Effect of square-stepping exercises on mobility, balance and knee joint position sense in individuals with multiple sclerosis

Background Multiple sclerosis (MS) is associated with impaired mobility, balance, and lower-limb position sense.Objective This study aimed to investigate the effects of Square-Stepping Exercise (SSE), a task-oriented sensorimotor stepping intervention, on mobility, balance, and knee joint position sense (JPS) in people with MS.Methods Forty individuals with MS, aged 20–50 years, were randomly allocated (1:1) to either the SSE group (n = 20) or the home-based Frenkel Coordination Exercise (FCE) group (control; n = 20). Both groups participated in their respective exercise programs twice weekly for eight weeks. Assessments were performed at baseline and post-intervention. Mobility and balance were assessed using the Timed 25-Foot Walk (T25FW), Five-Repetition Sit-to-Stand Test (5STS), Four Square Step Test (FSST), and the Activities-specific Balance Confidence Scale (ABC). Knee JPS was assessed using the K-FORCE Sens® device at target knee extension angles of 30° and 60°.Results Baseline-adjusted analysis of covariance (ANCOVA) revealed significant between-group differences favoring SSE, with large effect sizes, for T25FW (p < .001; Hedges’ g = −1.17), FSST (p < .001; g = −2.27), and ABC (p < .001; g = 1.23). Significant between-group differences favoring SSE were also observed for all knee JPS outcomes, with effect sizes ranging from small to large (p = .004–0.024; g = −0.45 to −0.80). No adjusted between-group difference was found for 5STS (p = .451; g = 0.22, small effect).Conclusion The SSE intervention was associated with favorable changes in mobility, balance, and knee JPS outcomes in individuals with MS.Trial Registration This trial was registered with ClinicalTrials.gov (NCT05682963) on December 24, 2022.