---
title: "Impact of Music-Based Therapies on Rehabilitation in Multiple Sclerosis: A Systematic Review"
id: "bmj-open-9-potential-benefits-of-music-based-therapies-on-rehabilitation-outcomes-in"
canonical_url: "https://medichelpline.com/clinical-feed/bmj-open-9-potential-benefits-of-music-based-therapies-on-rehabilitation-outcomes-in"
content_type: "clinical_feed_article"
specialty: "Neurology"
source_name: "BMJ Open"
source_url: "http://bmjopen.bmj.com/cgi/content/short/16/7/e116420?rss=1"
published_at: "2026-07-22T08:50:16.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Impact of Music-Based Therapies on Rehabilitation in Multiple Sclerosis: A Systematic Review
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/bmj-open-9-potential-benefits-of-music-based-therapies-on-rehabilitation-outcomes-in
- **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md)
- **Primary Source:** BMJ Open
- **Source URL:** [Original Journal Publication](http://bmjopen.bmj.com/cgi/content/short/16/7/e116420?rss=1)
- **Published At:** 2026-07-22T08:50:16.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This systematic review investigates the effects of **music-based therapies (MBTs)** on rehabilitation outcomes in adults with **multiple sclerosis (MS)**. - The review included 23 studies with 955 participants, focusing on various outcomes, especially **motor functions** and **quality of life**. - Key findings suggest potential improvements in gait and mobility, particularly through **rhythmic auditory stimulation** and **music-cued motor imagery**. - Limitations include heterogeneity in intervention types and study designs, necessitating further research to standardize outcomes and confirm efficacy. - The review advocates for high-quality trials to validate MBTs' effectiveness in clinical practice.
## Clinical Analysis & Structured Key Points
Skip to main content Intended for healthcare professionals Log In Basket Search for this keyword Advanced search Latest content Archive For authors About Browse by collection You are here Home Archive Volume 16, Issue 7 Email alerts Article Text Article info Citation Tools Share Rapid Responses Article metrics Alerts PDF Public health Original research Potential benefits of music-based therapies on rehabilitation outcomes in people with multiple sclerosis: a systematic review Nicky Ahadi1, Jeeyeon Kim2, http://orcid.org/0000-0002-7131-7158Daniel Whibley2,3, http://orcid.org/0000-0003-0139-6548Maxwell S Barnish4 Correspondence to Dr Maxwell S Barnish; m.s.barnish@exeter.ac.uk Abstract Objectives To assess the evidence for a benefit of music-based therapies (MBTs) on rehabilitation outcomes in adults with multiple sclerosis (MS). Setting Scholarly literature (published in English) from any country. This systematic review received no specific funding and was registered on PROSPERO as CRD420251083656. Data sources Six bibliographic databases: AMED (Ebsco), APA PsycINFO (Ovid), CINAHL (Ebsco), Cochrane CENTRAL, EMBASE (Ovid) and MEDLINE (Ovid), plus supplementary searches and citation chasing (search date July 2025). Primary and secondary outcome measures Eligible studies used a clinical trial or controlled quantitative observational study design to assess the benefit of MBTs on rehabilitation outcomes in adults with MS. Risk of bias was assessed using Critical Appraisal Skills Programme checklists. Data were synthesised using narrative synthesis. Results 23 studies were included (955 participants, of whom 880 people had MS and 691 received MBTs). The most frequently assessed outcome was motor function (16 studies), followed by quality of life (12 studies). Evidence suggests potential benefits for MBTs, particularly rhythmic auditory stimulation and music-cued motor imagery, on gait and mobility outcomes, including walking speed, walking distance, cadence, stride length and gait symmetry. Findings for other outcomes were less clear. Conclusions MBTs may benefit people with MS, with the most consistent evidence observed for gait and mobility outcomes. However, heterogeneity in intervention type, study design and outcome measurement limits the strength of conclusions. Higher-quality, adequately powered trials with standardised outcomes and direct comparisons between MBTs are needed to clarify effectiveness and inform clinical implementation. PROSPERO registration number CRD420251083656. Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information. The presented work is a systematic review. All relevant information is provided in the manuscript and appendices. This includes the data extraction form completed with the data from all included studies. No meta-analyses were conducted, so there is no analytical code. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. https://doi.org/10.1136/bmjopen-2026-116420 Request Permissions If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways. Request permissions STRENGTHS AND LIMITATIONS OF THIS STUDY Systematic review methods minimised subjectivity and bias. A structured outcome set was used. An independent dual review was conducted. Patient and public involvement was not conducted. Only English-language studies could be included. Introduction Multiple sclerosis Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system and a leading cause of neurological disability in young adults.1 2 It affects more than 2.8 million people worldwide and its prevalence has increased substantially in many regions, with the highest rates reported in North America, western Europe and Australasia.1–3 This rise is attributed to a combination of greater life expectancy, population growth and better access to diagnostic services.2 3 Common manifestations include optic neuritis, sensory disturbance, limb weakness and gait ataxia as any site in the central nervous system can be affected.1–3 MS is usually described as having three main types with Relapsing Remitting MS (RRMS) being the most common, affecting around 85%–90% of people with MS. Primary progressive MS accounts for about 10%–15% and progresses steadily without relapses. Over time, many with RRMS develop secondary progressive MS, where disability gradually increases.1 Treatment options for MS Disease-modifying therapies can reduce relapse frequency and delay disability progression, yet they do not fully address the multifactorial physical, cognitive and emotional consequences of living with a chronic, unpredictable condition. MS places a heavy burden on health systems and carries high economic costs.2 3 As symptoms often persist despite medication, there is increasing interest in non-pharmacological approaches to support holistic rehabilitation and improve quality of life (QoL).3 4 These approaches include arts-based interventions, which have been shown to be promising therapeutic approaches in anxiety and depression,5 palliative care,6 stroke7 and Parkinson’s disease (PD).8–10 Within this broad arts sphere, one focal point of therapeutic interest is the use of music for therapeutic benefit. The concept of music-based therapies A range of different approaches have been taken to conceptualising music interventions for therapeutic benefit. One established concept is music therapy (MT). The American Music Therapy Association defines MT as ‘the clinical and evidence-based use of music interventions to accomplish individualised goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy programme’.11 However, definitions of MT vary greatly internationally, making the concept challenging to interpret in the international literature. The UK, USA and Canada take a highly formalised approach to MT using protected, clinically based legal definitions, requiring specific MT qualifications and registration with a statutory body.11–13 Meanwhile, the German Music Therapy Society focuses on the ‘targeted use of music’ to restore, maintain and promote ‘mental, physical and cognitive health’,14 the Norwegian approach focuses on ‘community music therapy’, combining individual clinical work with social, community-based approaches,15 16 and the Chinese approach incorporates theories from traditional Chinese medicine, such as the ‘five tones’ model, alongside western MT approaches.17 Areas of between-country variation include whether statutory registration is required, whether the focus is on active or receptive MT approaches, and the extent to which MT is clinically focused and conducted individually or socially focused and conducted in groups. Therefore, MT does not have the same meaning in different countries—interventions that would be described as MT in some countries would not be permitted to be described as MT in other countries.14 Pragmatic definitions of MT have been used by some researchers5 8 9 to overcome this lack of a universal definition of MT, however, the misalignment of these definitions with those used by statutory bodies may be problematic. Noting these issues defining MT in a consistent and meaningful way for international research, broader concepts have been proposed that include interventions that may be beneficial but need not be delivered by a certified music therapist. The broadest alternative conceptualisation of the use of music for health benefit is ‘musical care’ (MC)—a concept developed by Spiro and Sanfilippo.18 MC is defined as ‘the role of music—music listening as well as music-making—in supporting any aspect of people’s developmental or health needs: for example, physical and mental health, cognitive and behavioural development and interpersonal relationships’.18 The authors state18 that MC encompasses MT but goes beyond MT and includes a wide range of musically based interventions. The concept of MC considers the role of music in its broadest sense and does not only consider structured interventions, nor does it only consider interventions that are therapeutic—MC includes unstructured activities that include music and interventions where music is not the primary therapeutic modality.18 This may be considered a limitation of the MC concept. Therefore, the concept of music-based therapies (MBTs) has been proposed, as well as the alternative term music-based interventions (MBIs). As these terms are synonymous, we shall use the term MBTs consistently. The concept of MBTs has been used in several previous systematic reviews in neurological conditions.19–21 Lin et al19 delineate their review in the full text as assessing MBTs, although the term MT is used in the article title. However, a common limitation in previous reviews using the MBTs concept across different health conditions has been a lack of an explicit definition of MBTs. The key distinction between MBTs and MT is that while MBTs are designed to be therapeutic and often to enhance general well-being or provide short-term symptom relief, they need not be clinical interventions delivered by a certified music therapist.22 Based on the work of Raglio,22 we propose the following explicit operational definition of MBTs for the purposes of our work: ‘structured musical activities designed to enhance well-being, reduce stress and improve QoL, without necessarily focusing on clinical diagnosis, assessment or long-term psychotherapy’. While professional regulation and licensing remain important for clinical governance, our conceptualisation prioritises the active components of MBTs over jurisdiction-specific labels. Ultimately, understanding which components produce therapeutic effects is most important for advancing the evidence base. Our theoretical and conceptual justification for aggregating diverse music-based activities under the concept of MBTs lies in their shared complexity as interventions with potentially multiple ‘active ingredients’ that promote health, well-being and neurophysiological change.23 MBTs are mid-range in their scope—broader than MT but narrower than MC, as MBTs do not include activities that are not therapeutic or do not comprise structured interventions. MT falls within the stated definition of MBTs, but not all aspects of MC are included under MBTs. Evidence for MBTs in MS We have identified six previous systematic,20 24–28 scoping or comprehensive reviews on MBTs for MS, in addition to a broad non-systematic literature review on ‘cognitive re-education’ for QoL and psychological well-being in MS.29 Table 1 summarises the scope, methodological approaches, interventions, outcomes and included studies of these reviews. Due to clinical, methodological and statistical heterogeneity between studies, no reviews have been able to include a meta-analysis. An early comprehensive review26 assessed MT in relation to a non-specified set of outcomes and found very limited evidence, with the only full-text peer-reviewed papers besides case reports or case series being two pilot studies.30 31 Systematic and scoping reviews have typically been limited to specific outcome domains: (1) gait and mobility25 28 and (2) psychological outcomes.24 Gardener et al24 conducted a systematic review on MT for psychological outcomes in a broader range of conditions and included only one pilot randomised controlled trial (RCT)32 on MS. Tan et al28 conducted a recent scoping review of 15 studies on music-based and rhythmic auditory interventions for walking in MS. They focused exclusively on gait and mobility outcomes and reported high acceptability and consistent short-term improvements in walking speed and quality. Kong et al25 similarly undertook a systematic review of 12 clinical trials of MT for gait disorders in MS, again concentrating on mobility outcomes and finding that music-based rhythmic cueing improved gait performance. Together, these reviews support the role of music-based approaches for gait rehabilitation but do not explore wider motor, cognitive or psychosocial domains. Lopes and Keppers20 provided the first MS-specific systematic review of MBTs as a rehabilitative approach. Across 10 clinical trials, they grouped interventions into rhythmic auditory strategies, instrument playing, dance-based strategies and neurological MT. They found that MBTs were superior to conventional therapy or no intervention for several motor and non-motor outcomes, including gait, fatigue, balance, hand dexterity, emotional status and pain, although evidence for memory and mental fatigability was less clear. The search period ended in 2020 and interventions and outcome measures were highly heterogeneous, with several protocols primarily dance-based rather than primarily music focused.20 Phillips et al27 extended the scope of the literature by comparing active and receptive music interventions across 15 studies in people with MS, with outcomes including anxiety, depression, QoL, cognition, gait, balance, fatigue and hand dexterity. Most interventions were receptive, often involving music listening during walking. While the review showed encouraging effects across motor and non-motor domains, its focus on engagement type and the limited number of studies mean it does not fully represent the breadth of MBTs for MS rehabilitation.27 VIEW INLINE VIEW POPUP Table 1 Previous systematic, scoping and comprehensive reviews Rationale Existing systematic reviews are fragmented and limited in scope. Available reviews either focus narrowly on gait and walking-related outcomes,25 28 only include a small number of heterogeneous studies,20 27 or provide findings from multiple neurological conditions without MS-specific conclusions.24 Reviews of related performing arts modalities, for example, dance, highlight potential motor and psychological benefits for people with MS, yet these interventions do not isolate the therapeutic contribution of the musical component.4 There is no recent systematic review of the potential benefit of MBTs across a broad range of rehabilitation outcomes relevant to people with MS. No existing review provides a comprehensive synthesis of the impact of MBTs on motor, cognitive, psychological or QoL domains, nor evaluates the diversity of interventions used. Considering specifically reviews published in 2025, here is a clear statement of how they differ from our systematic review and the advance to knowledge our work offers: Gardener et al24: This systematic review has a specific focus on MT and psychological outcomes; our review considers MBTs and mobility, cognitive function and QoL outcomes, therefore, offering broader intervention and outcome measure coverage. Phillips et al27: This systematic review considers ‘music interventions’, mode of engagement (active vs receptive interventions) and ‘balance’, ‘gait’, ‘anxiety’, ‘depression’ and ‘fatigue’. Our review explicitly uses the MBTs framework to define eligibility, includes mobility and psychological outcomes, and includes comparison of MBTs and control arms. Tan et al28: This is a scoping review, while our review is a systematic review. Systematic reviews are considered a higher level of evidence compared with scoping reviews and offer a structured assessment of risk of bias.33 This review considers ‘music interventions’ but does not use an explicitly defined framework such as MBTs, while our review explicitly uses the MBTs framework to define eligibility. This review limits its outcomes to gait and mobility, while our review also considers cognitive function, psychological well-being and QoL. Therefore, our review provides a clear advance in knowledge in terms of coverage of interventions and outcomes. We provide the first systematic review to provide an assessment of the potential benefit of music in MS using the MBTs framework to ensure appropriately broad intervention coverage and assessment of mobility, cognitive function, psychological outcomes and QoL outcomes. Aims The aim of our work was to provide a systematic review of the evidence for a benefit of MBTs on rehabilitation outcomes in adults with MS. In particular, the primary review question was: What is the impact of MBTs on rehabilitation outcomes in people with MS? Secondary review questions were: What types of MBTs have been studied for their rehabilitation potential for people with MS? What specific rehabilitation domains (eg, motor, cognitive, psychological and QoL) show the greatest response to MBTs in people with MS? Methods Design A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.34 Completed PRISMA and PRISMA for Abstracts checklists are provided in online supplemental files 1 and 2. Reporting of the narrative synthesis was compliant with the Synthesis without meta-analysis (SWiM) guidelines.35 This systematic review was registered on the PROSPERO database (CRD420251083656). One protocol amendment was made—to use risk of bias tools from the same suite for all study designs. Supplemental material [bmjopen-2026-116420supp001.pdf] Data sources AMED (Ebsco), APA PsycINFO (Ovid), CINAHL (Ebsco), Cochrane-CENTRAL, EMBASE (Ovid) and MEDLINE (Ovid) were searched from inception until July 2025. Supplementary searches were conducted on Google Scholar and through forward and backward citation chasing on studies identified for full-text review up to November 2025. Searches were designed to retrieve articles on MS and MBTs (strategies for all databases are shown in online supplemental file 3) and were designed by NA and MSB and conducted by the lead author NA. MSB conducted supplementary searches and citation chasing. Inclusion criteria Screening was initially conducted based on the title and abstract. Potentially relevant articles were screened at the full-text stage to determine inclusion (online supplemental file 4) or exclusion (online supplemental file 5) in the systematic review. Screening was initially conducted by NA based on titles and abstracts, followed by full text screening of potentially eligible studies. A second reviewer (MSB) independently screened all records to verify consistency, and any disagreements were resolved through discussion. Eligibility criteria are shown in box 1. The outcomes of interest were rehabilitation-related outcomes: functional recovery, motor function, gait and balance, cognitive function, psychological well-being and QoL. Studies with and without control arms were eligible. MBTs were defined using the operational definition proposed in the Introduction: ‘structured musical activities designed to enhance well-being, reduce stress and improve QoL, without necessarily focusing on clinical diagnosis, assessment, or long-term psychotherapy’. As MT falls within this definition of MBTs, studies on MT were eligible for inclusion. There were no specific requirements for what control arms should involve. Therefore, control arms could include alternative populations, such as healthy controls or people with another medical condition rather than MS, in addition to alternative interventions. While no limits were set on the types of control arms that
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