Rehabilitation interventions for improving gait for people with multiple sclerosis: A scoping review of reviews

Evidence for rehabilitation interventions to improve gait outcomes for people with multiple sclerosis (PwMS) has not been previously mapped, despite the prevalence and impact of gait impairment in MS. This review of reviews aimed to map the scope of physical based rehabilitation interventions intended to improve objective gait outcomes in PwMS.

We conducted a scoping review of reviews searching five databases, from inception to January 2024, focusing on "Multiple Sclerosis", "Rehabilitation," "gait," and "systematic review". A narrative synthesis of evidence was used due to the significant data heterogeneity. Evidence Mapping, using the corrected covered area (CCA), was applied to assess the degree of overlap among included reviews. Quality appraisal was conducted using the Joanna Briggs Institute (JBI) Checklist for Systematic Reviews and Research Syntheses.

Out of 409 identified reviews, 67 met inclusion criteria and 56 were classified as high-quality reviews. Exercise training was the most commonly investigated intervention, followed by whole-body vibration and robot-assisted gait training. The most frequently used gait assessment tools were 10-Meter Walk Test and Timed 25-Foot Walk Test (for gait speed), 6-Minute Walk Test (for gait endurance), and Timed Up and Go Test (for functional mobility).

This review highlights a substantial body of evidence, yet also reveals considerable overlap reported in CCA scores across the included reviews for most of interventions. To maximize clinical impact, future research must move beyond broad generalizations and focus on developing targeted evidence for specific groups of PwMS based on age groups, disability level, and functional goals.