Effectiveness of vestibular rehabilitation in patients with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.

Abstract

Background Patients with multiple sclerosis (MS) frequently experience postural instability, dizziness, and impaired eye-head-body coordination, which reduce mobility and quality of life (QoL). Vestibular rehabilitation (VR) may improve vestibulo-ocular and vestibulo-spinal function. Objectives To evaluate the effects of VR on balance, gait function, transfer ability, dizziness, fatigue, depression, and QoL in patients with MS. Methods PubMed, EMBASE, the Cochrane Library, Web of Science, and ClinicalTrials.gov were searched from inception to May 2026. Eligible randomized controlled trials (RCTs) compared VR with traditional physiotherapy, usual care, or no intervention. Random-effects meta-analyses were performed using Review Manager 5.4.1. Results Thirteen RCTs involving 454 patients with MS were included. Compared with the control interventions, VR significantly improved balance (standardized mean difference [SMD]: 1.24, 95% confidence interval [CI] 0.46-2.01), walking speed (MD: 0.19, 95% CI 0.12-0.26), walking endurance (SMD: 0.43, 95% CI 0.08-0.78), dizziness (MD -10.56, 95% CI -18.42 to -2.71), fatigue (SMD: -1.23, 95% CI -2.25 to -0.21), and depression (MD -4.14, 95% CI -7.16 to -1.12). No significant between-group differences were observed in transfer ability (SMD: -0.58, 95% CI -1.22 to 0.06), balance self-efficacy (MD 14.58, 95% CI -2.92 to 32.09), or QoL (SMD 0.51, 95% CI-0.45 to 1.48). Conclusions VR may improve balance, walking speed, walking endurance, dizziness, fatigue, and depression in patients with MS; however, the certainty of evidence is generally low or very low. Therefore, larger RCTs are required.