Key messages

• Immediately after occupational therapy (OT), people with multiple sclerosis may show small improvements in daily functioning and mental health-related quality of life (HR-QoL), but OT may have little to no effect on physical HR-QoL or participation.

• Three to six months after therapy, OT may lead to small improvements in mental HR-QoL, but may have little effect on daily activities or physical HR-QoL. Compared to usual care, occupational therapy may cause some improvement in daily functioning and physical and mental health-related QoL.

• Due to lack of information, we are uncertain about the long-term benefits or harms of OT.

• The real effect of OT may be undervalued in our findings because the studies tested a wide range of different OT interventions, and we did not include studies that evaluated a combination of OT and other therapies unless the specific effects of the OT were measured.

• Future research should aim to identify which components work best for whom and in what context.

What is multiple sclerosis?

Multiple sclerosis (MS) is a common disease of the central nervous system, affecting about 2.9 million people worldwide. In MS, the immune system mistakenly attacks the protective layer around nerve fibres in the brain and spinal cord. This disrupts communication between the brain and the rest of the body, causing symptoms like fatigue, muscle weakness and balance problems. MS can make everyday tasks like dressing, preparing meals or walking difficult. It can also affect memory and concentration, making work and social interactions more challenging.

How is multiple sclerosis treated?

Medications for MS aim to reduce flare-ups, slow disease progression and manage symptoms. Rehabilitation therapies can support people with MS to manage their symptoms, improve daily functioning and stay active in the community.

One rehabilitation therapy is occupational therapy (OT). OT helps people with everyday tasks like dressing, cooking, bathing and working. Occupational therapists teach people ways to make these activities easier and provide tools to help manage symptoms. They also work on improving strength and coordination to make daily life more manageable.

What did we want to find out?

We wanted to find out how OT benefits people with MS, specifically how it affects daily functioning, physical and mental health-related quality of life (HR-QoL), and participation. We also wanted to find out if OT causes any unwanted effects.

What did we do?

We searched for studies that compared OT interventions with other interventions, usual care or no treatment in people with MS. We excluded multidisciplinary studies — studies where several different types of health professionals provide care in parallel — unless the contribution of OT was specifically reported. We were interested in the effects immediately after treatment, three to six months after treatment (medium term) and one year after treatment (long term). We combined the results of the studies and rated our confidence in the evidence, based on factors such as study methods and number of studies.

What did we find?

We found 20 studies of OT interventions that involved 1628 people with MS. Ten studies looked at ways to help people with MS manage their fatigue; nine focused on improving daily activities like dressing and cooking; and one aimed to support greater involvement in social activities. The studies were mostly carried out in high-income countries. The participants in the studies were adults aged 18 to 70 years who had MS causing mild to moderate disability.

What were the results?

OT may give small improvements in daily functioning compared with other treatments in the short term, and possibly larger benefits compared with usual care or no intervention, but the evidence is often uncertain. Medium-term and long‑term effects are unclear.

OT may lead to small improvements in mental HR-QoL in the short term, but have little to no effect on physical HR-QoL. Results for comparisons with usual care or no intervention are very uncertain, and medium-term and long‑term effects are unclear.

OT may have little to no effect on participation in the short term; evidence is very limited.

No study reported harms from OT in a systematic way, so these remain unknown.

What are the limitations of the evidence?

There is limited evidence about how OT affects physical HR-QoL for people with MS. We are unsure how OT compares to usual care or no treatment because there are not enough studies to draw firm conclusions. There is no evidence about potential harmful effects of OT, and limited evidence about OT for people with high levels of disability due to MS.

Another limitation was that we grouped very different OT interventions together, making the results less certain and harder to interpret. OT is made up of many different approaches, not just one. Also, by leaving out most team-based studies unless the role of OT was clearly described, we may have missed important evidence.

More studies are needed to fully understand the impact of OT on people with MS.

How up to date is this evidence?

The evidence is based on searches run in November 2024.