Effectiveness of vestibular physical therapy on balance and dizziness in people with multiple sclerosis: A systematic review and meta-analysis

Multiple Sclerosis (MS) is a chronic, inflammatory, and degenerative disease of the central nervous system. Balance impairments are very common symptoms among people with MS (PwMS). Vestibular physical therapy (VPT) is an evidence-based approach aimed at managing and improving gaze and balance stability, which could be used to mitigate balance disorders in MS. The objective of this systematic review with meta-analysis is to evaluate the effects of VPT in managing balance and dizziness in PwMS.Electronic databases were searched in February 2025 (PubMed, Scopus and Cochrane) and screened by two blind reviewers. Risk of Bias was assessed using PEDro Scale. A meta-analysis was conducted to evaluate, across multiple studies, the effect sizes for two clinical outcomes: the Dizziness Handicap Inventory (DHI) and the Activities-specific Balance Confidence Scale (ABC).After screening, 16 articles were included in the review, mostly comparing VPT with other conventional approaches. Analysis of the Risk of bias showed quality deficiencies in these studied with respect to the blinding of participants, assessor and physiotherapist. The meta-analysis showed significant efficacy of VPT against control using the DHI as outcome measure (Hedges' g = 1.451, CI [0.190, 2.713]).In conclusion, VPT is a safe approach in reducing dizziness-related disability of PwMS. Further studies are needed to refine assessment methods and explore individualized approaches.