Interventions to Improve Quality of Life in Multiple Sclerosis: New Opportunities and Key Talking Points

Figures & data

Table 1 Inclusion Criteria

	Inclusion Criteria	Exclusion Criteria
Study design	Randomized and nonrandomized controlled trials, pilot studies, qualitative studies	Study protocols.
Population	Adults with a diagnosis of MS	Other neurological conditions
Intervention	Non-pharmacological, intervention, non-drug, health-related quality of life, quality of life, life satisfaction, life quality	Imaging studies, pharmacological interventions, acute interventions, aquatic exercises, numeric tools
Primary outcomes	Improved quality of life, health-related quality of life, life satisfaction, or life quality

Figure 1 Search Strategy.

Table 2 Summary of Evidence Organized by Theme

Theme	Author/Year	Intervention	Interventions Findings Related to Quality of Life in pwMS	Methodological Quality and Type of Study. (PEDro Scale, PRISMA)
Fatigue and Sleep	Harrison AM, Safari R, Mercer T, et al (2021)^Citation24	Balance exercise General exercises Cognitive Behavioral Therapy (CBT)	Moderate effect on reducing fatigue Moderate effect on reducing fatigue Large effect on reducing fatigue	Moderate-High level of evidence (PRISMA) Meta-analysis Systematic Review
	Amin, N.S., Tayebi, H.M.E. (2023)^Citation29	Resistance training	Demonstrated to improve overall well-being and quality of life	Narrative Review
	Zrzavy, T., Pfitzner, A., et al (2021)^Citation30	Endurance training	Endurance training provides substantial benefits to fatigue management.	Moderate evidence (PEDRO) Randomized prospective longitudinal pilot study
	Salarvand, S., Heidari, M.E., et al (2021)^Citation31	Massage	Large effect of decreased pain and fatigue levels	Moderate evidence (PRISMA) Systematic Review
	Moss-Morris R, Harrison A, et al (2019)^Citation32	Exercise Behavioral therapy	Low level of evidence demonstrating effectiveness at decreasing fatigue Moderate level of evidence demonstrating effectiveness at decreasing fatigue	Low level (PRISMA) Systematic Review
	D’arma, A., Saresella, M., et al (2022)^Citation33	Brief High Impact Multidimensional Rehab Program in MS	Improved clinical parameters and quality of life potential reduction in inflammation related to MS	Moderate level of evidence. (PEDRO) Quasi-experimental
	Al-Sharman, A., Khalil, H., et al (2019)^Citation22	Aerobic exercise	Effective and safe method to improve sleep quality, fatigue, and quality of life in pwMS	Moderate level of evidence (PEDRO) RCT (randomized controlled trial)
	Cancelli A., Cottone C, et al (2018)^Citation34	Neuromodulation interventions	Significant fatigue reduction compared to sham in mildly disabled adults with MS and fatigue symptoms	Moderate-High level of evidence (PEDRO) Replication RCT
	Nourbakhsh B, Waubant E, et al (2021)^Citation35	Exercise and Cognitive Behavioral therapy	Exercise and behavioral therapy should be prioritized for fatigue treatment	Position Paper
	Feys P, Moumdjian, L et al (2019)^Citation36	Community “start to run” program over 12 weeks.	Community-located run training improved aerobic capacity, functional mobility, visuospatial memory, fatigue, and quality of life, and pallidum volume in pwMS.	Moderate evidence (PEDRO) RCT
	Cortes-Perez I, Sanchez-Alcala, M, et al (2021)^Citation37	Virtual Reality-Based Therapy	RBT effectively reduces fatigue and MS impact and improves the quality of life in pwMS.	Systematic Review with Meta-analysis (PRISMA)
Mental and Emotional Health	Di Cara, M., Grezzo, D, et al (2022)^Citation38	Mindfulness interventions	Resulted in decreased depressive symptoms, reduced fatigue, and improved quality of life	Descriptive Review
	Langroudi, R.R., Ghiasian, M., R et al, (2020)^Citation39	Group therapy for pain, fatigue, and quality of life	Effective at improving fatigue, pain levels, and quality of life when used along with medical therapies	Moderate le evidence Quasi-experimental (pre/post) design (PEDRO)
	Schreiner, T.G., Ignat, B.E. (2020)^Citation20	Nonpharmacological approaches combined with pharmacological	Improved depressive symptoms when nonpharmacological approaches are used in conjunction with depression medications	Literature review
	Homayuni A, Abdeini S, et al (2021)^Citation40	Qualitative interviews to determine pwMS’s perceptions on how to improve quality of life	To improve the quality of life for pwMS, the factors listed below should be included in routine medical care: leisure time, spirituality, positive thinking, exercise, and social support.	Moderate level of evidence (NICE- Quality appraisal checklist for qualitative study) Qualitative Study
Cognition	Harand, C., Defer, G (2020)^Citation27	Cognitive rehabilitation	Moderate level of evidence demonstrating effectiveness at improving cognitive functioning, quality of life, and self-esteem	Extended Review
	Ozkul C, Guclu-Gunduz A, et al (2020)^Citation41	Combined exercise training (aerobic and pilates) 3x week for eight weeks.	Demonstrated significant improvement in verbal memory, walking capacity, cognitive fatigue, and quality of life	High level of evidence RCT (PEDRO)
	Montanes-Masisa B, Bort-Roig J et al (2022)^Citation42	Cognitive behavioral therapy (CBT) and mindfulness interventions (MBI)	Psychological online interventions may improve socio-affective and cognitive symptoms and improve quality of life for pwMS.	Low level of evidence Systematic Review (PRISMA)
	Nauta I. M., Speckens, AEM, et al (2017)^Citation26	Cognitive rehabilitation therapy (CRT) and mindfulness-based cognitive therapy (MBCT)	CRT and MBCT are effective at improving the quality of life for pwMS	Narrative Review
Physical Health	Grazioli, E., Nigro, E., C, et al (2020)^Citation43	Four months of moderate-intensity training exercises	Resulted in a statically significant improvement in perceived quality of life.	Case study
	Eldemir K, Guclu-Gunduz, et al (2023)^Citation41	Pilates-based telerehabilitation (Pilates-TR) 3x week for six weeks.	Pilates-TR was effective in improving physical performance and quality of life in pwMS.	Moderate level of evidence RCT (PEDRO)
	Naro A, Leo A, et al (2017)^Citation44	Neurostimulation and vibration therapy for spasticity management	Increasing evidence supporting NINM and vibration therapy to reduce spasticity and improve quality of life	Narrative Literature review
Chronic Pain	Zucchella, C., Mantovani, E., D et al (2020)^Citation45	Non-invasive brain and spinal stimulation (NIBSS) for pain related to MS	The studies converge in showing a significant improvement in pain after active NIBSS	Moderate level of evidence Systematic Review (PRISMA)
	Amatya, B., Young, J., Khan, F. (2019)^Citation46	Pain reduction strategies (TENS, psychotherapy, tDCS)	Low level of evidence and limited evidence of effectiveness on QOL.	Low level of evidence Cochrane review

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