Orthotic interventions for lower limb impaired patients with multiple sclerosis: an Umbrella Review

Abstract: Background: Multiple sclerosis is a chronic inflammatory auto-immune disease with various symptoms, which requires comprehensive multidisciplinary treatment for distinct and individualized conditions. Reviews on this population address treatment alternatives (i.e., pharmaceutical and rehabilitation). Orthotic interventions are seldom mentioned or mentioned briefly in conjunction with physiotherapy interventions. Aim: This study aims to critically appraise and summarize current evidence regarding orthotic interventions for multiple sclerosis population with lower limb deficiencies. Methods: This study uses umbrella review protocol for systematic reviews. 5 databases were used (CINAHL, Cochrane, PubMed, Scopus, Web of Science). From 44 reviews, 6 systematic reviews were obtained using JBI appraisal tool. Methodological quality is appraised using AMSTAR II, data were extracted via JBI data extraction form for umbrella reviews. 2 articles were excluded and the evidence quality of the remaining 4 articles were appraised via GRADE. Results: 2 out of 4 investigated the effect of foot orthoses, whilst the remaining investigated FES devices. 3 out of 4 articles scored “Critically low” in methodological quality, 1 scored “High”. The evidence quality of the different outcomes ranges from "Very low” to “High”. Conclusion: Foot orthoses reported an increase RoM in ankle and knee joints. FES intervention found an increase in speed and endurance during gait and increased RoM of ankle and knee. However, more studies with higher quality are needed to establish clinical recommendations.