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

Carlotta Gualco; Erica Grange; Federica Rotondi; Marco Salivetto; Elena Pignattelli; Tommaso Manacorda; Maria Grazia Grasso; Giorgia Presicce; Matilde Inglese; Lorenza Nasone; Paolo Durando; Guglielmo Dini; Benedetta Persechino; Giampaolo Brichetto; Michela Ponzio

doi:10.1371/journal.pone.0350122

Peer Review History

Original SubmissionFebruary 6, 2026
3 May 2026 Decision Letter - Karlo Toljan, Editor -->PONE-D-26-06438-->-->Vocational Rehabilitation for people with Multiple Sclerosis: A Systematic Scoping Review of International Evidence-->-->PLOS One Dear Dr. Gualco, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jun 17 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:--> A letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. --> If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. As the corresponding author, your ORCID iD is verified in the submission system and will appear in the published article. PLOS supports the use of ORCID, and we encourage all coauthors to register for an ORCID iD and use it as well. Please encourage your coauthors to verify their ORCID iD within the submission system before final acceptance, as unverified ORCID iDs will not appear in the published article. Only the individual author can complete the verification step; PLOS staff cannot verify ORCID iDs on behalf of authors. We look forward to receiving your revised manuscript. Kind regards, Karlo Toljan Academic Editor PLOS One Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1.Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please note that funding information should not appear in any section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. Please remove any funding-related text from the manuscript. 3. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. 4. Thank you for stating the following financial disclosure: “The author(s) received no specific funding for this work.” We note that one or more of the authors is affiliated with the funding organization, indicating the funder may have had some role in the design, data collection, analysis or preparation of your manuscript for publication; in other words, the funder played an indirect role through the participation of the co-authors. If the funding organization did not play a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript and only provided financial support in the form of authors' salaries and/or research materials, please do the following: 1. Review your statements relating to the author contributions, and ensure you have specifically and accurately indicated the role(s) that these authors had in your study. These amendments should be made in the online form. 2. Confirm in your cover letter that you agree with the following statement, and we will change the online submission form on your behalf: “The funder provided support in the form of salaries for authors [insert relevant initials], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section. 5. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 6. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: Dear authors, I appreciate your patience. Unfortunately, it was difficult to secure reviewers sooner. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions -->Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. --> Reviewer #1: Partly ******** -->2. Has the statistical analysis been performed appropriately and rigorously? --> Reviewer #1: N/A ****** -->3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.--> Reviewer #1: Yes ****** -->4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.--> Reviewer #1: Yes ****** -->5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)--> Reviewer #1: I enjoyed reading this paper and I like the scope of this review including a summary of stakeholders’ perspective. I do have some concerns, which are listed below: • There should be one clear definition of vocational rehabilitation that is used throughout the article. The authors use different definitions in the abstract (‘Vocational rehabilitation aims to optimize job access and the return to work through multidisciplinary and person-centered approaches.’, ‘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’) and introduction (‘Vocational rehabilitation (VR) aims to ease work difficulties and to optimise work participation in individuals with chronic illness or disability’) • The systematic review from Kahn and colleagues is very relevant for this topic and should be mentioned in the article: Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis - PubMed • It should be clear in table 1 who the target group for the intervention is since the authors include VR interventions for people who are working, who are looking for work etc. and these groups are very different • The descriptive statistics in the text describe which articles included different characteristics of the population (e.g. ethnicity) but the article does not specify this further; I’d like to see this either in the text or one of the tables (e.g. what ethnicities were included and in which articles) • The authors conclude that there is a pivotal role of VR interventions in facilitating access to and retention in work for PwMS, however effects were not taken into account in this review so that statement feels out of place ****** -->6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.--> Reviewer #1: Yes:Shalina R.D. Saddal ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. --> Attachments Attachment Submitted filename: Review PLOS one 01-05-2026.docx https://doi.org/10.1371/journal.pone.0350122.r001
Revision 1
7 May 2026 Author Response Author’s Response Reviewer specific comments and responses 1. There should be one clear definition of vocational rehabilitation that is used throughout the article. The authors use different definitions in the abstract (‘Vocational rehabilitation aims to optimize job access and the return to work through multidisciplinary and person-centered approaches.’, ‘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’) and introduction (‘Vocational rehabilitation (VR) aims to ease work difficulties and to optimise work participation in individuals with chronic illness or disability’) #1: We would like to thank the reviewer once again for giving us the opportunity to clarify the theoretical background on which this scoping review is based. Throughout the scoping review, our intention was to consistently use the definition provided by Escorpizo et al (2011). To avoid any confusion regarding differing definitions, we have revised the abstract and main text to ensure consistent use of a single definition of vocational rehabilitation throughout the manuscript and clarified all relevant passages accordingly. In the abstract, VR interventions are now described as follow: 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. In the introduction: According to Escorpizo et al., 2011, Vocational rehabilitation (VR) aims to optimise job participation in individuals with disability [20], and it has emerged as a promising method for delivering employment support services to individuals with different conditions [21]. In this framework, VR is conceptualised as an intervention capable of supporting people with disabilities at all stages of their working life, facilitating access in the workforce and job retention , as well as in the return to work [20] In the eligibility criteria: In line with the definition proposed by Escorpizo et al. 2011, we included all types of VR interventions aimed at supporting pwMS in access to, retention in, and return to work. 2. The systematic review from Kahn and colleagues is very relevant for this topic and should be mentioned in the article: Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis - PubMed #2: We would like to thank the reviewer for their suggestion. The Cochrane systematic review by Khan et al. (2009) has been discussed as a relevant background source in both the Introduction (74 and 101-102) and in the Discussion (453-454). It is included as Reference 3 in the reference list. To improve clarity and facilitate identification, we have checked the citation and ensured that the full reference is accurately reported in the manuscript. In addition, we have included a more explicit reference to the review in the introduction (lines 101–102), as follows: However, VR for pwMS is still an emerging field [22, 23], and evidence regarding the efficacy of VR for pwMS is still limited, as highlighted in the Cochrane review by Khan et al., 2009, [3]. 3. It should be clear in table 1 who the target group for the intervention is since the authors include VR interventions for people who are working, who are looking for work etc. and these groups are very different #3: We would like to thank the reviewer for this comment, which we believe will improve the qualitative summary of the results. We have therefore added a new column to Table 1, entitled ‘Worker characteristics’, in which we have included three possible categories: ‘Job seekers’, ‘Workers needing job retention support’ and ‘Workers returning to work’. All the changes can be seen in the version “Revised Manuscript with Track Changes”. 4. The descriptive statistics in the text describe which articles included different characteristics of the population (e.g. ethnicity) but the article does not specify this further; I’d like to see this either in the text or one of the tables (e.g. what ethnicities were included and in which articles) #4: Thank you for this helpful comment. Detailed study-level information regarding participant sociodemographic and population characteristics (including, where reported, ethnicity/geographical origin, education, marital status, and occupational variables) is provided in the Supplementary Materials (Table S2). Given the heterogeneity in the reporting of these variables across studies, we chose to summarise the descriptive statistics narratively in the main text while presenting the full study-level details in the supplementary materials to preserve readability and avoid overburdening the main manuscript. In the narrative synthesis, we reported only the most frequently represented category within each variable (e.g., predominantly Caucasian/European participants where ethnicity was reported) to provide an overall summary of sample characteristics. To improve clarity, we have revised the manuscript to more explicitly indicate that detailed participant characteristics for each included study are available in supporting information (S2 Table. Detailed characteristics of participants across the included studies, including, geographical origins, marital and occupational status, MS type, EDSS and disease duration). All the changes can be seen in the version “Revised Manuscript with Track Changes”. 5. The authors conclude that there is a pivotal role of VR interventions in facilitating access to and retention in work for PwMS, however effects were not taken into account in this review so that statement feels out of place #5: We would like to thank the reviewer for pointing out this inconsistency. We agree that this sentence goes beyond the findings and scope of this scoping review. We have therefore amended the conclusions, changing the sentence as follows (All the changes can be seen in the version “Revised Manuscript with Track Changes”): We have mapped the existing literature on VR for pwMS who need to enter, return to or remain in employment. (…) Attachments Attachment Submitted filename: PLOS one_Response to reviewer.docx https://doi.org/10.1371/journal.pone.0350122.r002
11 May 2026 Decision Letter - Karlo Toljan, Editor Vocational rehabilitation for people with multiple sclerosis: a systematic scoping review of international evidence PONE-D-26-06438R1 Dear Dr. Gualco, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Karlo Toljan Academic Editor PLOS One Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0350122.r003
Formally Accepted
Acceptance Letter - Karlo Toljan, Editor PONE-D-26-06438R1 PLOS One Dear Dr. Gualco, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Karlo Toljan Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0350122.r004

Open letter on the publication of peer review reports

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. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .