

People with Multiple Sclerosis (PwMS) often experience imbalance, gait dysfunction, and fatigue. Circuit Training (CT) can be viable for improving balance, gait, and fatigue in MS. To the author’s knowledge, no studies have systematically reviewed the existing literature evaluating the effectiveness of CT in PwMS.

Objectives

To investigate the effectiveness of CT in improving balance, gait, and reducing fatigue in PwMS and provide a quantitative and qualitative synthesis of Randomized Controlled Trials (RCTs).

Data sources

MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, Google Scholar, and PEDro Database (Dec 2021 to May 2024).

Study selection

RCTs using CT in PwMS including balance, gait, or fatigue outcomes.

Data synthesis

Search inclusion criteria were: i) available full text, ii) CT rehabilitation, iii) balance, gait, or fatigue measured as outcomes, and iv) articles in English. Full text articles were analyzed by two screeners. If there was disagreement regarding inclusion, a further reviewer was consulted. No discrepancies were found.

Results

We identified 878 studies, 14 studies were eligible including 716 PwMS with a mean (standard deviation) age of 49.9 (10.9) years, disease duration of 10.8 (7.2) years, and Expanded Disability Status Scale score of 4.3 (0.9) points. RevMan 5.4.1 was used to run the meta-analysis. We found a significant overall effect on Berg Balance Scale (Mean Difference (MD) = 6.07 points, 95%CI:1.40,10.75; p = 0.01) and in Fatigue Severity Scale (MD = 0.98 points, 95%CI:0.30,1.66; p = 0.005) in favor of CT. We did not find a significant effect in Timed Up and Go (MD = 0.46 second, 95%CI:−0.04,0.96; p = 0.07), in Six-Minute Walk Test (MD = 17.46 m, 95%CI:−8.06,42.97; p = 0.18), and in Modified Fatigue Impact Scale (MD = 3.34 points, 95%CI:−0.41,7.09; p = 0.08) in favor of CT. We assessed methodological quality using RoB 2.0, and quality of evidence using GRADE.

Limitations

Small number of studies, all identifying having some risk of bias.

Conclusion

Circuit training can have positive effects on PwMS in terms of increasing balance, gait, and reducing fatigue. Further research is needed.

Systematic Review Registration Number

PROSPERO CRD42021286834.

Contribution of the Paper

-
Circuit training rehabilitation seems to be an effective option for the treatment of balance, gait, and fatigue in people with Multiple Sclerosis.
-
Circuit training rehabilitation comprising balance and resistance exercises may improve balance and reduce fatigue symptoms in People with Multiple Sclerosis with mild to moderate levels of disability.
-
Future studies with higher quality are recommended.

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探索循环训练康复对多发性硬化症患者平衡、步态和疲劳的影响：系统回顾和荟萃分析

背景多发性硬化症（PwMS）患者经常会出现不平衡、步态功能障碍和疲劳。循环训练（CT）可以改善多发性硬化症患者的平衡、步态和疲劳。据笔者所知，目前还没有研究对现有文献进行系统回顾，以评估 CT 在多发性硬化症患者中的有效性。目的研究 CT 在改善多发性硬化症患者平衡、步态和减轻疲劳方面的有效性，并对随机对照试验 (RCT) 进行定量和定性综述。数据来源MEDLINE、Cochrane Central Register of Controlled Trials、EMBASE、CINAHL、Google Scholar 和 PEDro Database（2021 年 12 月至 2024 年 5 月）.研究选择在 PwMS 中使用 CT（包括平衡、步态或疲劳结果）的 RCT.数据综述研究纳入标准为：i) 全文可用；ii) CT 康复；iii) 平衡、步态或疲劳作为测量结果；iv) 英文文章。全文由两名筛选者进行分析。如果在纳入问题上出现分歧，则咨询另一位审稿人。结果我们确定了 878 项研究，14 项研究符合条件，其中包括 716 名 PwMS，平均（标准差）年龄为 49.9（10.9）岁，病程为 10.8（7.2）年，扩展残疾状况量表评分为 4.3（0.9）分。我们使用 RevMan 5.4.1 进行了荟萃分析。我们发现，CT 对 Berg 平衡量表（平均差 (MD) = 6.07 分，95%CI:1.40,10.75; p = 0.01）和疲劳严重程度量表（MD = 0.98 分，95%CI:0.30,1.66; p = 0.005）有明显的总体效果。我们在定时起立行走（MD = 0.46 秒，95%CI:-0.04,0.96; p = 0.07）、六分钟步行测试（MD = 17.46 米，95%CI:-8.06,42.97; p = 0.18）和改良疲劳影响量表（MD = 3.34 分，95%CI:-0.41,7.09; p = 0.08）中均未发现对 CT 有明显影响。我们使用 RoB 2.0 评估了方法学质量，并使用 GRADE 评估了证据质量。局限性研究数量较少，所有研究都存在一定的偏倚风险。系统综述注册号PROSPERO CRD42021286834.Contribution of the Paper-Circuit training rehabilitation seems to be an effective option for the treatment of balance, gait, and fatigue in people with Multiple Sclerosis.-Circuit training rehabilitation comprising balance and resistance exercises may improve balance and reduce fatigue symptoms in People with Multiple Sclerosis with mild to moderate levels of disability.-Future studies with higher quality are recommended.

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来源期刊

Physiotherapy 医学-康复医学

CiteScore

6.40

自引率

3.00%

发文量

377

审稿时长

82 days

期刊介绍： Physiotherapy aims to publish original research and facilitate continuing professional development for physiotherapists and other health professions worldwide. Dedicated to the advancement of physiotherapy through publication of research and scholarly work concerned with, but not limited to, its scientific basis and clinical application, education of practitioners, management of services and policy. We are pleased to receive articles reporting original scientific research, systematic reviews or meta-analyses, theoretical or debate articles, brief reports and technical reports. All papers should demonstrate methodological rigour.