From usability to clinical impact: a systematic review of digital technologies for motor rehabilitation in multiple sclerosis

Abstract

Background: People with multiple sclerosis (PwMS) often experience motor impairments that require long-term rehabilitation. In recent years, digital technologies such as mobile applications and sensor-based systems, have been explored as tools to support motor rehabilitation in this population. However, their implementation in real-world settings critically depends on usability, which influences user engagement, adherence, and integration into clinical practice. Objective: To systematically review the usability, acceptability, and preliminary clinical impact of digital rehabilitation interventions targeting motor function in pwMS. Methods: A systematic literature search was conducted in PubMed, Scopus, Embase, and Web of Science up to June 2025, to identify studies that evaluated usability within the context of motor rehabilitation interventions delivered through digital platforms. Only studies involving pwMS were included. Results: Nine studies were included. Interventions employed Kinect-based exergaming, mobile applications, pressure-sensitive platforms, and wearable sensors. Usability was generally high, with System Usability Scale (SUS) scores >70 in several studies. Adherence ranged from moderate to high, particularly when interventions incorporated real-time feedback, personalization, and user-centered design. Preliminary improvements were observed in gait speed, balance, cognitive-motor function, and physical activity levels. Conclusion: Digital rehabilitation tools demonstrate promising usability and feasibility for motor rehabilitation in pwMS. Personalized, interactive systems designed with user-centered approaches may enhance engagement and support behavioural activation. Future large-scale trials with standardized outcomes are needed to establish clinical effectiveness and inform integration into routine care. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251125034, PROSPERO CRD420251125034.