Task-oriented training may help MS balance issues, study finds
Researcher calls for more study amid 'inconsistent' evidence
Task-oriented training may help balance issues for people with multiple sclerosis (MS), particularly when combined with conventional physiotherapy, according to a systematic review and meta-analysis.
But the study came with a note of caution.
“These findings suggest inconsistent outcomes and highlight the need for cautious interpretation and further research,” wrote lead author Anas Alashram, PhD, an assistant professor at Middle East University in Amnan, Jordan.
The study, “Efficacy of task-oriented training on balance ability in people with multiple sclerosis: A systematic review and meta-analysis,” was published in the Journal of Bodywork and Movement Therapies.
People with MS often experience coordination and balance problems, which can impair mobility and limit participation in social activities. “Rehabilitation plays a crucial role in improving balance” for these patients, Alashram wrote.
Task-oriented training to rewire the brain
Physiotherapy for balance issues in MS may include walking on a treadmill, stretching, and mobility exercises. Data has shown that some exercises are better than others at easing specific balance issues.
Task-oriented training is a rehabilitation approach designed to stimulate neuroplasticity, or the brain’s ability to rewire itself in response to new experiences. It involves practicing specific, goal-directed movements, such as stepping in different directions or rising from a chair, to help the brain re-learn lost functions.
While this type of training has shown promise in other neurological conditions, such as stroke, its benefits in MS remain unclear.
Alashram reviewed nine published studies that assessed the impact of task-oriented training in the balance of people with MS. The studies involved 231 patients who complained of balance issues, with a mean age of 42.
The majority of the studies followed a randomized controlled design, comparing task-oriented training against a control intervention. The rest were pilot studies, in which the approach was tested in all participants without a control group.
Specific task-oriented training approaches varied across the studies. The interventions lasted between 10 and 90 minutes and participants received at least 10 training sessions, spread across two to five weeks.
While the studies relied on different metrics to monitor balance, five used the Berg Balance Scale (BBS). A pooled analysis of these studies found small to moderate improvements in balance with task-oriented training. But the improvement was not statistically significant, and the results were highly variable across studies.
“There was heterogeneity in the training protocols, which may have led to conflicting findings and the inability to distinguish the effective [task-oriented] training treatment program,” Alashram wrote.
Across the studies, three used task-oriented training alone, and six tested it in combination with standard physiotherapy. Among the studies that used task-oriented training alone, two showed improvements in balance metrics, while the third found no significant changes.
Results also varied among the studies that used task-oriented training in combination with another approach, with five studies reporting improvement in at least one balance metric.
None of the studies reported side effects following task-oriented training, suggesting the approach is safe for people with MS.
Differences across the studies were the main limitation of the meta-analysis. As well as variability in the training programs, variability in the outcome metrics used to test balance changes made comparison across studies difficult.
Small sample sizes, lack of long-term follow-up, and inconsistent outcome measures were also among the study’s limitations, Alashram wrote.
“Further well-designed trials with long-term follow-up are essential to confirm effectiveness and determine optimal treatment protocols,” the study concluded.
About the Author
