Physical therapy in human T-lymphotropic virus type 1-associated myelopathy: A narrative review

Abstract

Human T-lymphotropic virus type 1-associated myelopathy progressively impairs gait, balance and bladder function, and physical therapy is indicated although the certainty of the supporting evidence has not been graded for the set of interventions. This narrative review aimed to identify the physical therapy interventions evaluated in adults with this myelopathy and to analyze their effects, and the certainty of the supporting evidence, on gait, mobility, balance and secondary outcomes. Five databases were searched in October 2026 without language restriction; the risk of bias of each study was assessed, and the certainty of the evidence from randomized trials was graded per comparison and outcome, without meta-analysis. Nineteen Brazilian studies were included: ten randomized trials and nine studies without a control group, all at high risk of bias or with some concerns. All graded comparisons had very low certainty, including virtual reality compared with no intervention, whose effect on mobility and gait remains uncertain. In the trials of home-based exercise, Pilates, proprioceptive neuromuscular facilitation, pelvic floor electrical stimulation and neuromodulation, the reported improvements came mostly from within-group comparisons, and the studies without a control group only described changes after the intervention. None of the included studies measured falls as a comparative outcome, and only four recorded adverse events with a described method. The evidence characterizes the reported results and their limitations, but does not establish the direction or magnitude of the effects, or their safety.