Relaxation interventions in neurological rehabilitation: a scoping review

Authors

  • Pia Rings Department of Nursing, Midwifery and Therapeutic Sciences, Bochum University of Applied Sciences, Bochum, Germany; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
  • Juliana Dziurla Department of Nursing, Midwifery and Therapeutic Sciences, Bochum University of Applied Sciences, Bochum, Germany https://orcid.org/0009-0002-2011-9765
  • Tine Van Damme Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium https://orcid.org/0000-0002-8197-6704
  • Kaat Alaerts Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium https://orcid.org/0000-0001-8665-6374
  • Christina Groll Department of Nursing, Midwifery and Therapeutic Sciences, Bochum University of Applied Sciences, Bochum, Germany https://orcid.org/0009-0009-0941-4561
  • Dörte Zietz Department of Nursing, Midwifery and Therapeutic Sciences, Bochum University of Applied Sciences, Bochum, Germany https://orcid.org/0000-0002-3008-9400

DOI:

https://doi.org/10.2340/jrm.v58.45972

Keywords:

mind-body and relaxation techniques, multiple sclerosis., neurological rehabilitation, relaxation therapy, Stroke/therapy, scoping review

Abstract

Objective: To offer a comprehensive synthesis that maps current research on relaxation interventions in neurological rehabilitation settings.

Methods: The review was registered (DOI: 10.17605/OSF.IO/QD4TM) and followed the Joanna Briggs Institute framework. Six databases were searched from inception to August 2025. Eligible sources examined interventions aiming to induce a physiological relaxation response within neurological rehabilitation contexts. Two reviewers independently screened records and appraised study quality.

Results: 63 sources were included. The findings reveal a heterogeneous evidence landscape, within which several patterns emerge. Relaxation interventions have most frequently been studied in people with multiple sclerosis and stroke. They are generally reported as feasible and well accepted, but often adapted to specific functional needs and preferences. Outcomes were primarily assessed at the level of body structure and function domain, particularly psychological functioning. Key gaps in the evidence base include limited research into less prevalent conditions, few qualitative designs and comparative effectiveness studies, as well as limited assessment of outcomes relating to perceived and physiological stress, activities, and participation.

Conclusion: By mapping the existing literature on relaxation interventions in neurological rehabilitation settings, the review offers a structured synthesis of the field and informs both clinical decision-making and the prioritization of future research.

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References

Guo H, Zheng L, Xu H, Pang Q, Ren Z, Gao Y, et al. Neurobiological links between stress, brain injury, and disease. Oxid Med Cell Longev 2022; 8111022. DOI: https://doi.org/10.1155/2022/8111022

Herman JP. Introduction: Stress and neurological disease. Exp Neurol 2012; 233: 1–2. DOI: https://doi.org/10.1016/j.expneurol.2011.12.041

Chrousos GP. Stress and disorders of the stress system. Nat Rev Endocrinol 2009; 5: 374–381. DOI: https://doi.org/10.1038/nrendo.2009.106

McEwen BS. Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol Rev 2007; 87: 873–904. DOI: https://doi.org/10.1152/physrev.00041.2006

Asada Y, Nishio K, Iitsuka K, Yaeda J. A qualitative study of stressors faced by older stroke patients in a convalescent rehabilitation hospital. PLoS One 2024; 19: e0309457. DOI: https://doi.org/10.1371/journal.pone.0309457

Kawaguchi T, Sakaguchi S, Tajiri K, Sato E, Watanabe H. Study on factors of inpatient stress. JSNR 1994; 17: 2_21-2_29.

Gerges S, Hallit R, Hallit S. Stressors in hospitalized patients and their associations with mental health outcomes: testing perceived social support and spiritual well-being as moderators. BMC Psychiatry 2023; 23: 323. DOI: https://doi.org/10.1186/s12888-023-04833-6

Schottke H, Giabbiconi CM. Post-stroke depression and post-stroke anxiety: prevalence and predictors. Int Psychogeriatr 2015; 27: 1805–1812. DOI: https://doi.org/10.1017/S1041610215000988

Sturm JW, Donnan GA, Dewey HM, Macdonell RA, Gilligan AK, Thrift AG. Determinants of handicap after stroke: the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke 2004; 35: 715–720. DOI: https://doi.org/10.1161/01.STR.0000117573.19022.66

Peres DS, Rodrigues P, Viero FT, Frare JM, Kudsi SQ, Meira GM, et al. Prevalence of depression and anxiety in the different clinical forms of multiple sclerosis and associations with disability: a systematic review and meta-analysis. Brain Behav Immun Health 2022; 24: 100484. DOI: https://doi.org/10.1016/j.bbih.2022.100484

Lim S-W, Shiue Y-L, Ho C-H, Yu S-C, Kao P-H, Wang J-J, et al. Anxiety and depression in patients with traumatic spinal cord injury: a nationwide population-based cohort study. PLoS One 2017; 12: e0169623. DOI: https://doi.org/10.1371/journal.pone.0169623

Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: a review. EXCLI J 2017; 16: 1057–1072.

Vaccarino V, Bremner JD. Stress and cardiovascular disease: an update. Nat Rev Cardiol 2024; 21: 603–616. DOI: https://doi.org/10.1038/s41569-024-01024-y

Hassamal S. Chronic stress, neuroinflammation, and depression: an overview of pathophysiological mechanisms and emerging anti-inflammatories. Front Psychiatry 2023; 14: 1130989. DOI: https://doi.org/10.3389/fpsyt.2023.1130989

Braun J, Patel M, Kameneva T, Keatch C, Lambert G, Lambert E. Central stress pathways in the development of cardiovascular disease. Clin Auton Res 2024; 34: 99–116. DOI: https://doi.org/10.1007/s10286-023-01008-x

Godoy LD, Rossignoli MT, Delfino-Pereira P, Garcia-Cairasco N, De Lima Umeoka EH. A comprehensive overview on stress neurobiology: basic concepts and clinical implications. Front Behav Neurosci 2018; 12: 127. DOI: https://doi.org/10.3389/fnbeh.2018.00127

Gyawali P, Chow WZ, Hinwood M, Kluge M, English C, Ong LK, et al. Opposing associations of stress and resilience with functional outcomes in stroke survivors in the chronic phase of stroke: a cross-sectional study. Front Neurol 2020; 11: 230. DOI: https://doi.org/10.3389/fneur.2020.00230

Ostwald SK, Swank PR, Khan MM. Predictors of functional independence and stress level of stroke survivors at discharge from inpatient rehabilitation. J Cardiovasc Nurs 2008; 23: 371–377. DOI: https://doi.org/10.1097/01.JCN.0000317435.29339.5d

Holman EA, Cramer SC, Shah S, Griessenauer CJ, Patel N, Lin DJ, et al. Lifetime and acute stress predict functional outcomes following stroke: findings from the longitudinal STRONG study. Stroke 2023; 54: 2794–2803. DOI: https://doi.org/10.1161/STROKEAHA.123.043356

Von Drathen S, Gold SM, Peper J, Rahn AC, Ramien C, Magyari M, et al. Stress and multiple sclerosis: systematic review and meta-analysis of the association with disease onset, relapse risk and disability progression. Brain Behav Immun 2024; 120: 620–629. DOI: https://doi.org/10.1016/j.bbi.2024.06.004

Schwartz CE, Foley FW, Rao SM, Bernardin LJ, Lee H, Genderson MW. Stress and course of disease in multiple sclerosis. Behav Med 1999; 25: 110–116. DOI: https://doi.org/10.1080/08964289909596740

Mitsonis CI, Potagas C, Zervas I, Sfagos K. The effects of stressful life events on the course of multiple sclerosis: a review. Int J Neurosci 2009; 119: 315–335. DOI: https://doi.org/10.1080/00207450802480192

Toussaint L, Nguyen QA, Roettger C, Dixon K, Offenbächer M, Kohls N, et al. Effectiveness of progressive muscle relaxation, deep breathing, and guided imagery in promoting psychological and physiological states of relaxation. Evid Based Complement Alternat Med 2021; 2021: 1–8. DOI: https://doi.org/10.1155/2021/5924040

Benson H. The relaxation response: its subjective and objective historical precedents and physiology. Trends Neurosci 1983; 6: 281–284. DOI: https://doi.org/10.1016/0166-2236(83)90120-0

Jacobson E. Progressive relaxation. Chicago: University of Chicago Press; 1938.

Schultz JH. Das autogene Training (konzentrative Selbstentspannung). Versuch einer klinisch-praktischen Darstellung. Leipzig: Thieme; 1932.

Hamasaki H. Effects of diaphragmatic breathing on health: a narrative review. Medicines 2020; 7: 65. DOI: https://doi.org/10.3390/medicines7100065

Hall E, Hall C, Stradling P, Young D. Guided imagery: creative interventions in counselling & psychotherapy. London: SAGE Publications; 2006.

Giggins OM, Persson UM, Caulfield B. Biofeedback in rehabilitation. J Neuroeng Rehabil 2013; 10: 60. DOI: https://doi.org/10.1186/1743-0003-10-60

Rogerson O, Wilding S, Prudenzi A, O’Connor DB. Effectiveness of stress management interventions to change cortisol levels: a systematic review and meta-analysis. Psychoneuroendocrinology 2024; 159: 106415. DOI: https://doi.org/10.1016/j.psyneuen.2023.106415

Koncz A, Demetrovics Z, Takacs ZK. Meditation interventions efficiently reduce cortisol levels of at-risk samples: a meta-analysis. Health Psychol Rev 2021; 15: 56–84. DOI: https://doi.org/10.1080/17437199.2020.1760727

Webster KE, Halicka M, Bowater RJ, Parkhouse T, Stanescu D, Punniyakotty AV, et al. Effectiveness of stress management and relaxation interventions for management of hypertension and prehypertension: systematic review and network meta-analysis. BMJ Med 2025; 4: e001098. DOI: https://doi.org/10.1136/bmjmed-2024-001098

Calderone A, Marafioti G, Latella D, Corallo F, D’Aleo P, Quartarone A, et al. Effectiveness of relaxation techniques for stress management and quality of life improvement in cardiovascular disease and hypertensive patients: a systematic review. Psychol Health Med 2025; 30: 1281–1352. DOI: https://doi.org/10.1080/13548506.2025.2458255

Reaves C, Angosta AD. The relaxation response: influence on psychological and physiological responses in patients with COPD. Appl Nurs Res 2021; 57: 151351. DOI: https://doi.org/10.1016/j.apnr.2020.151351

Manzoni GM, Pagnini F, Castelnuovo G, Molinari E. Relaxation training for anxiety: a ten-years systematic review with meta-analysis. BMC Psychiatry 2008; 8: 41. DOI: https://doi.org/10.1186/1471-244X-8-41

Hamdani SU, Zill-e-Huma, Zafar SW, Suleman N, Um-ul-Baneen, Waqas A, et al. Effectiveness of relaxation techniques ‘as an active ingredient of psychological interventions’ to reduce distress, anxiety and depression in adolescents: a systematic review and meta-analysis. Int J Ment Health Syst 2022; 16: 31. DOI: https://doi.org/10.1186/s13033-022-00541-y

Chang B-H, Dusek JA, Benson H. Psychobiological changes from relaxation response elicitation: long-term practitioners vs. novices. Psychosomatics 2011; 52: 550–559. DOI: https://doi.org/10.1016/j.psym.2011.05.001

Hinwood M, Ilicic M, Gyawali P, Coupland K, Kluge MG, Smith A, et al. Psychological stress management and stress reduction strategies for stroke survivors: a scoping review. Ann Behav Med 2023; 57: 111–130. DOI: https://doi.org/10.1093/abm/kaac002

Mak TCT, Wong TWL, Ng SSM. The use of mindfulness-based interventions in stroke rehabilitation: a scoping review. Rehabil Psychol 2023; 68: 221–234. DOI: https://doi.org/10.1037/rep0000505

Kneebone II, Van Zanden BE, Dorstyn DS, Roberts RM, Lord SR, Querstret D, et al. Relaxation and related therapies for people with multiple sclerosis (MS): a systematic review. Clin Rehabil 2022; 36: 883–899. DOI: https://doi.org/10.1177/02692155221091509

Love MF, Sharrief A, Chaoul A, Savitz S, Beauchamp JES. Mind–body interventions, psychological stressors, and quality of life in stroke survivors: a systematic review. Stroke 2019; 50: 434–440. DOI: https://doi.org/10.1161/STROKEAHA.118.021150

García-Muñoz C, González-García P, Casuso-Holgado MJ, Martínez-Calderón J, Heredia-Rizo AM. Are movement-based mindful exercises (QIGONG, TAI CHI, AND YOGA) beneficial for stroke and Parkinson’s disease? A scoping review. Complement Ther Med 2023; 72: 102912. DOI: https://doi.org/10.1016/j.ctim.2022.102912

Pollock D, Peters MDJ, Tricco AC, Munn Z, Jia RM, Alexander L, Pieper D, Evans C, Godfrey CM, Brandão de Moraes E, Saran A, Campbell F, Khalil H. Scoping reviews (2026). Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI Manual for Evidence Synthesis. JBI; 2024. Available from: https://synthesismanual.jbi.global

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018; 169: 467–473. DOI: https://doi.org/10.7326/M18-0850

Kohl C, McIntosh EJ, Unger S, Haddaway NR, Kecke S, Schiemann J, et al. Online tools supporting the conduct and reporting of systematic reviews and systematic maps: a case study on CADIMA and review of existing tools. Environ Evid 2018; 7: https://doi.org/10.1186/s13750-018-0115-5 DOI: https://doi.org/10.1186/s13750-018-0115-5

World Health Organization. International classification of functioning, disability, and health: ICF. Geneva; WHO; 2001.

Barker TH, Habibi N, Aromataris E, Stone JC, Leonardi-Bee J, Sears K, et al. The revised JBI critical appraisal tool for the assessment of risk of bias for quasi-experimental studies. JBI Evid Synth 2024; 22: 378–388. DOI: https://doi.org/10.11124/JBIES-23-00268

Barker TH, Stone JC, Sears K, Klugar M, Tufanaru C, Leonardi-Bee J, et al. The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evid Synth 2023; 21: 494–506. DOI: https://doi.org/10.11124/JBIES-22-00430

Munn Z, Barker TH, Moola S, Tufanaru C, Stern C, McArthur A, et al. Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Evid Synth 2020; 18: 2127–2133. DOI: https://doi.org/10.11124/JBISRIR-D-19-00099

Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, Currie M, Lisy K, Qureshi R, Mattis P, Mu P. Systematic reviews of etiology and risk (2020). Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI Manual for Evidence Synthesis. JBI; 2024. Available from: https://synthesismanual.jbi.global DOI: https://doi.org/10.46658/JBIMES-24-06

Lockwood C, Munn Z, Porritt K. Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. Int J Evid Based Healthc 2015; 13: 179–187. DOI: https://doi.org/10.1097/XEB.0000000000000062

Porritt K, Evans C, Bennett C, Loveday H, Bjerrum M, Salmond S, et al. Systematic reviews of qualitative evidence. In: Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, eds. JBI manual for evidence synthesis. Adelaide: JBI; 2024.

Hong QN, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, et al. The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Educ Inf 2018; 34: 285–291. DOI: https://doi.org/10.3233/EFI-180221

Wang Y-L, Wu W-X, Yang C-C, Huang S-M, Chang C-C, Li C-R, et al. Heart rate variability biofeedback enhances cognitive, motor, psychological, and autonomic functions in post-stroke rehabilitation. Int J Psychophysiol 2024; 203: 112411. DOI: https://doi.org/10.1016/j.ijpsycho.2024.112411

Chang W-L, Lee J-T, Li C-R, Davis AHT, Yang C-C, Chen Y-J. Effects of heart rate variability biofeedback in patients with acute ischemic stroke: a randomized controlled trial. Biol Res Nurs 2020; 22: 34–44. DOI: https://doi.org/10.1177/1099800419881210

Beitollahi M, Forouzi MA, Tirgari B, Jahani Y. Fatigue, stigma, and mood in patients with multiple sclerosis: effectiveness of guided imagery. BMC Neurol 2022; 22: 152. DOI: https://doi.org/10.1186/s12883-022-02677-3

Kesik G, Ozdemir L, Mungan Ozturk S. The effects of relaxation techniques on pain, fatigue, and kinesiophobia in multiple sclerosis patients: a 3-arm randomized trial. J Neurosci Nurs 2022; 54: 86–91. DOI: https://doi.org/10.1097/JNN.0000000000000620

Schlesinger I, Benyakov O, Erikh I. Relaxation guided imagery reduces motor fluctuations in Parkinson’s disease. J Parkinsons Dis 2014; 4: 431–436. DOI: https://doi.org/10.3233/JPD-130338

Javdan T, Imani E, Negahi AA. Evaluation the effect of progressive muscle relaxation technique on fatigue and daily living activities in patients with multiple sclerosis. PJMHS 2021; 15: 1773–1777. DOI: https://doi.org/10.53350/pjmhs211561773

Saifan AR, Aburuz ME, Dhaher EA, Rayyan A, Jaberi MA, Masa’Deh R. The effect of Benson relaxation technique on depression, anxiety, and stress of Jordanian patients diagnosed with multiple sclerosis: a cross-sectional study. Depress Res Treat 2021; 2021: 1–8. DOI: https://doi.org/10.1155/2021/8300497

Ozkul C, Guclu-Gunduz A, Yazici G, Atalay Guzel N, Irkec C. Effect of immersive virtual reality on balance, mobility, and fatigue in patients with multiple sclerosis: A single-blinded randomized controlled trial. Eur J Integr Med 2020; 35: 101092. DOI: https://doi.org/10.1016/j.eujim.2020.101092

Mirhosseini S, Mohammadi A, Rezaei M, Mirbagher Ajorpaz N. The effect of Benson relaxation technique on the fatigue severity of patients with MS. JCCNC 2019; 5: 175–182. DOI: https://doi.org/10.32598/JCCNC.5.3.175

Mirhosseini S, Rezaei M, Ajorpaz NM. The effect of Benson relaxation technique on general health in multiple sclerosis (MS) patients in Kashan, Iran: a randomized controlled trial. J Res Dev Nurs Midw 2021; 18: 17–20. DOI: https://doi.org/10.52547/jgbfnm.18.1.17

Akbari A, Ahmadi F, Jalili E, Khazaei S. The effect of relaxation technique (Jacobsen and Benson) on depression, anxiety, and stress in patients with multiple sclerosis. Curr Psychiatry Res Rev 2021; 16: 213–219. DOI: https://doi.org/10.2174/2666082216999200819105928

Nazari F, Soheili M, Hosseini S, Shaygannejad V. A comparison of the effects of reflexology and relaxation on pain in women with multiple sclerosis. J Complement Integr Med 2016; 13: 65–71. DOI: https://doi.org/10.1515/jcim-2015-0046

Park J, Jung M, Ha J, Park JJ, Im S. Smartphone-based non-invasive biofeedback therapy for post-stroke sleep disorders: short report. Front Neurol 2025; 16: 1601821. DOI: https://doi.org/10.3389/fneur.2025.1601821

Mohd Nordin NA, Thazhakkattu Vasu D, Ezzat Ghazali S. Effectiveness of autogenic relaxation training as an adjunct to usual physiotherapy in enhancing emotional well-being and functional independence in stroke survivors: a randomized controlled study. Top Stroke Rehabil 2025; 32: 573–585. DOI: https://doi.org/10.1080/10749357.2024.2444117

Safi SZ. A Fresh look at the potential mechanisms of progressive muscle relaxation therapy on depression in female patients with multiple sclerosis. Iran J Psychiatry Behav Sci 2015; 9: e340. DOI: https://doi.org/10.17795/ijpbs340

Masoudi R, Sharifi Faradonbeh A, Mobasheri M, Moghadasi J. Evaluating the effectiveness of using a progressive muscle relaxation technique in reducing the pain of multiple sclerosis patients. J Musculoskelet Pain 2013; 21: 350–357. DOI: https://doi.org/10.3109/10582452.2013.852150

Moriya R, Ikeda N. A pilot study of the effects of progressive muscle relaxation on fatigue specific to multiple sclerosis. Br J Neurosci Nurs 2013; 9: 35–41. DOI: https://doi.org/10.12968/bjnn.2013.9.1.35

Ozkul C, Guclu-Gunduz A, Eldemir K, Apaydin Y, Yazici G, Irkec C. Combined exercise training improves cognitive functions in multiple sclerosis patients with cognitive impairment: a single-blinded randomized controlled trial. Mult Scler Relat Disord 2020c; 45: 102419. DOI: https://doi.org/10.1016/j.msard.2020.102419

Ozkul C, Guclu-Gunduz A, Eldemir K, Apaydin Y, Gulsen C, Yazici G, et al. Effect of task-oriented circuit training on motor and cognitive performance in patients with multiple sclerosis: a single-blinded randomized controlled trial. NeuroRehabilitation 2020b; 46: 343–353. DOI: https://doi.org/10.3233/NRE-203029

Dayapoğlu N, Tan M. Evaluation of the effect of progressive relaxation exercises on fatigue and sleep quality in patients with multiple sclerosis. J Altern Complement Med 2012; 18: 983–987. DOI: https://doi.org/10.1089/acm.2011.0390

Ghafari S, Ahmadi F, Nabavi M, Anoshirvan K, Memarian R, Rafatbakhsh M. Effectiveness of applying progressive muscle relaxation technique on quality of life of patients with multiple sclerosis. J Clin Nurs 2009; 18: 2171–2179. DOI: https://doi.org/10.1111/j.1365-2702.2009.02787.x

Garis G, Dettmers C, Hildebrandt A, Duning T, Hildebrandt H. Comparing two relaxation procedures to ease fatigue in multiple sclerosis: a single-blind randomized controlled trial. Neurol Sci 2023; 44: 4087–4098. DOI: https://doi.org/10.1007/s10072-023-07042-x

Fox EE, Hough AD, Creanor S, Gear M, Freeman JA. Effects of pilates-based core stability training in ambulant people with multiple sclerosis: multicenter, assessor-blinded, randomized controlled trial. Phys Ther 2016; 96: 1170–1178. DOI: https://doi.org/10.2522/ptj.20150166

De Luca R, Torrisi M, Piccolo A, Bonfiglio G, Tomasello P, Naro A, et al. Improving post-stroke cognitive and behavioral abnormalities by using virtual reality: a case report on a novel use of nirvana. Appl Neuropsychol Adult 2018; 25: 581–585. DOI: https://doi.org/10.1080/23279095.2017.1338571

Nave AH, Rackoll T, Grittner U, Bläsing H, Gorsler A, Nabavi DG, et al. Physical Fitness Training in Patients with Subacute Stroke (PHYS-STROKE): multicentre, randomised controlled, endpoint blinded trial. BMJ 2019; 366: l5101. DOI: https://doi.org/10.1136/bmj.l5101

Oostra K, Oomen A, Vanderstraeten G, Vingerhoets G. Influence of motor imagery training on gait rehabilitation in sub-acute stroke: a randomized controlled trial. J Rehabil Med 2015; 47: 204–209. DOI: https://doi.org/10.2340/16501977-1908

Golding K, Kneebone I, Fife-Schaw C. Self-help relaxation for post-stroke anxiety: a randomised, controlled pilot study. Clin Rehabil 2016; 30: 174–180. DOI: https://doi.org/10.1177/0269215515575746

Castro-Sánchez AM, Matarán-Peñarrocha GA, Lara-Palomo I, Saavedra-Hernández M, Arroyo-Morales M, Moreno-Lorenzo C. Hydrotherapy for the treatment of pain in people with multiple sclerosis: a randomized controlled trial. J Evid Based Complementary Altern Med 2012; 2012: 1–8. DOI: https://doi.org/10.1155/2012/473963

Carin-Levy G, Kendall M, Young A, Mead G. The psychosocial effects of exercise and relaxation classes for persons surviving a stroke. Can J Occup Ther 2009; 76: 73–80. DOI: https://doi.org/10.1177/000841740907600204

Hampson N, King L, Eriksson L-M, Smee H. The effects of relaxation training on depression and anxiety in people living with long-term neurological conditions. Disabil Rehabil 2020; 42: 2100–2105. DOI: https://doi.org/10.1080/09638288.2018.1554009

Giovannetti AM, Quintas R, Tramacere I, Giordano A, Confalonieri P, Messmer Uccelli M, et al. A resilience group training program for people with multiple sclerosis: results of a pilot single-blind randomized controlled trial and nested qualitative study. PLoS One 2020; 15: e0231380. DOI: https://doi.org/10.1371/journal.pone.0231380

Rohrmann S, Hopf M, Hennig J, Netter P. Psychobiologische Effekte von Autogenem Training und Progressiver Muskelrelaxation bei Patienten mit Rückenschmerzen, Patienten mit Multipler Sklerose und Gesunden. ZPPP 2001; 49: 373–387.

Carletto S, Borghi M, Bertino G, Oliva F, Cavallo M, Hofmann A, et al. Treating post-traumatic stress disorder in patients with multiple sclerosis: a randomized controlled trial comparing the efficacy of eye movement desensitization and reprocessing and relaxation therapy. Front Psychol 2016; 7: 526. DOI: https://doi.org/10.3389/fpsyg.2016.00526

Kos D, Duportail M, Meirte J, Meeus M, D’hooghe MB, Nagels G, et al. The effectiveness of a self-management occupational therapy intervention on activity performance in individuals with multiple sclerosis-related fatigue: a randomized-controlled trial. Int J Rehabil Res 2016; 39: 255–262. DOI: https://doi.org/10.1097/MRR.0000000000000178

Mead GE, Greig CA, Cunningham I, Lewis SJ, Dinan S, Saunders DH, et al. Stroke: a randomized trial of exercise or relaxation. J Am Geriatr Soc 2007; 55: 892–899. DOI: https://doi.org/10.1111/j.1532-5415.2007.01185.x

Artemiadis AK, Vervainioti AA, Alexopoulos EC, Rombos A, Anagnostouli MC, Darviri C. Stress management and multiple sclerosis: a randomized controlled trial. Arch Clin Neuropsychol 2012; 27: 406–416. DOI: https://doi.org/10.1093/arclin/acs039

Mackereth PA, Booth K, Hillier VF, Caress A-L. Reflexology and progressive muscle relaxation training for people with multiple sclerosis: a crossover trial. Complement Ther Clin Pract 2009; 15: 14–21. DOI: https://doi.org/10.1016/j.ctcp.2008.07.002

Wang X, Thiel L, Graff ND. Mindfulness and relaxation techniques for stroke survivors with aphasia: a feasibility and acceptability study. Healthcare 2022; 10: 1409. DOI: https://doi.org/10.3390/healthcare10081409

Wang X, Smith C, Ashley L, Hyland ME. Tailoring self-help mindfulness and relaxation techniques for stroke survivors: examining preferences, feasibility and acceptability. Front Psychol 2019; 10: 391. DOI: https://doi.org/10.3389/fpsyg.2019.00391

Brambila-Tapia AJL, Gutiérrez-García MM, Ruiz-Sandoval JL, Vázquez-Vázquez D, Ramírez-Martínez JF, Macias-Islas MÁ, et al. Using hypnoanalysis and guided imagery to identify and manage emotional aspects of multiple sclerosis. Explore (NY) 2022; 18: 88–95. DOI: https://doi.org/10.1016/j.explore.2020.10.002

Wood C, Cutshall SM, Lawson DK, Ochtrup HM, Henning NB, Larsen BE, et al. Music therapy for anxiety and pain after spinal cord injury: a pilot study. Glob Adv Health Med 2021; 10: 21649561211058697. DOI: https://doi.org/10.1177/21649561211058697

Monden KR, Nupp J, Ali A, MacIntyre B, Sevigny M, Hanks Philippus A. Exploring the feasibility of heart rate variability biofeedback for individuals with tetraplegia: a pilot clinical trial. Rehabil Psychol 2024; 70: 214–225. DOI: https://doi.org/10.1037/rep0000577

Case LK, Jackson P, Kinkel R, Mills PJ. Guided imagery improves mood, fatigue, and quality of life in individuals with multiple sclerosis: an exploratory efficacy trial of healing light guided imagery. J Evid Based Complementary Altern Med 2018; 23: 2515690X17748744. DOI: https://doi.org/10.1177/2515690X17748744

Schoffl J, Arora M, Pozzato I, McBain C, Rodrigues D, Vafa E, et al. Heart rate variability biofeedback in adults with a spinal cord injury: a laboratory framework and case series. J Clin Med 2023; 12: 7664. DOI: https://doi.org/10.3390/jcm12247664

Ostojic K, Sharp N, Paget S, Khut G, Morrow A. BrightHearts: a pilot study of biofeedback assisted relaxation training for the management of chronic pain in children with cerebral palsy. Paediatr Neonatal Pain 2022; 4: 33–42. DOI: https://doi.org/10.1002/pne2.12062

El-Helou R, Ryan B, Hilari K, Kneebone I. Evaluating the co-designed “kalmer” relaxation intervention for people with aphasia: a feasibility case series. Aphasiology 2024; 1–18. DOI: https://doi.org/10.1080/02687038.2024.2437784

Lovas J, Tran Y, Middleton J, Bartrop R, Moore N, Craig A. Managing pain and fatigue in people with spinal cord injury: a randomized controlled trial feasibility study examining the efficacy of massage therapy. Spinal Cord 2017; 55: 162–166. DOI: https://doi.org/10.1038/sc.2016.156

El-Helou R, Ryan B, Kneebone I. Development of the “Kalmer” relaxation intervention: co-design with stroke survivors with aphasia. Disabil Rehabil 2023; 45: 1517–1529. DOI: https://doi.org/10.1080/09638288.2022.2069294

Novais PGN, Batista KDM, Grazziano EDS, Amorim MHC. The effects of progressive muscular relaxation as a nursing procedure used for those who suffer from stress due to multiple sclerosis. Rev Lat Am Enfermagem 2016; 24: e2789. DOI: https://doi.org/10.1590/1518-8345.1257.2789

Mackay AM, Buckingham R, Schwartz RS, Hodgkinson S, Beran RG, Cordato DJ. The effect of biofeedback as a psychological intervention in multiple sclerosis: a randomized controlled study. Int J MS Care 2015; 17: 101–108. DOI: https://doi.org/10.7224/1537-2073.2014-006

Van Kessel K, Moss-Morris R, Willoughby E, Chalder T, Johnson MH, Robinson E. A randomized controlled trial of cognitive behavior therapy for multiple sclerosis fatigue. Psychosom Med 2008; 70: 205–213. DOI: https://doi.org/10.1097/PSY.0b013e3181643065

Sutherland G, Andersen MB, Morris T. Relaxation and health-related quality of life in multiple sclerosis: the example of autogenic training. J Behav Med 2005; 28: 249–256. DOI: https://doi.org/10.1007/s10865-005-4661-2

Jensen MP, Barber J, Romano JM, Molton IR, Raichle KA, Osborne TL, et al. A comparison of self-hypnosis versus progressive muscle relaxation in patients with multiple sclerosis and chronic pain. Int J Clin Exp Hypn 2009; 57: 198–221. DOI: https://doi.org/10.1080/00207140802665476

Kneebone I, Walker-Samuel N, Swanston J, Otto E. Relaxation training after stroke: potential to reduce anxiety. Disabil Rehabil 2014; 36: 771–774. DOI: https://doi.org/10.3109/09638288.2013.808275

Wardell DW, Rintala DH, Duan Z, Tan G. A pilot study of healing touch and progressive relaxation for chronic neuropathic pain in persons with spinal cord injury. J Holist Nurs 2006; 24: 231–240. DOI: https://doi.org/10.1177/0898010106289840

Grzesiak RC. Relaxation techniques in treatment of chronic pain. Arch Phys Med Rehabil 1977; 58: 270–272.

Ortega DF. Relaxation exercise with cerebral palsied adults showing spasticity. J Appl Behav Anal 1978; 11: 447–451. DOI: https://doi.org/10.1901/jaba.1978.11-447

Mauersberger K, Artz K, Duncan B, Gurgevich S. Can children with spastic cerebral palsy use self-hypnosis to reduce muscle tone? A preliminary study. Int Med 2000; 2: 93–96. DOI: https://doi.org/10.1016/S1096-2190(00)00008-1

Nordin L, Rorsman I. Cognitive behavioural therapy in multiple sclerosis: a randomized controlled pilot study of acceptance and commitment therapy. J Rehabil Med 2012; 44: 87–90. DOI: https://doi.org/10.2340/16501977-0898

Golding K, Fife-Schaw C, Kneebone I. Twelve month follow-up on a randomised controlled trial of relaxation training for post-stroke anxiety. Clin Rehabil 2017; 31: 1164–1167. DOI: https://doi.org/10.1177/0269215516682820

Golding K, Fife-Schaw C, Kneebone I. A pilot randomized controlled trial of self-help relaxation to reduce post-stroke depression. Clin Rehabil 2018; 32: 747–751. DOI: https://doi.org/10.1177/0269215517741947

Kirzinger B, Stroux A, Rackoll T, Endres M, Flöel A, Ebinger M, et al. Elevated serum inflammatory markers in subacute stroke are associated with clinical outcome but not modified by aerobic fitness training: results of the randomized controlled PHYS-STROKE Trial. Front Neurol 2021; 12: 713018. DOI: https://doi.org/10.3389/fneur.2021.713018

Rackoll T, Nave AH, Ebinger M, Endres M, Grittner U, Flöel A, et al. Physical Fitness Training in Patients with Subacute Stroke (PHYS-STROKE): safety analyses of a randomized clinical trial. Int J Stroke 2022; 17: 93–100. DOI: https://doi.org/10.1177/17474930211006286

Zhang J, Zhu L. Trends in exercise therapy research for neurological diseases: a bibliometric and visualization approach from 2000 to 2024. Front Neurol 2024; 15: 1479731. DOI: https://doi.org/10.3389/fneur.2024.1479731

Apel A, Greim B, König N, Zettl UK. Frequency of current utilisation of complementary and alternative medicine by patients with multiple sclerosis. J Neurol 2006; 253: 1331–1336. DOI: https://doi.org/10.1007/s00415-006-0217-9

Lang CE, MacDonald JR, Reisman DS, Boyd L, Jacobson Kimberley T, Schindler-Ivens SM, et al. Observation of amounts of movement practice provided during stroke rehabilitation. Arch Phys Med Rehabil 2009; 90: 1692–1698. DOI: https://doi.org/10.1016/j.apmr.2009.04.005

Pajaro-Blázquez M, Pons JL. Research highlights in neurorehabilitation. J Neuroeng Rehabil 2014; 11: 21. DOI: https://doi.org/10.1186/1743-0003-11-21

Boon P, Lescrauwaet E, Aleksovska K, Konti M, Berger T, Leonardi M, et al. A strategic neurological research agenda for Europe: towards clinically relevant and patient-centred neurological research priorities. Eur J Neurol 2023; 31: e16171. DOI: https://doi.org/10.1111/ene.16171

Krüger M, Lux V. Failure of motor function: a Developmental Embodiment Research perspective on the systemic effects of stress. Front Hum Neurosci 2023; 17: 1083200. DOI: https://doi.org/10.3389/fnhum.2023.1083200

Metz GA. Stress as a modulator of motor system function and pathology. Rev Neurosci 2007; 18: 209–222. DOI: https://doi.org/10.1515/REVNEURO.2007.18.3-4.209

Apazoglou K, Mazzola V, Wegrzyk J, Frasca Polara G, Aybek S. Biological and perceived stress in motor functional neurological disorders. Psychoneuroendocrinology 2017; 85: 142–150. DOI: https://doi.org/10.1016/j.psyneuen.2017.08.023

Treadwell JR, Tsou AY, Rouse B, Ivlev I, Fricke J, Buse DC, et al. Behavioral interventions for migraine prevention: a systematic review and meta-analysis. Headache 2025; 65: 668–694. DOI: https://doi.org/10.1111/head.14914

Paudel P, Sah A. Efficacy of biofeedback for migraine: a systematic review and meta-analysis. Complement Ther Med 2025; 90: 103153. DOI: https://doi.org/10.1016/j.ctim.2025.103153

Shahriari M, Dehghan M, Pahlavanzadeh S, Hazini A. Effects of progressive muscle relaxation, guided imagery and deep diaphragmatic breathing on quality of life in elderly with breast or prostate cancer. J Educ Health Promot 2017; 6: 1. DOI: https://doi.org/10.4103/jehp.jehp_147_14

World Health Organization. Rehabilitation [accessed 2025]. Available from https://www.who.int/news-room/fact-sheets/detail/rehabilitation

Kersting C, Hülsmann J, Weckbecker K, Mortsiefer A. Patients’ perspective on supposedly patient-relevant process and outcome parameters: a cross-sectional survey within the ‘PRO patients study’. BMC Health Serv Res 2022; 22: 72. DOI: https://doi.org/10.1186/s12913-021-07437-6

Crosswell AD, Lockwood KG. Best practices for stress measurement: How to measure psychological stress in health research. Health Psychol Open 2020; 7: 2055102920933072. DOI: https://doi.org/10.1177/2055102920933072

Oldehinkel AJ, Ormel J, Bosch NM, Bouma EMC, Van Roon AM, Rosmalen JGM, et al. Stressed out? Associations between perceived and physiological stress responses in adolescents: the TRAILS study. Psychophysiology 2011; 48: 441–452. DOI: https://doi.org/10.1111/j.1469-8986.2010.01118.x

Weber J, Heming M, Apolinário-Hagen J, Liszio S, Angerer P. Comparison of the Perceived Stress Reactivity Scale with physiological and self-reported stress responses during ecological momentary assessment and during participation in a virtual reality version of the Trier Social Stress Test. Biol Psychol 2024; 186: 108762. DOI: https://doi.org/10.1016/j.biopsycho.2024.108762

Dorsey A, Scherer EM, Eckhoff R, Furberg R. Measurement of human stress: a multidimensional approach. Research Triangle Park, NC: RTI Press; 2022. DOI: https://doi.org/10.3768/rtipress.2022.op.0073.2206

Hyland ME, Halpin DM, Blake S, Seamark C, Pinnuck M, Ward D, et al. Preference for different relaxation techniques by COPD patients: comparison between six techniques. Int J Chron Obstruct Pulmon Dis 2016; 11: 2315–2319. DOI: https://doi.org/10.2147/COPD.S113108

Davidson L, Roe D, Stern E, Zisman-Ilani Y, O’Connell M, Corrigan P. If I choose it, am I more likely to use it? Int J Pers Cent Med 2012; 2: 577–592.

Stanhope V, Barrenger SL, Salzer MS, Marcus SC. Examining the relationship between choice, therapeutic alliance and outcomes in mental health services. J Pers Med 2013; 3: 191–202. DOI: https://doi.org/10.3390/jpm3030191

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2026-10-08

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Rings, P., Dziurla, J., Van Damme, T., Alaerts, K., Groll, C., & Zietz, D. (2026). Relaxation interventions in neurological rehabilitation: a scoping review. Journal of Rehabilitation Medicine, 58, jrm45972. https://doi.org/10.2340/jrm.v58.45972

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