Evidence for Occupational Therapy Interventions Supporting Work and Social Participation for Adults With Multiple Sclerosis: A Systematic Review

Method

This systematic review was supported by the AOTA Evidence-Based Practice (EBP) Program. It was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P; Liberati et al., 2009). The study protocol was not registered. We, along with a medical librarian, research methodologist, and AOTA staff, developed the review protocol and finalized the search terms and research question. To enhance the transparency of the review, an external advisory group of content experts with knowledge of neurodegenerative diseases and systematic reviews reviewed the research question and search terms before the review was undertaken.

Results

The database search yielded 12,894 articles, of which 618 were fully screened after inappropriate articles were removed (duplicates, clearly outside the scope of occupational therapy, wrong year, not research, wrong population). Eight additional duplicate articles were removed during the screening process, yielding 610 full-text articles that were assessed for eligibility (Figure 1). Articles were removed after review if they did not meet the inclusion criteria. Ultimately, 4 articles were identified for inclusion in this systematic review. The articles included all the data needed for the review, and authors were not contacted with any follow-up questions.

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Figure 1.

Flow of articles through the systematic review process.

Three articles in the study addressed work, 1 Level 1b (Dorstyn et al., 2018) and 2 Level 3b (Dorstyn et al., 2017; Lexell et al., 2014). These 3 studies were further grouped into two subthemes on the basis of the type of work intervention: community-based online intervention (Dorstyn et al., 2017, 2018) and hospital-based interdisciplinary rehabilitation (Lexell et al., 2014). One Level 1b article addressed social participation (Hasanpour-Dehkordi et al., 2016). None of the other outcomes of interest—education, volunteering, and leisure—were addressed by the studies that met the inclusion criteria.

Discussion

No studies assessing education, volunteering, or leisure participation met the criteria for this review. The final review included only 4 studies, which addressed work and social participation outcomes. All 4 studies were conducted outside of the United States. The Dorstyn et al. (2017, 2018) studies were conducted in Australia, and the Hasanpour-Dehkordi et al. (2016) and Lexell et al. (2014) studies were conducted in Iran. MS affects nearly one million people in the United States (National Multiple Sclerosis Society, 2020), but no study from the United States met the inclusion criteria for this review. The void in research on the effectiveness of interventions within the scope of occupational therapy practice to improve or maintain the performance of and participation in these occupations is disadvantageous to the profession and to people with MS. Occupational therapy practitioners would benefit from more research so that they can provide evidence-based interventions for their clients. The World Health Organization and Multiple Sclerosis International Federation (2008) reported the global median estimated prevalence of MS to be 30 per 100,000. The number of people living with MS warrants research on the effectiveness of interventions provided by occupational therapy practitioners.

On the basis of this review, there is evidence that online modules are an intervention approach that has potential to improve work-related skills (Dorstyn et al., 2017, 2018). Online education on aspects of work prepared participants to understand vocational and career goals and improved self-esteem among community members with MS (Dorstyn et al., 2018). In addition, online education resulted in gains in self-efficacy, identity, and life optimism (Dorstyn et al., 2017). Using online resources to supplement individualized goal-oriented interdisciplinary therapy should be considered if clients have a desire to return to work or are seeking alternative work opportunities.

In addition, moderate strength of evidence indicated that group yoga classes help to improve quality of life and social functioning among community members with MS (Hasanpour-Dehkordi et al., 2016). Incorporating yoga into therapy or as a leisure activity for adults with MS who are interested in yoga should also be considered. Because research is limited, occupational therapy practitioners will need to continue to use their clinical judgment and expertise to determine the appropriate interventions when working with adults with MS. The outcome of the review indicates that more evidence is required.

Implications for Occupational Therapy Practice, Research, and Education

This review has the following implications for occupational therapy practice, research, and education:

Limitations

This review was limited by the small number of studies and low level of evidence of the studies. Only English-language studies were included, which may have resulted in missing pertinent articles. Although a standardized approach was taken for the review, it is possible that articles were missed. Articles that did not include successful interventions may not have been published, thus raising the possibility of publication bias. As always with occupational therapy research, the complexity of the interventions and differences between participant groups can make it difficult to compare studies.

Conclusion

Evidence supported interventions to improve work and social participation for adults with MS; however, we found no evidence for education, volunteering, or leisure. These facets of occupation are important for people with MS, and research is needed to guide clinical practice. There is a critical need for research in these areas to support the interventions for use with adults with MS.

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