Does Pilates Exercise Improve Balance and Walking in People With Multiple Sclerosis? A Systematic Review

Abstract

was carried out by both. If any article was deemed relevant to the topics of interest (wheelchair standards development, wheelchair testing using standards and evidence on product failure) by only one reviewer as per the abstract, then both reviewers read through the article to determine its relevance. Articles related to product's usability, satisfaction, and perfor-mance in simulated environments were excluded. Studies on motorized wheelchairs, scooters, and manual suspension wheelchairs were not taken into account.The papers that were deemed relevant were read entirely and reviewed by the two researchers for inclusion in this literature review. Of the 1112 citations retrieved, 29 articles met our inclusion criteria and were categorized and analyzed further. Data Extraction: Data collection and analysis was performed by the primary author. The articles related to ISO standards were evaluated for under-standing whether conditions seen in less-resourced settings were considered during the test method development process. Extracted elements from studies on ISO wheelchair testing included wheelchair sample size, ISO durability testing results (number of cycles completed) and part failures. For articles related to wheelchair failures in less-resourced communities, data elements of sample size, study design, duration, outcomes (failures), con-sequences of failures and confounding factors were considered. Data Synthesis: Less-resourced countries have not had much participation in the ISO test method revisions until recently, and thus it appears that the unique environment and use conditions seen in LRCs have not been addressed in the process. There are no sections of the ISO standards which focus directly on the LRC conditions. ISO testing studies with wheelchair models provided in LRCs indicate that products are of poor quality. Data retrieved from wheelchair evaluation studies in community and photographic evidence indicate that failure modes with wheelchairs are diverse owing to demanding conditions in LRCs. ISO tests do not cover the test factors that cause these different failure modes and this finding was also echoed by the ISWP experts based on their field observations. Our findings indicate the need to develop a wide-range of tests for LRCs, with the highest priority ones being related to corrosion of all wheelchair components, rolling resistance of wheelchairs wheels, and durability of caster wheels and fork assemblies. Conclusions: Published evidence combined with expert advice and photographic evidence of field observations indicate that wheelchairs fail in less-resourced settings in ways that would not be predicted by ISO standards which suggests additional tests should be performed. The failure modes that were identified include corrosion/degradation due to the environmental conditions and additional testing should be conducted for rolling resistance and caster durability including whole-chair testing. ISWP is in the process of developing test methods to evaluate wheelchairs against the identified failure modes. Objectives: To assess the effectiveness of Pilates exercise in improving balance and walking in people with multiple sclerosis through a systematic review of randomised controlled trials. Data Sources: A search for " pilates " AND " multiple sclerosis " in five data-bases was undertaken: PubMed, Physiotherapy Evidence Database, Cochrane Library, Scopus, Cumulative Index to Nursing and Allied Health Literature. Study Selection: Two reviewers were involved in the selection and quality appraisal of studies. Randomised controlled trials were included if they were published in English and assessed the effect of Pilates exercise on balance and walking in people with multiple sclerosis. The Modified Physiotherapy Evidence Database tool was utilised to assess trial methodological quality. Data Extraction: Five studies were included. Descriptions of the study population, intervention, comparison, and outcome measures were tabu-lated, and outcomes summated as between group mean differences and 95% confidence intervals. Data Synthesis: Methodological quality was variable. A qualitative syn-thesis of data was undertaken due the clinical heterogeneity. When Pilates exercise was compared to a control, statistically significant improvements were noted in only low quality studies. When Pilates exercise was compared to alternative forms of exercise, inferior or equivalent results were reported in high quality trials, while low quality trials reported either no benefit or improvement in only static balance. When Pilates exercise was compared to a control, statistically significant improvements were noted in low quality studies. Conclusions: There is no high quality evidence to currently support the use of Pilates exercise in people with MS to improve balance and walking. Different results may be obtained if study populations have greater diffi-culties with balance and gait and Pilates exercise treatment is optimised.