Vocational rehabilitation for people with multiple sclerosis: A systematic scoping review of international evidence

RESEARCH ARTICLE Vocational rehabilitation for people with multiple sclerosis: A systematic scoping review of international evidence Carlotta Gualco 1*, Erica Grange 2,3, Federica Rotondi1, Marco Salivetto 1, Elena Pignattelli1, Tommaso Manacorda4, Maria Grazia Grasso5, Giorgia Presicce5, Matilde Inglese6,7, Lorenza Nasone6, Paolo Durando8,9, Guglielmo Dini8,9, Benedetta Persechino10, Giampaolo Brichetto 2,3, Michela Ponzio1 1 Public Health Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy, 2 NeuroBRITE Research Center, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy, 3 Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genova, Genova, Italy, 4 Italian Multiple Sclerosis Association (AISM), Genoa, Italy, 5 Multiple Sclerosis Unit, IRCCS S. Lucia Foundation, Rome, Italy, 6 Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy, 7 IRCCS Azienda Ospedaliera Metropolitana, Genoa, Italy, 8 Department of Health Sciences, University of Genoa, Genoa, Italy, 9 Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy, 10 Italian Workers’ Compensation Authority (INAIL), Rome, Italy * OPEN ACCESS Citation: Gualco C, Grange E, Rotondi F, Salivetto M, Pignattelli E, Manacorda T, et al. (2026) Vocational rehabilitation for people with multiple sclerosis: A systematic scoping review of international evidence. PLoS One 21(5): e0350122. https://doi.org/10.1371/journal. pone.0350122 Editor: Karlo Toljan, Cleveland Clinic Abu Dhabi, UNITED ARAB EMIRATES Received: February 6, 2026 Accepted: May 9, 2026 Published: May 27, 2026 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal. pone.0350122 Copyright: © 2026 Gualco et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, Abstract Introduction People with multiple sclerosis (pwMS) may encounter challenges in their professional lives, due to a combination of environmental and individual factors. According to Escorpizo et al., 2011 framework, Vocational rehabilitation (VR) aims to optimise job participation, providing support in the job access, retention and in the return to work for people with disability. However, the corpus of research on VR for pwMS is poor. This scoping review aims to map the available literature on VR interventions for pwMS, summarising their characteristics, study designs, implementation features, feasibility, and stakeholders’ perspectives. Methods Following the Joanna Briggs Institute (JBI) and the PRISMA-ScR guidelines, seven databases were searched up to October 2025: PubMed, SCOPUS, PsycInfo, CINAHL, Google Scholar, OT Seeker (University of Queensland), and the Physiotherapy Evidence Database (PEDro). Studies were eligible if they were related to VR interventions for pwMS, focused on job access, return, or retention and if they were primary articles. Data were extracted and synthesised following the Population–Concept–Context (PCC) framework. PLOS One | https://doi.org/10.1371/journal.pone.0350122 May 27, 2026 1 / 32 and reproduction in any medium, provided the original author and source are credited. Data availability statement: All relevant data are within the manuscript and its Supporting information files. Funding: This study was funded by the Italian Workers’ Compensation Authority (INAIL), in the framework of the BRIC 2022: “RiaL SM” project (Bando BRIC 2022_ID 31). However, the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Abbreviations: MS, Multiple Sclerosis; pwMS, people with Multiple Sclerosis; VR, Vocational Rehabilitation; RCT, Randomized Controlled Trial; OSF, Open Science Framework; EDSS, Expanded Disability Status Scale; PRISMAScR, Preferred Reporting Items for Systematic Reviews and Meta-analyses extensions for Scoping review; JBI, Joanna Briggs Institute; RA, Reasonable accomodations; RR, RelapsingRemitting; NA, Not applicable; NR, Not reported; OT, Occupational therapist. Results Out of 2,360 records, 28 articles describing 28 distinct VR interventions were included. Studies were published between 1996 and 2025, mostly from Western countries. Designs ranged from descriptive to randomized trials, with an increasing number of interventional and feasibility studies in recent years. The 61% of the interventions were multi-dimensional delivering a combination of rehabilitation, educational, and reasonable accommodation services. PwMS highlighted the importance of empathetic and individualized approaches, symptom management, and legal counselling as key elements in VR interventions, while logistical, personal and health issues were barriers to participation. Overall, interventions were considered feasible and acceptable. Conclusions This is the first comprehensive overview of VR interventions for pwMS, outlining a progressive shift toward multidisciplinary and goal-oriented approaches over time. Despite promising feasibility and stakeholder satisfaction, further rigorous trials are needed to evaluate effectiveness and inform evidence-based implementation of VR programmes in diverse contexts. Introduction Multiple sclerosis (MS) is a chronic disease of the central nervous system characterised by autoimmune and neurodegenerative processes [1]. MS presents a wide range of physical, cognitive and psychological symptoms that may have a detrimental effect on an individual’s work capacity [2–4]. This may lead to challenges in accessing employment, returning to work after diagnosis, and job retention [5,6]. As a result, the 36% of people with MS (pwMS) are unemployed, and 17% of workers with MS are forced into early retirement [6]. The premature job loss produces a financial burden for pwMS and their families [7,8], affecting individuals in the early stages of their professional careers [9]. In this context, work is also widely recognised as a pivotal social determinant of health, and an essential means of achieving self-determination and psychological well-being [10,11]. Ensuring that pwMS can access and retain their jobs is crucial not only to limit the economic burden but also to promote improved health management [10]. The diverse symptoms experienced by pwMS can result in a corresponding array of obstacles when attempting to access and maintain employment [12]. Architectural barriers in the workplace can impede the movement of workers with MS, both during the commute to and within the work (...truncated)