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Vestibular rehabilitation improves balance, walking speed, and reduces dizziness in patients with multiple sclerosisVestibular rehabilitation improves balance and walking for people with MS

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Key Takeaway
Consider vestibular rehabilitation to improve balance, walking speed, and fatigue in patients with multiple sclerosis.

This meta-analysis evaluated the impact of vestibular rehabilitation (VR) on patients with multiple sclerosis (MS) compared to traditional physiotherapy, usual care, or no intervention. The study included a total of 454 patients to assess various physical and psychological outcomes.

The analysis found significant improvements in several key areas: balance (SMD: 1.24; 95% CI 0.46-2.01), walking speed (MD: 0.19; 95% CI 0.12-0.26), and walking endurance (SMD: 0.43; 95% CI 0.08-0.78). Additionally, patients reported significant improvements in 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 differences were observed in transfer ability, balance self-efficacy, or quality of life. The authors note that the certainty of evidence for these findings is generally low or very low. While VR may be clinically relevant for managing symptoms like balance and fatigue in MS, larger randomized controlled trials are required to establish more certain evidence.

How this fits prior evidence

This meta-analysis addresses a gap in managing physical and psychological symptoms in multiple sclerosis. While previous evidence has identified high prevalence of neurogenic bladder and autonomic gastrointestinal dysfunction in MS patients, this finding provides evidence that vestibular rehabilitation may specifically improve balance, walking speed, and fatigue. It does not directly relate to the reported findings regarding brain age, glutamatergic agents, or environmental risks for Parkinson's disease.

Living with multiple sclerosis (MS) can make simple movements feel unpredictable. Many people with MS struggle with balance and dizziness, which can make walking feel tiring or even unsafe. New data suggests that vestibular rehabilitation, a type of physical therapy focused on the balance system, may offer significant help.

Researchers looked at data from 454 patients to see how this specific therapy compared to standard care. The results showed that patients who practiced vestibular rehabilitation saw significant improvements in their balance, walking speed, and walking endurance. They also reported less dizziness and lower levels of fatigue and depression.

While these results are promising, it is important to note that the overall certainty of the evidence is currently low. The study did not find significant changes in transfer ability or quality of life scores. Because the evidence is not yet firm, larger clinical trials are needed to confirm these findings and understand how well it works for everyone.

What this means for you:
Vestibular rehabilitation can improve balance, walking speed, and reduce dizziness and fatigue in people with MS.

Common questions

What symptoms can vestibular rehabilitation help with?

Vestibular rehabilitation can significantly improve balance, walking speed, and walking endurance. It also helps reduce symptoms of dizziness, fatigue, and depression in people with multiple sclerosis.

Is it effective for walking and balance?

Yes, the data shows that patients who underwent vestibular rehabilitation saw significant improvements in both balance and walking speed compared to those receiving standard care or no intervention.

Is the evidence for this treatment certain?

The certainty of the evidence for these improvements is currently low or very low. Because the evidence is not yet firm, larger clinical trials are needed to confirm the results.

Study Details

Study typeMeta analysis
Sample sizen = 454
EvidenceLevel 1
PublishedAug 2026
View Original 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.
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