Potential benefits of music-based therapies on rehabilitation outcomes in people with multiple sclerosis: a systematic review

Clinical Snapshot

Key Findings

• P Value: Not reported at the review level; individual study p-values not synthesised

• Effect Size: Not quantifiable — no meta-analysis performed; narrative synthesis only

• Primary Outcome: Motor function assessed in 16 of 23 studies; gait and mobility outcomes (walking speed, walking distance, cadence, stride length, gait symmetry) showed the most consistent evidence of potential benefit from MBTs, particularly rhythmic auditory stimulation (RAS) and music-cued motor imagery

• Nnt Or Sensitivity: Not calculable from available data; no pooled effect estimates reported. Quality of life was assessed in 12 of 23 studies with less consistent findings than gait outcomes

• Confidence Interval: Not reported — narrative synthesis precludes confidence interval estimation

Clinical Application

Music-based therapies, particularly rhythmic auditory stimulation, are generally low-cost, non-invasive, and can be delivered in outpatient, inpatient rehabilitation, or community settings. RAS requires minimal specialist equipment (metronome or music player with rhythmic cues) and can be integrated into physiotherapy-led gait training. Music-cued motor imagery may be delivered by trained music therapists or adapted by physiotherapists. Scalability is feasible but standardisation of protocols remains a barrier to widespread implementation. In Australia, music therapy is a recognised allied health profession regulated through the Australian Music Therapy Association (AMTA), and registered music therapists (RMT) may be accessible through NDIS funding for eligible MS patients with functional impairment. MS Australia and the MS Research Australia network support rehabilitation research, and the RACGP and Neurological Alliance of Australia recognise the importance of multidisciplinary rehabilitation in MS management. Rhythmic auditory stimulation is not currently listed on the Medicare Benefits Schedule (MBS) as a standalone item, though physiotherapy-delivered gait rehabilitation (which could incorporate RAS principles) is MBS-reimbursable. TGA approval is not applicable to music-based therapies as non-pharmacological interventions. Clinicians should note that the evidence base, while promising for gait outcomes, does not yet meet the threshold for formal RACGP guideline endorsement, and MBTs should currently be considered adjunctive to evidence-based pharmacological and rehabilitation management of MS. Adults with multiple sclerosis of any disease course (relapsing-remitting, secondary progressive, primary progressive) experiencing gait and mobility impairment who are engaged in or eligible for rehabilitation programmes. The evidence base is most relevant to ambulatory MS patients with measurable gait deficits.

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.

References

1. 1.Ahadi, N., Kim, J., Whibley, D., & Barnish, M. S. (2026). Potential benefits of music-based therapies on rehabilitation outcomes in people with multiple sclerosis: a systematic review. BMJ Open. https://doi.org/10.1136/bmjopen-2026-116420