Effects of nonpharmaceutical treatments on symptom management in adults with mild and moderate multiple sclerosis: a meta-analysis

Keira Leigh Byrnes, Stephney Whillier

Research output: Contribution to journalReview articlepeer-review

14 Citations (Scopus)


Objective: The aim of this study was to conduct a meta-analysis of clinical trials on the effect of nonpharmaceutical
treatments on outcomes for multiple sclerosis (MS).
Methods: The CINAHL, Mantis, Medline, PEDro, PubMed, and Scopus databases were searched. Final papers
meeting inclusion criteria were scored with the Physiotherapy Evidence Database for quality and included in a metaanalysis.
Forty papers in the meta-analysis totaled 1673 participants. The interventions were grouped into 6
subcategories: physical activity, technology, rehabilitation, alternative, resistance training, and psychological.
Results: The combined effect of interventions produced a large overall effect size for the outcome fatigue; medium effect
sizes for functionality, balance, and quality of life; and no effect on pain or spasticity. Physical activity had the greatest effect,
improving fatigue, function, and balance. Rehabilitation and resistance training had a large effect on functionality.
Comparatively, psychological approaches had only a small effect on improving quality of life. Sample sizes of included
papers tended to be small with large variability in design. Therefore, results should be interpreted cautiously.
Conclusion: Our results suggest there may be effective nonpharmaceutical treatment options available that can
improve the symptoms of fatigue, poor functionality, balance, and quality of life. We found that physical activity,
alternative approaches, rehabilitation, and resistance training were effective for improving the management of a
number of MS symptoms.
Original languageEnglish
Pages (from-to)514-531
Number of pages18
JournalJournal of Manipulative and Physiological Therapeutics
Issue number7
Publication statusPublished - Sept 2019


  • Meta-analysis
  • Multiple Sclerosis
  • Complementary Therapies


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