Morelli Nathan, Morelli Haley
Rehabilitation Sciences, College of Health Sciences, University of Kentucky, 900 S Limestone, Lexington, KY 40536, USA.
Rehabilitation Department, Chandler Medical Center at University of Kentucky, Lexington, KY, USA.
Mult Scler Relat Disord. 2021 Apr;49:102794. doi: 10.1016/j.msard.2021.102794. Epub 2021 Jan 27.
People with Multiple Sclerosis (PwMS) exhibit deteriorated balance and gait performance during dual task (DT) conditions. Impaired dual tasking is related to increased fall risk and lower quality of life in PwMS. While dual task interventions have proven effective in various patient populations, evidence is lacking to support the use of DT interventions to improve clinical measures of balance and gait in PwMS. Therefore, the purpose of this systematic review was to synthesize the effectiveness of DT intervention at improving balance and gait in PwMS.
A systematic search was completed using CINHAL, PubMed and MEDLINE. Methodological quality, level of evidence and recommendations for included studies was assessed by two reviewers. Effect sizes with 95% confidence intervals comparing single and DT outcomes were calculated for all balance and gait variables.
Five randomized control trials (RCTs) were included for review. Of the 23 effect sizes calculated, three had 95% confidence intervals which did not pass zero and were therefore interpreted as strong. Due to inconsistent level one evidence of DT interventions being superior to single task balance and gait interventions a grade B recommendation was given.
There is inconsistent evidence supporting the use of DT interventions to improve clinical balance measures in PwMS. There is supportive evidence for the use of DT interventions to improve both single and DT gait speed. However, there was heterogeneity between interventions and dosage among RCTs. Despite multiple promising findings, DT interventions appear to have minimal impact on clinical balance and gait measures in PwMS.
多发性硬化症患者（PwMS）在执行双重任务（DT）时，平衡和步态表现会变差。双重任务执行能力受损与PwMS患者跌倒风险增加和生活质量降低有关。虽然双重任务干预已在各种患者群体中证明有效，但缺乏证据支持使用DT干预来改善PwMS患者平衡和步态的临床指标。因此，本系统评价的目的是综合DT干预对改善PwMS患者平衡和步态的有效性。
使用CINHAL、PubMed和MEDLINE完成系统检索。由两名评价者评估纳入研究的方法学质量、证据水平和推荐意见。计算所有平衡和步态变量的效应量及95%置信区间，以比较单任务和DT任务的结果。
纳入五项随机对照试验（RCT）进行综述。在计算的23个效应量中，有三个的95%置信区间未穿过零点，因此被解释为强效应。由于DT干预优于单任务平衡和步态干预的一级证据不一致，因此给出了B级推荐。
支持使用DT干预改善PwMS患者临床平衡指标的证据不一致。有支持性证据表明使用DT干预可改善单任务和DT任务的步态速度。然而，RCT之间的干预措施和剂量存在异质性。尽管有多项有前景的研究结果，但DT干预似乎对PwMS患者的临床平衡和步态指标影响最小。
