Objective: The National Service Framework (NSF) for Long-Term Neurological Conditions (LTNC) highlights the need for vocational rehabilitation (VR) services in quality requirement 6. As a part of a review of this requirement, an extensive literature review was undertaken to identify, review and report on all relevant research undertaken in the area of employment for people with multiple sclerosis (MS). Data sources: A systematic review of the English language literature for studies under the headings: multiple sclerosis and employment, unemployment, vocational rehabilitation, occupational health, job and work adjustment. The following databases were systematically searched AMED (1985 to Feb 2010), CINAHL (1982 to Feb 2010), PsycINFO (1806 to Feb 2010), EMBASE (1974 to Feb 2010), Medline (1950 to Feb 2010) and PubMed (1950 to Feb 2010). Data extraction and study selection: Four hundred and sixty-two papers were identified. This number was reduced removing the duplicates, non-English, not reporting research, not primarily about MS and not primarily about work which left 89 papers reviewed. Conclusion: The body of evidence reviewed gives clear indicators as to what the barriers to working with MS are and what is required for a VR service to meet the often complex needs of people with MS. Further research is needed to identify the efficacy of different models of VR, and their cost-effectiveness, and particularly for means of identifying and measuring the effectiveness of interventions that support work retention. [Box: see text].