Augmented and Mixed Reality Interventions in People with Multiple Sclerosis: A Systematic Review

Background: In recent years, extended reality has gained traction in people with multiple sclerosis (MS) for their ability to deliver engaging, task-specific, and multisensory therapeutic experiences. Aim: This systematic review investigates the application of Mixed Reality (MR) and Augmented Reality (AR) technologies in neurorehabilitation for individuals with MS. Method: A comprehensive systematic review was conducted across seven databases and seven eligible studies were identified involving MR/AR interventions targeting motor and cognitive functions, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO). Data extraction was performed independently by the two reviewers and discrepancies were resolved by consensus or consultation with a third reviewer. Participants were predominantly diagnosed with relapsing-remitting MS and presented mild to moderate disability. Technologies ranged from head-mounted displays to home-based AR platforms, with interventions addressing gait, upper-limb coordination, and dual-task performance. Outcome measures were mapped to the ICF framework, encompassing body function, activity, participation, and contextual factors. Results: Findings suggest short-term improvements in gait parameters, grip strength, and motor coordination, with enhanced engagement and usability reported. Methodological quality was moderate, with small sample sizes and heterogeneous protocols limiting generalizability. Risk of bias varied across study designs. Despite promising results, further research is needed to validate long-term efficacy, optimize cognitive load, and standardize intervention protocols. Conclusions: MR and AR may serve as effective complements to conventional and VR-based rehabilitation, particularly in personalized, task-oriented training for MS populations.