Systematic ReviewResearchPatient EducationQuality Improvement

Vestibular rehabilitation may improve balance, walking, and dizziness in multiple sclerosis

Journal of neurology (PubMed)Aug 27, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A meta-analysis of randomized trials found vestibular rehabilitation may improve balance, walking speed and endurance, dizziness, fatigue, and depression in people with multiple sclerosis, although evidence certainty was generally low or very low.

What NurseJet pulled from the source

Thirteen randomized trials included 454 participants. Pooled results favored vestibular rehabilitation for several balance, walking, dizziness, fatigue, and depression measures, while transfer ability, balance self-efficacy, and quality of life did not differ significantly. The authors call for larger trials because certainty was low or very low.

Why this matters for nurses

Dizziness and postural instability increase fall risk and can limit daily activity for people with multiple sclerosis. Nurses can identify vestibular symptoms, protect mobility, and support referral and adherence without presenting rehabilitation as a proven solution for every outcome.

Bedside takeaway

Consider vestibular symptoms in fall and mobility assessments; rehabilitation may help several outcomes, but the evidence remains low certainty.

How This Applies in Practice

Use this when: Assessing mobility or discharge needs for a person with multiple sclerosis who reports dizziness, imbalance, or reduced walking tolerance.

On your shift

Assess symptom triggers, gait and transfer safety, recent falls, fatigue, and the assistive device or help needed for mobility.
Communicate vestibular and mobility findings to the rehabilitation team and follow the ordered activity and fall-prevention plan.
Use teach-back to confirm the patient understands the prescribed exercises, pacing, and safety precautions before discharge.

Keep in mind: The evidence does not identify one protocol for all patients. Follow the individualized rehabilitation plan, facility policy, and provider orders.

Key takeaways

The meta-analysis included 13 randomized trials with 454 people with multiple sclerosis.
Vestibular rehabilitation may improve balance, walking speed, walking endurance, and dizziness compared with control interventions.
Pooled estimates also favored rehabilitation for fatigue and depression measures.
Transfer ability, balance self-efficacy, and quality of life did not show significant between-group differences.

Practice implications

Assess dizziness, gait, transfer safety, fatigue, and recent falls; use the ordered mobility plan and assistive devices; and communicate persistent vestibular symptoms for rehabilitation evaluation. Reinforce the prescribed home program only after confirming technique and safety precautions.

Limitations & cautions

The pooled evidence came from 13 small trials, comparator interventions varied, and certainty was generally low or very low. The abstract does not establish a single optimal rehabilitation protocol or sustained benefit after treatment ends.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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Journal of neurology (PubMed)

Journal of neurology (PubMed). Effectiveness of vestibular rehabilitation in patients with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42658257/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Renal failure (PubMed)Sep 7, 2026Research Article

A single-center retrospective cohort found that approximately one quarter of laboratory-defined acute kidney injury cases on internal medicine wards were not documented, particularly when maximal creatinine was lower.

Med-SurgAI summaryReview source

Research ArticleResearchQuality ImprovementAI summary · original source linked below

Among 161 adult hospitalizations meeting serum-creatinine criteria for acute kidney injury, 39 cases (24.2%) were undocumented. Length of stay and in-hospital mortality did not differ significantly by documentation status.

Key takeaways

In the 149 hospitalizations with a demonstrable creatinine change, 33 cases (22.1%) were undocumented.
Higher maximal creatinine was associated with lower adjusted odds of underdocumentation.
The study did not test whether a detection or documentation intervention improves care or outcomes.

Why this matters on shift

A smaller creatinine rise may receive less attention even when it meets the study's laboratory definition of acute kidney injury, which can affect how renal risk is communicated across the inpatient team.

Bedside takeaway

Trend ordered renal-function results and communicate clinically important changes through local escalation and documentation workflows.

Nursing implications

Trend ordered renal-function results and communicate clinically important changes through the care team according to local escalation and documentation workflows.

Limitations & cautions

Abstract-only summary. This was a retrospective, single-center study of 161 hospitalizations; urine-output criteria and reliable preadmission creatinine values were unavailable, and the reference creatinine method may affect case classification.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Renal failure (PubMed). Underdocumentation of laboratory-defined acute kidney injury in internal medicine wards: a retrospective cohort study.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Pediatric emergency care (PubMed)Sep 7, 2026Research Article

A double-blind randomized trial found no reduction in vomiting or faster oral tolerance with intravenous pantoprazole versus placebo in children with acute gastroenteritis and persistent vomiting after ondansetron.

Peds EmergencyAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

The trial randomized 100 children. Vomiting episodes and oral tolerance at 6 and 12 hours did not differ significantly, while median hospital stay was 2 days with pantoprazole and 1 day with placebo.

Key takeaways

The median participant age was 14 months, and 67% of participants were male.
Oral tolerance at 12 hours was 86% in both groups.
The longer stay associated with pantoprazole requires cautious interpretation because this was a single-center trial.

Why this matters on shift

The trial does not support empiric intravenous proton-pump inhibition for persistent vomiting in pediatric acute gastroenteritis after ondansetron.

Bedside takeaway

Clarify the indication for empiric acid suppression and keep hydration and oral-tolerance assessment central to care.

Nursing implications

Prioritize the ordered hydration and oral-tolerance plan, document ongoing emesis, and clarify the indication before administering empiric acid suppression.

Limitations & cautions

Abstract-only summary. This was a single-center study of 100 children in Tehran, and the abstract does not describe adverse events or explain why hospitalization was longer in the pantoprazole group.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Pediatric emergency care (PubMed). Effect of Intravenous Pantoprazole on Clinical Outcomes in Pediatric Acute Gastroenteritis: A Placebo-Controlled RCT.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

European heart journal (PubMed)Sep 6, 2026Research Article

In the pragmatic TARGET-D randomized trial, vitamin D dosing titrated to a serum target did not significantly reduce the composite of death, recurrent myocardial infarction, heart-failure hospitalization, or stroke after myocardial infarction.

Telemetry Med-SurgAI summaryReview source

Research ArticleResearchMedication SafetyPatient EducationAI summary · original source linked below

Among 630 participants followed for an average of 4.2 years, major cardiovascular events occurred in 15.7% with targeted vitamin D management and 18.4% with usual care (hazard ratio 0.85, 95% CI 0.58 to 1.24; P=0.40).

Key takeaways

At baseline, 87% of participants had a 25-hydroxyvitamin D level of 40 ng/mL or lower.
The primary composite outcome and the individual outcomes of death, heart-failure hospitalization, and stroke were not significantly different.
A lower recurrent-MI rate was a secondary finding and should not override the nonsignificant primary result.

Why this matters on shift

The trial cautions against presenting targeted vitamin D supplementation as a proven strategy for reducing major cardiovascular events after myocardial infarction.

Bedside takeaway

Present vitamin D as prescribed supplementation, not as a replacement for established post-MI secondary prevention.

Nursing implications

Reinforce the prescribed secondary-prevention plan and avoid implying that vitamin D replaces therapies with established post-MI benefit.

Limitations & cautions

Abstract-only summary. The trial included 630 participants, 78.1% were men, the primary confidence interval included benefit and no benefit, and individual secondary outcomes were not the primary endpoint.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

European heart journal (PubMed). Targeted vitamin D supplementation and major adverse cardiovascular events after myocardial infarction: the TARGET-D trial.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

One in four laboratory-defined AKI cases went undocumented on medicine wards

IV pantoprazole did not improve vomiting or oral tolerance in pediatric gastroenteritis

Targeted vitamin D did not significantly reduce major cardiovascular events after MI