Summary of findings for the main comparison. Exercise compared to control (post‐intervention) for preventing falls in people with multiple sclerosis.
| Exercise compared to control (post‐intervention) for preventing falls in people with multiple sclerosis | ||||||
| Patient or population: people with multiple sclerosis (including people with relapsing‐remitting, secondary progressive or primary progressive types of MS), mean age: 53 years Setting: community or home Intervention: exercise (community‐based or home‐based exercise interventions), ranging from 6 to 24 weeks in duration, ranging from once to 5 times weekly frequency Comparison: usual care treatment or wait‐list control | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with control (post‐intervention) | Risk with Exercise | |||||
| Falls rate Falls were measured using prospective daily diaries, prospective monthly calendars or retrospectively. Falls rate calculation= number of falls/number in group * (number of days/365) The timing of measurement was post‐intervention for all studies |
Not applicable | Not applicable | Rate ratio 0.68 (0.43 to 1.06) | 399 (5 RCTs) | ⊕⊕⊕⊝ VERY LOW |
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| Number of fallers Falls were measured using prospective daily diaries, prospective monthly calendars or retrospectively The timing of measurement was post‐intervention for all studies |
305 per 1,000 | 259 per 1,000 (156 to 436) | RR 0.85 (0.51 to 1.43) | 355 (5 RCTs) | ⊕⊕⊕⊝ LOW |
|
| Adverse events The timing of measurement was post‐intervention for all studies |
44 per 1,000 | 56 per 1,000 (12 to 268) | RR 1.25 (0.26 to 6.03) | 97 (3 RCTs) | ⊕⊕⊕⊝ LOW |
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| Quality of life | see comments | see comments | not estimable | Studies included in this analysis did not report data on quality of life | ||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio. | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
Falls rate: GRADE assessment‐ Downgraded one level due to risk of bias and one level due to imprecision and one level due to inconsistency. Four studies at high risk of bias in allocation concealment domain; five studies at unclear risk of bias in blinding of participants domain; two studies at high risk of bias and one study at unclear risk of bias in selective reporting domain; wide CI; I2= 59%
Number of fallers: GRADE assessment‐ Downgraded one level due to risk of bias and one level due to imprecision, One study at high risk of bias in attrition domain; two study at unclear risk of bias in allocation concealment domain; five studies at unclear risk of bias in blinding of participants domain; and four studies at high risk of bias in selective reporting domain; wide CI
Adverse events: GRADE assessment‐ Downgraded one level due to risk of bias and one level due to imprecision, One study at unclear risk of bias in allocation concealment domain; three studies at unclear risk of bias in blinding of participants domain; and three studies at high risk of bias in selective reporting domain; wide CI