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Alfuth M.1
1Niederrhein University of Applied Sciences, Faculty of Health Care, Therapeutic Sciences, Krefeld, Germany
Background: Patients with neurological diseases, such as multiple sclerosis and Parkinson's disease, show significant balance and gait impairments that could be associated with sensorimotor deficits and decreased foot sole sensitivity.
Purpose: To investigate the effects of textured or other types of stimulating insoles on balance and gait characteristics in patients with multiple sclerosis and Parkinson's disease.
Methods: A systematic review of clinical studies was conducted following systematic searches of PubMed, Physiotherapy Evidence Database (PEDro) and Cochrane library (CENTRAL). Studies considered for analysis were selected using the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). They were included if they investigated the influence of textured or other types of stimulating insoles on balance and/or gait in patients with multiple sclerosis or Parkinsons disease aged >18 years. The outcomes pooled for meta-analysis were the center of pressure (CoP) displacement and CoP velocity for balance as well as cadence, velocity and step length for gait. Quality of the studies was assessed by the author using the 25-item checklist of the CONSORT-Statement. Thereby, a total of 37 sub-items were answered. Moreover, a random-effects meta-analysis was conducted to estimate the effects of using the insoles on the outcome variables. For continuous outcomes, standardized mean differences (SMD) with 95% Confidence Intervals (CI) were calculated. Subtotals were calculated to estimate the treatment effects in the subgroups multiple sclerosis and Parkinsons disease. Furthermore, totals were computed to estimate the treatment effects for all included studies. Finally, heterogeneity between studies was assessed using I²- and Chi²- statistics.
Results: The search identified 29 studies. Six studies met the eligibility criteria and were finally analyzed. Five studies had low methodological quality, scoring 17/37 on the checklist and one study had moderate quality, scoring 27/37. Due to designs of the studies, only immediate effects could be calculated. Among the outcome measures of gait, there was no evidence of an effect of using textured/stimulating insoles compared with the respective control condition (totals: SMD -0.09, 95% CI -0.35 to 0.16; SMD 0.18, 95% CI -0.17 to 0.53; SMD -0.13, 95% CI -0.31 to 0.05). Among the outcome measures CoP displacement and CoP velocity no evidence of an effect was found as well (subtotals multiple sclerosis: SMD 0.07, 95% CI -0.15 to 0.28; SMD -0.08, 95% CI -0.55 to 0.39). There was evidence of heterogeneity between all studies (I2=56%, p=0.04) and between subgroups (I2=90.5%, p=0.001) with respect to gait velocity. For CoP displacement and CoP velocity, there was evidence of heterogeneity between the studies and their conditions of the subgroup multiple sclerosis (I2=58%, p=0.008; I2=85%, p 0.001).
Conclusion(s): Using textured or other types of stimulating insoles for the treatment of balance and gait impairments in patients with multiple sclerosis and Parkinsons disease seems to have no effect. However, based on only few available studies, there is very low evidence that there is no effect.
Implications: Physiotherapists should critically reflect the use of textured/stimulating insoles in their treatment of patients with multiple sclerosis or Parkinsons disease who demonstrate balance and gait impairments.
Funding acknowledgements: None.
Topic: Human movement analysis
Ethics approval: Ethics approval was not required for this systematic review.
All authors, affiliations and abstracts have been published as submitted.
