This systematic review aims to determine the effectiveness of non-pharmacological interventions for the management of spasticity in people with multiple sclerosis (pwMS). A comprehensive literature search in health science databases (MEDLINE, Embase, CENTRAL, CINHAL) was performed to identify randomized controlled trials (RCTs) (up to April 2024). Manual searching in journals and screening of the reference lists of identified studies were conducted. Two authors independently selected the studies, assessed the methodological quality, and summarized the evidence. A meta-analysis was not feasible due to the methodological, clinical, and statistical diversity of the included studies. Overall, 32 RCTs (n=1,481 participants) investigated various types of non-pharmacological interventions including: physical activity, transcranial magnetic stimulation (intermittent theta burst stimulation [iTBS], repetitive transcranial magnetic stimulation [rTMS]), electromagnetic therapy, transcutaneous electrical nerve stimulation, vibration therapy, shock wave therapy, self-management educational programs, and acupuncture. All studies scored ‘low’ on the methodological quality assessment, implying a high risk of bias. The findings suggest ‘moderate to low certainty’ evidence for physical activity programs used in isolation or combination with other interventions (pharmacological or non-pharmacological), and for iTBS/rTMS with or without adjuvant exercise therapy in improving spasticity in adults with MS. There is ‘very low certainty’ evidence supporting the use of other modalities for treating spasticity in this population. Despite a wide range of non-pharmacological interventions used for the management of spasticity in pwMS, there is a lack of conclusive evidence for many. More robust trials with larger sample sizes and longer-term follow-ups are needed to build evidence for these interventions.

Citations

• The effect of the EXOPULSE Mollii suit on motor functions in patients with multiple sclerosis – a randomized sham-controlled crossover trial
  Samar S Ayache, Joseph G Mattar, Alain Créange, Mohamed Abdellaoui, Mickael Zedet, Jean-Pascal Lefaucheur, Hana Megherbi, Hayfa Khaled, Georges Naïm Abi Lahoud, Moussa A Chalah
  Multiple Sclerosis Journal – Experimental, Translational and Clinical.2025;[Epub]     CrossRef
• Efeito agudo do ultrassom no padrão espástico do bíceps braquial em indivíduos com distúrbios neurológicos
  João Sávio Carneiro Silva, Letícia Costa Mengoni, Gabriel Pádua da Silva, Wellington Marcelo Queixas Moreira, Oswaldo Luiz Stamato Taube, Bruno Ferreira
  RCMOS - Revista Científica Multidisciplinar O Saber.2025;[Epub]     CrossRef
• Balancing innovation and affordability in relapsing-remitting multiple sclerosis: a budget impact analysis from Saudi Arabia
  Ahmed Al-Jedai, Hajer Almudaiheem, Faisal Al-Suweidan, Mohamed al Jumah, Ahmed al-Thobaiti, Fahad Alzureiqan, Wejdan Abu Ras, Fahad M. Al-Dosari, Yaser Al Malik, Pratik Dhopte, Rita Ojeil
  Frontiers in Public Health.2025;[Epub]     CrossRef
• Trigeminal neuralgia in multiple sclerosis patients: a systematic review and meta-analysis of minimally invasive surgical procedures, decompression, and the pain outcomes
  Daniel Encarnación-Santos, Gennady Chmutin, Nazmin Ahmed, Egor Chmutin, Emmanuel Batista-Geraldino, Bipin Chaurasia
  Headache Medicine.2025; 16(4): 244.     CrossRef

With the increasing frequency of disasters and the significant upsurge of survivors with severe impairments and long-term disabling conditions, there is a greater focus on the importance of rehabilitation in disaster management. During disasters, rehabilitation services confront a greater load due to the influx of victims, management of persons with pre-existing disabilities and chronic conditions, and longer-term care continuum. Despite robust consensus amongst the international disaster response and management community for the rehabilitation-inclusive disaster management process, rehabilitation is still less prioritised. Evidence supports the early involvement of rehabilitation professionals in disaster response and management for minimising mortality and disability, and improving clinical outcomes and participation in disaster survivors. In the last two decades, there have been substantial developments in disaster response/management processes including the World Health Organization Emergency Medical Team (EMT) initiative, which provides a standardized structured plan to provide effective and coordinated care during disasters. However, rehabilitation-inclusive disaster management plans are yet to be developed and/or implemented in many disaster-prone countries. Strong leadership and effective action from national and international bodies are required to strengthen national rehabilitation capacity (services and skilled workforce) and empower international and local EMTs and health services for comprehensive disaster management in future calamities. This narrative review highlights the role of rehabilitation and current developments in disaster rehabilitation; challenges and key future perspectives in this area.

Citations

• A Survey on Awareness of Disaster Rehabilitation among Therapists
  Akiyuki Okamoto, Yui Kasamatsu, Hiromi Hashimoto, Rikito Zaiki, Koya Nakai, Ken Kouda
  The Japanese Journal of Rehabilitation Medicine.2026;[Epub]     CrossRef
• Rehabilitation under fire: insights from SUMC
  Alan Friedman, Cheryl Benjamin, Iuly Treger
  The Lancet.2025; 405(10487): 1338.     CrossRef
• Interleaved Practice in Remediating Basic Arithmetic Proficiency in Grade One
  Junessa Bonite
  Journal of Interdisciplinary Perspectives.2025;[Epub]     CrossRef
• Disaster Risk Reduction and Management of the Province of Siquijor: A Basis for a Strategic Development Plan
  Enrico Zerna
  Journal of Interdisciplinary Perspectives.2025;[Epub]     CrossRef
• The Philippine Disaster Risk Reduction and Management in Health: A Sequential Explanatory Approach
  Mary Joy Hermosura, Aaron Carlo Decendario, Leo Chiong
  Journal of Interdisciplinary Perspectives.2025;[Epub]     CrossRef
• Ensuring Delivery of Effective Pain Management during Disasters
  Saurabh RamBihariLal Shrivastava, Prateek Sudhakar Bobhate, Sanjay Deshpande
  Nigerian Postgraduate Medical Journal.2025; 32(3): 259.     CrossRef
• Disaster competencies among physiotherapists in a Conflict-Ridden world: an overview of current Challenges and future directions – “Letter to the editor”
  Mohammad Sidiq, Aksh Chahal, Jyoti Sharma
  European Journal of Physiotherapy.2025; 27(5): 328.     CrossRef
• Unprepared and Overlooked: Strengthening Disaster Readiness in Vocational Rehabilitation
  Lee Ann Rawlins Williams
  The Rehabilitation Professional.2025;[Epub]     CrossRef
• Afet Sonrası Tıbbi Rehabilitasyon Süreci ve Küresel Gelişmeler
  Cem Zafer Yıldır
  Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi.2024; 19(1): 134.     CrossRef
• Development and implementation of a rehabilitation triage algorithm for disasters in the subacute phase: an experience from the 2024 Noto peninsula earthquake
  Shigehito Shiota, Naoya Orita, Yuma Tsubakita, Masaya Ichimoto, Noboru Shimada, Naoya Goto, Tomohiro Hirota, Shunsuke Taito, Kazuhiko Hirata, Yukio Mikami
  Frontiers in Disaster and Emergency Medicine.2024;[Epub]     CrossRef
• Prosthesis applications and challenges in children with earthquake-related amputations
  Sibel Basaran, Aylin Sariyildiz, Sila Olmez, Bugra Kundakci, Omer Sunkar Bicer
  Injury.2024; 55(11): 111920.     CrossRef
• Efficacy of a Novel Recording Method in Facilitating Rapid Documentation of Disaster Rehabilitation Support Activities
  Akira Morikawa, Masao Tomioka, Ryuichi Saura
  The Japanese Journal of Rehabilitation Medicine.2024; 61(8): 757.     CrossRef
• Challenges in accessing health care services for women and girls with disabilities using a humanitarian physical rehabilitation program in Lebanon: a mixed method study
  Linda Abou-Abbas, Diana Sabbagh, Rodolfo Rossi, Lavanya Vijayasingham, Maria Rita Lteif, Haya Rawi, Rouba Mitri, Hala Al Sultan, Aicha Benyaich, Ahmad AL-MOSA, Claudia Truppa
  International Journal for Equity in Health.2024;[Epub]     CrossRef