Improving work outcomes in people with multiple sclerosis: A scoping review of non-pharmacological interventions

ObjectiveTo evaluate the effectiveness of non-pharmacological intervention studies on work outcomes in people with multiple sclerosis (MS).Data sourcesWe searched three electronic databases (MEDLINE, PsycINFO, and Web of Science: Conference Proceeding Citation Index) and included studies reporting on having/returning to paid employment, work productivity, or factors related to work ability.Review methodsThe Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA extension for scoping reviews checklist were followed. All steps were conducted by two reviewers.ResultsThe search (inception-April 2026) yielded 10449 articles. Sixteen studies were included: four vocational, seven psychological, one exercise, and four combining these intervention types. Reported work outcomes included employment status, work difficulties, workplace accommodations, promotions, impact on work and education, work productivity and impairment, and work and social adjustment. Eight studies aimed to improve work outcomes. Five interventions demonstrated significant improvement: two targeting fatigue with cognitive behavioral therapy (β = -0.34, 95% CI: -0.66 to -0.03; β = -3.68, 95% CI: -5.82 to -1.537), one on conscientiousness (effect size not reported), one on information processing speed (f2 = 0.04, p = 0.044), and one on job seeking (career goals and appraisal of potential work difficulties (t = -2.68, p = 0.009), self-esteem (t = 2.47, p = 0.016), relations (t = 2.44, p = 0.017), finances (t = 2.14, p = 0.036)).ConclusionFew non-pharmacological interventions evaluate work outcomes. Cognitive behavioral therapy targeting MS-related fatigue shows promise for improving work outcomes. The heterogeneity of MS and variability in work contexts add challenges, indicating that personalized interventions may ultimately prove more effective than generic approaches.