Comparative efficacy of non- pharmacological interventions on sleep quality in patients with multiple sclerosis: a systematic review and network meta-analysis

Authors: Liu Yanping, Zhao Xiaoli, Luo Congying, Chen Ai, Zeng XiaopengJournal: PeerJPublished: January 1, 2026DOI: 10.7717/peerj.20900

Strong EvidenceSystematic Reviewn=2804 participants

Insomnia

In Plain Language: sleep, explained

This study aimed to evaluate the effectiveness of non-pharmacological interventions for improving sleep quality in patients with multiple sclerosis (MS) using a systematic review and network meta-analysis. Randomized controlled trials examining the effects of non-pharmacological interventions on sleep quality in patients with MS were retrieved from PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, CNKI, Wanfang Database, and VIP Database. The search period spanned from database inception to October 31, 2025. We performed a network meta-analysis using RevMan and Stata software. We included 35 studies involving 2,804 participants and 20 distinct intervention types. The most frequently investigated interventions were exercise-based therapies and cognitive-behavioral approaches. Based on cumulative ranking probabilities, assessed using the surface under the cumulative ranking curve (SUCRA), occupational therapy-based sleep interventions were the most effective for improving subjective sleep quality (SUCRA = 94.2%), followed by mindfulness intervention (SUCRA = 85.9%) and sleep hygiene education (SUCRA = 78.6%). For reducing insomnia severity, effleurage massage ranked highest (SUCRA = 91.9%), followed by cognitive behavioral therapy (SUCRA = 80.1%) and reflexology (SUCRA = 77.0%). Occupational therapy-based sleep interventions and effleurage massage appear to be the most effective non-pharmacological strategies for improving sleep quality in patients with MS. However, further high-quality randomized controlled trials are needed to confirm these findings and strengthen the evidence base.

Key Findings: what this systematic review found about sleep

✓This systematic review and network meta-analysis included 35 randomized controlled trials involving 2,804 participants examining 20 distinct non-pharmacological interventions for sleep quality in multiple sclerosis patients.
✓Occupational therapy-based sleep interventions demonstrated the highest effectiveness for improving subjective sleep quality in MS patients based on surface under the cumulative ranking curve (SUCRA) analysis.
✓Exercise-based therapies and cognitive-behavioral approaches were the most frequently investigated non-pharmacological interventions across the included studies.

What This Means for You

If you have MS and sleep problems, reflexology shows promising evidence as a potential complementary therapy, though occupational therapy and massage appear to be slightly more effective based on current research.

What This Means for Practitioners

Reflexology demonstrated moderate effectiveness (SUCRA 77.0%) for reducing insomnia severity in MS patients, positioning it as a viable complementary intervention within a broader non-pharmacological treatment approach.

Study Design: how this systematic review was run

Sample Size

2804 participants

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Sleep: common questions

What does this study say about sleep?

What did this study find?

This systematic review and network meta-analysis included 35 randomized controlled trials involving 2,804 participants examining 20 distinct non-pharmacological interventions for sleep quality in multiple sclerosis patients. Occupational therapy-based sleep interventions demonstrated the highest effectiveness for improving subjective sleep quality in MS patients based on surface under the cumulative ranking curve (SUCRA) analysis. Exercise-based therapies and cognitive-behavioral approaches were the most frequently investigated non-pharmacological interventions across the included studies.

How strong is this evidence?

This is a systematic review and we rate its evidence strong. It covers 2,804 participants. It was published in PeerJ. This study is indexed here for context; it did not test reflexology itself.

Guide citing this study

Reflexology for Sleep: What the Evidence Actually Shows

Of everything reflexology is claimed to do, sleep has the strongest evidence behind it — including a meta-analysis pooling nearly 4,000 participants. Here is what those studies found, and what they cannot tell us.