To explore the motor performance in people with multiple sclerosis (MS) using virtual reality (VR), and to investigate the effect of fatigue and cognitive function on motor performance in MS.

Twenty MS participants and 20 controls were recruited to the study. To assess motor performance, each participant was asked to perform a VR game for 5 times (blocks). The main outcomes were time to complete the VR game and number of recorded errors. To assess fatigue level and cognitive function, participants were asked to complete the Arabic versions of the modified fatigue impact scale (MFIS) and the Montréal Cognitive Assessment (MOCA) respectively.

MS participants and controls demonstrated a practice-related improvement in performance as shown by the main effect of block for each of the outcome measures (p<0.001, time required to complete VR game; p<0.001, errors recorded). Significant and robust correlations between recorded errors and MOCA (r=0.75, p<001) and between performance errors and MFIS (r= 0.55, p=0.011) were found in the MS participants.

Motor performance in individuals with MS is preserved and influenced by cognitive function and fatigue level. Health care professionals are advised to be aware of the negative impact of cognitive dysfunctions and fatigue on motor performance. A multi-component intervention that targets these factors is advisable. Future research, however, is required to determine the content and potential benefits of such an intervention in the MS population.