Measuring participation in people living with multiple sclerosis: a comparison of self-reported frequency, importance and self-efficacy

Using Objective and Subjective Measures of Cognition to Predict Instrumental Activities of Daily Living Abilities in Multiple Sclerosis

BACKGROUND

Cognitive impairment, difficulty performing basic activities of daily living (ADLs) and instrumental ADLs (IADLs), depression, and fatigue are common among individuals with multiple sclerosis (MS). Some associations between these symptoms are known; however, many of their relationships remain unclear. This study investigated the contributions of subjective and objective cognition, depressive symptom severity, and fatigue on ADLs and IADLs.

METHODS

Participants (N = 217) were individuals with MS from a comprehensive MS center, participating in a larger study characterizing upper extremity function in MS. Outcome measures of ADL and IADL abilities were the Functional Status Index-Assistance (FSI-A) and Functional Status Index-Difficulty (FSI-D) and the Test D'évaluation Des Membres Supérieurs de Personnes Âgées (TEMPA). Predictors were objective cognition (Symbol Digit Modalities Test; SDMT), subjective cognition (Performance Scales©-Cognition; PS-C), depressive symptom severity (Center for Epidemiologic Studies Depression Scale; CES-D-10), and fatigue (Modified Fatigue Impact Scale; MFIS-5). Correlations were conducted, followed by hierarchal linear regressions. The SDMT and PS-C were entered into separate models.

RESULTS

After controlling for demographics, the SDMT significantly predicted the TEMPA and FSI-A, while the PS-C predicted only the FSI-D. The CES-D-10 predicted the FSI-D even after accounting for PS-C and SDMT, while the MFIS-5 only predicted the FSI-D when the SDMT was included. Neither the CES-D-10 nor MFIS-5 significantly predicted the FSI-A or TEMPA.

CONCLUSIONS

The way an individual with MS perceived their symptoms significantly contributed to their reported difficulty with functional tasks, while only their objective cognitive functioning predicted ADL and IADL performance and the level of assistance they would require.

social determinants of health in multiple sclerosis

Social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are the non-medical factors that influence health outcomes. Evidence indicates that health behaviours, comorbidities and disease-modifying therapies all contribute to multiple sclerosis (MS) outcomes; however, our knowledge of the effects of social determinants — that is, the ‘risks of risks’ — on health has not yet changed our approach to MS. Assessing and addressing social determinants of health could fundamentally improve health and health care in MS; this approach has already been successful in improving outcomes in other chronic diseases. In this narrative Review, we identify and discuss the body of evidence supporting an effect of many social determinants of health, including racial background, employment and social support, on MS outcomes. It must be noted that many of the published studies were subject to bias, and screening tools and/or practical interventions that address these social determinants are, for the most part, lacking. The existing work does not fully explore the potential bidirectional and complex relationships between social determinants of health and MS, and the interpretation of findings is complicated by the interactions and intersections among many of the identified determinants. On the basis of the reviewed literature, we consider that, if effective interventions targeting social determinants of health were available, they could have substantial effects on MS outcomes. Therefore, funding for and focused design of studies to evaluate and address social determinants of health are urgently needed.

Here, the authors discuss the potential effects of social determinants of health on multiple sclerosis risk and outcomes. They suggest that addressing these determinants of health could substantially improve the lives of individuals with multiple sclerosis and call for more research.

Addressing an individual’s social determinants of health — that is, the conditions under which they are born, grow, live, work and age — could provide opportunities to reduce the burden of living with multiple sclerosis (MS).

Individual factors that may influence MS-related outcomes include sex, gender and sexuality, race and ethnicity, education and employment, socioeconomic status, and domestic abuse.

Societal infrastructures, including access to food, health care and social support, can also affect MS-related outcomes.

Awareness of the specific circumstances of a patient with MS might help neurologists deliver better care.

Social determinants of health are not static and can change according to wider sociopolitical contexts, as highlighted by the COVID-19 pandemic.

Rigorous studies of interventions to ameliorate the effects of poor social determinants on people with MS are urgently needed.

A protocol for Removing Environmental Barriers to Independent Living (REBIL): An adapted evidence-based occupational therapy intervention to increase community participation for individuals aging with long-term physical disabilities

Background

People aging with long-term physical disabilities (PAwLTPD) are living longer and experiencing the challenges of aging, including the onset of secondary and age-related health conditions. PAwLTPD are at high risk of falls, fall injuries, diminished functional abilities, and compromised participation. However, no available programs support PAwLTPD to participate safely at home and in the community. The proposed study is to examine the feasibility and efficacy of an adapted intervention: Removing Environmental Barriers to Independent Living (REBIL).

Method/Design

A single-blinded randomized controlled trial (RCT) will be conducted. Participants who are 45-65 years old; self-report difficulty with ≥2 daily activities; have had a physical disability for ≥5 years; and live within 60 miles of the research lab are eligible. All participants will receive an initial in-home evaluation before randomization. The treatment group will receive REBIL (total five visits), which is tailored. The waitlist control group will be offered the same intervention after 6-month follow-up. Expected outcomes are high acceptability, fidelity, and adherence; low safety risk; improved community participation and daily activities performance; and fewer environmental barriers and fall hazards.

Discussion

Findings will serve as preliminary evidence for occupational therapy community practice. Outcomes will also inform future large, pragmatic trials.

Trial Registration

ClinicalTrials.gov identifier NCT04589988.

Self-reported Reasons for Changes in Performance of Everyday Activities During a 2-Year Multidisciplinary Multiple Sclerosis Rehabilitation

Background: Few multidisciplinary rehabilitation studies with a heterogeneous design have focused on people with multiple sclerosis (MS). This study compared subjective-reported changes in performance and satisfaction with daily activities among moderately and severely disabled people with MS during a 2-year, multidisciplinary, group-based, outpatient rehabilitation program comprising education in self-management and compensatory techniques, exercise, and guided peer support.

Methods: Thirty-eight adults with moderate disability (Expanded Disability Status Scale [EDSS] score of 4.0–5.5, 74% women, mean age of 48 years) and 41 persons with severe disability (EDSS 6.0–8.5, 63% women, mean age of 48 years) were assessed at baseline and after 12 and 21 months of outpatient rehabilitation using the Canadian Occupational Performance Measure. Group × time interactions were analyzed using mixed analysis of variance. Participants’ explanations of reasons for changes in activity performance were collected via semistructured interviews and content analyzed.

Results: Statistically significant improvements in Canadian Occupational Performance Measure performance and satisfaction scores were reported in both groups from baseline to 21 months of rehabilitation. No significant between-group differences in improvement were observed. The self-reported reasons for improvement were mainly linked to environmental factors.

Conclusions: The outpatient rehabilitation program, including four themes—cognition, mood, energy conservation, and body control—improved the self-reported performance of patients with MS with moderate and severe disabilities. Environmental factors warrant consideration during rehabilitation.

Activity limitations and participation restrictions in people with multiple sclerosis: a detailed 10-year perspective

AIM

To conduct a detailed investigation into changes in activity limitations and participation restrictions over 10 years in people with mild, moderate and severe multiple sclerosis.

METHODS

This study was a 10-year longitudinal study of 264 people with multiple sclerosis living in Stockholm County, Sweden. Ten-year changes in personal and instrumental activities in daily living were assessed using the Katz Activities in Daily Living Index Extended and participation in social/lifestyle activities using the Frenchay Activities Index.

RESULTS

While people with moderate multiple sclerosis, compared to baseline, demonstrated significantly higher proportions of dependency in most activities of personal and instrumental activities in daily living at the 10-year follow-up, the mild group primarily increased their dependency in instrumental activities and the severe group in personal activities. Significantly higher proportions of the moderate group showed restricted participation in domestic and outdoor activities whereas the mild group only showed restrictions in a few domains of participation. A majority of people with severe multiple sclerosis showed restricted participation in all social/lifestyle activities at baseline and the 10-year follow-up.

CONCLUSIONS

Prominent long-term increases in activity limitations and participation restrictions occurred across the spectrum of disease severity but was most pronounced in those more moderately affected. Implications for rehabilitation This study provides guidance with regard to specific activities that are prone to deteriorate across 10 years and thereby reflect important targets and outcomes for interventions. Increases in activity limitations and participation restrictions were most pronounced in those moderately affected by multiple sclerosis. Those mildly affected by multiple sclerosis primarily increased their dependency in instrumental activities of daily living while those severely affected increased their dependency in personal activities of daily living.

The Self-Efficacy in Multiple Sclerosis (SEMS) Scale

Abstract. This research developed a new scale to evaluate Self-Efficacy in Multiple Sclerosis (SEMS). The aim of this study was to investigate dimensionality, item functioning, measurement invariance, and concurrent validity of the SEMS scale. Data were collected from 203 multiple sclerosis (MS) patients (mean age, 39.5 years; 66% women; 95% having a relapsing remitting form of MS). Fifteen items of the SEMS scale were submitted to patients along with measures of psychological well-being, sense of coherence, depression, and coping strategies. Data underwent Rasch analysis and correlation analysis. Rasch analysis indicates the SEMS as a multidimensional construct characterized by two correlated dimensions: goal setting and symptom management, with satisfactory reliability coefficients. Overall, the 15 items reported acceptable fit statistics; the scale demonstrated measurement invariance (with respect to gender and disease duration) and good concurrent validity (positive correlations with psychological well-being, sense of coherence, and coping strategies and negative correlations with depression). Preliminary evidence suggests that SEMS is a psychometrically sound measure to evaluate perceived self-efficacy of MS patients with moderate disability, and it would be a valuable instrument for both research and clinical applications.

Modified Functional Walking Categories and participation in people with multiple sclerosis

BACKGROUND

Gait velocity influences the ability of a person to move in different outdoor or indoor contexts and has accordingly been classified through the Modified Functional Walking Categories (MFWC). Community ambulation in persons with multiple sclerosis (PwMS) may give information on their social and productive participation, as well as independence in household activities.

OBJECTIVES

To investigate factors associated with walking and mobility restrictions as classified by the Modified Functional Walking Categories (MFWC) and analyze the influence of disease characteristics, demographical and walking factors on participation in PwMS.

METHODS

155 PwMS attending two rehabilitation center were evaluated. Community ambulation was classified with the MFWC; participation was measured with the Community Integration Questionnaire (CIQ). MFWC and statistically significant variables associated with CIQ score were entered in a multivariate logistic model to assess the multiple relationships.

RESULTS

PwMS with a secondary progressive type of disease, longer disease duration and using walking aids were classified in the worse MFWC. Participation restrictions were more frequent in Limited Household (72.3%) and in Physiological Walkers (93.7%). The final multivariate model (p < 0.0001) showed that the use of a walking aid (OR = 2.59), being male (OR = 2.94) and older (OR = 1.06) increased the likelihood of having participation restrictions. The same variables predicted home participation; MFWC and age predicted productive participation while only age influenced social participation.

CONCLUSIONS

Modified Functional Walking Categories were associated with type of disease, disease duration, disability level and type of walking aid. The best clinical predictor of participation restriction was walking aid while walking categories only predicted productive participation.

Self-Rated Communication-Related Quality of Life of Individuals With Oromandibular Dystonia Receiving Botulinum Toxin Injections

PURPOSE

In this preliminary study, we examined self-rated communication-related quality of life (CR-QoL) of 10 control participants and 10 individuals with oromandibular dystonia (OMD) and dysarthria receiving therapeutic botulinum toxin (BoNT-A) injections.

METHOD

Participants with OMD and associated dysarthria self-rated CR-QoL pre- and post- BoNT-A injection using the American Speech-Language-Hearing Association's Quality of Communication Life Scale (ASHA QCL; Paul et al., 2004). Control participants self-rated CR-QoL during a single experimental visit.

RESULTS

Significant differences were found between control participants and participants with OMD on ratings of CR-QoL across all 5 domains and subdomains of the ASHA QCL. No significant differences in CR-QoL were found over the course of the BoNT-A treatment cycle.

CONCLUSIONS

CR-QoL was rated lower by participants with OMD as compared with control participants across all ASHA QCL domains/subdomains with "socialization/activities" and "confidence/self-concept" having the largest effect sizes. No differences in CR-QoL were found over the course of the treatment cycle. We advocate for outcome measures that include patient report. The use of patient-reported outcome measures in conjunction with objective or impairment-based outcome measures can help inform meaningful clinical indicators of treatment success. This study adds novel information that may aid our understanding of the experience of living with OMD in this underserviced clinical population.

Cross-Sectional Examination of the Associations Between Symptoms, Community Integration, and Mental Health in Multiple Sclerosis

OBJECTIVE

To determine the frequency and severity of 8 symptoms in persons with multiple sclerosis (MS) and to examine the association between these symptoms and community integration and mental health.

DESIGN

Cross-sectional survey that assessed 8 symptoms (pain, fatigue, imbalance, numbness, weakness, shortness of breath, vision loss, and memory loss), disease progression (self-report version of the Expanded Disability Status Scale), community integration, and mental health.

SETTING

Community.

PARTICIPANTS

Adults with self-reported MS who responded to a mailed survey (N=180).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The presence and intensity of symptoms were measured with a symptoms checklist. Community integration was assessed with the Community Integration Questionnaire, and mental health was measured by the Mental Health Index of the Medical Outcomes Study 36-Item Short-Form Health Survey.

RESULTS

The average number of symptoms reported was 5.07±2.18. The most common symptoms (fatigue, weakness, and imbalance) were also rated as the most severe. Not all symptoms were associated with level of disease progression or with MS subtype. Symptoms related to mobility were more likely to be associated with these variables. The 8 symptoms as a whole accounted for significant amounts of variance (range, 13%-21%) in measures of community integration and mental health, with specific symptoms making differential independent contributions to these measures.

CONCLUSIONS

This study demonstrates that most individuals with MS report a number of bothersome symptoms. Type of MS or level of progression does not tell the whole story regarding the impact of symptoms.

Cognitive Impairment and Community Integration Outcomes in Individuals Living With Multiple Sclerosis

OBJECTIVES

To determine the association between unique domains of cognitive impairment and community integration in individuals with multiple sclerosis (MS), and to determine the contributions of cognitive impairment to community integration beyond the influence of demographic and clinical variables.

DESIGN

Cross-sectional analysis of objective neuropsychological assessment and self-report data. Data were collected during baseline assessment of a randomized, multisite controlled trial of ginkgo biloba for cognitive impairment in MS. Hierarchical regression analyses examined the association between subjective and objective measures of cognitive impairment and 3 domains of community integration, adjusting for relevant covariates.

SETTING

Two Veterans Affairs medical center MS clinics.

PARTICIPANTS

Adults (N=121; ages 24-65y) with a confirmed MS diagnosis.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Primary outcomes were scores on the Home Integration (CIQ-H), Social Integration (CIQ-S), and Productivity (CIQ-P) domains of the Community Integration Questionnaire (CIQ).

RESULTS

Cognitive impairment was associated with lower scores on the CIQ-H and CIQ-S, but not the CIQ-P. Greater levels of subjective cognitive impairment were associated with lower scores on the CIQ-H and CIQ-S. Greater levels of objective cognitive impairment, specifically slower processing speed and poorer inhibitory control, were related to lower CIQ-S scores. Subjective and objective measures of cognitive impairment were significantly and independently associated with CIQ-S.

CONCLUSIONS

Objective cognitive impairment may interfere with participation in social activities. Subjective cognitive impairment is also important to assess, because individuals who perceive themselves to be cognitively impaired may be less likely to participate in both home and social activities. Clinical interventions to enhance community integration in individuals with MS may benefit from addressing objective and subjective cognitive impairment by integrating cognitive rehabilitation approaches with self-efficacy-enhancing strategies.

Correlates of participation in meaningful activities among people with multiple sclerosis

OBJECTIVE

To explore the associations between impairments, self-management self-efficacy, self-management behaviors, and environmental factors and their role in predicting participation in meaningful activities among people with multiple sclerosis.

DESIGN

Online cross-sectional survey.

SUBJECTS/PATIENTS

Randomly selected individuals (n = 335) from a large multiple sclerosis patient registry.

METHODS

Participation in activities that are meaningful to the individual was measured with Community Participation Indicators (CPI), the dependent variable. Independent variables included symptom severity, activities of daily living limitations, cognitive problems, stages of change for physical activity, nutritional behaviors, self-efficacy, and environmental barriers. A backwards selection regression analysis was used to compare the relative contributions of independent variables in predicting the CPI. A path analysis was conducted to explore the associations between independent variables and their direct and indirect effects on the CPI.

RESULTS

The final regression model included self-management self-efficacy (β = 0.12), environmental barriers (β = -0.16), cognitive problems (β = -0.22), and stages of change for physical activity (β = 0.12). Path analysis indicated that impairments and environmental barriers might negatively influence self-management self-efficacy. Self-management self-efficacy might have indirect effects on the CPI via engagement in self-management behaviors.

CONCLUSION

Future research should explore whether interventions that promote self-management self-efficacy can facilitate participation in meaningful activities.

A review of the psychometric properties of generic utility measures in multiple sclerosis

OBJECTIVE

The reliability and validity of generic utility measures have not yet been summarized in people with multiple sclerosis (MS). It is important to assess the psychometric properties of these measures, to ensure that the values obtained by the scoring system are valid for interpretation and utilization by clinicians, researchers and policy makers. Therefore, the objective of this review was to summarize the evidence from published literature on the psychometric properties of generic utility measures in MS.

METHODS

A structured literature search was conducted by using multiple electronic databases. All potentially relevant abstracts and full-text articles were read to identify publications that may be eligible for inclusion in the review. A meta-analysis was conducted to combine correlation coefficient values for convergent validity. The Schmidt-Hunter method, a weighted mean of the correlation coefficient values, was used. Heterogeneity, the percentage of total variation across studies that is due to between-study differences rather than chance, was assessed using the I (2) statistic.

RESULTS

The following generic utility measures were identified: the EQ-5D (n = 9)/EQ-5D-5 Level (EQ-5D-5L) (n = 1), followed by the Health Utilities Index Mark 3/2 (HUI2/HUI3) (n = 3), the SF-6D (n = 2), the Assessment of Quality of Life (AQOL) (n = 2), and the Quality of Well-Being (QWB) scale (n = 1). Ceiling and floor effects were present for the EQ-5D and the SF-6D, but not for the HUI3. The EQ-5D, the SF-6D and the HUI3 demonstrated excellent reliability. In terms of discriminative ability, the SF-6D and the QWB scale were not able to differentiate between moderately and severely disabled MS patients, and the EQ-5D was not able to differentiate between those who were mildly and moderately disabled. The AQOL and the HUI3, on the other hand, demonstrated good discriminative ability, as both measures were able to differentiate between all levels of disability. As for convergent validity, the HUI2/HUI3 were highly correlated (r = 0.7) against measurement instruments that evaluated impairments such as disease severity, ambulation and manual dexterity. The EQ-5D, SF-6D and the QWB scale demonstrated small to moderate correlations (r = 0.4) against instruments evaluating impairments, and slightly stronger correlations against measures of activity limitations/participation restrictions and health-related quality of life (HRQL) (r = 0.6).

CONCLUSION

To our knowledge this is the first study to review the validity and reliability of generic utility measures in MS. The HUI3 demonstrated the strongest psychometric properties when compared with other utility measures. However, the HUI3 only measures impairment and excludes important components of HRQL such as participation restrictions. The EQ-5D, the SF-6D and the QWB scale, on the other hand, do include items on participation. However, these measures demonstrated a lack of content validity in MS by missing certain domains that were important to the disease, as well as difficulty in differentiating between different levels of disability. The addition of MS-specific 'bolt-ons' to generic utility measures and the development of an MS specific utility measure are possible areas of exploration for future research.

Self-efficacy as a predictor of self-reported physical, cognitive, and social functioning in multiple sclerosis

OBJECTIVE

The objective of this study was to investigate whether self-efficacy is associated with physical, cognitive, and social functioning in individuals with multiple sclerosis (MS) when controlling for disease-related characteristics and depressive symptomatology.

METHOD

Study subjects were 81 individuals between the ages of 29 and 67 with a diagnosis of clinically definite MS. Hierarchical regression analysis was used to examine the relationships between self-efficacy and self-reported physical, cognitive, and social functioning.

RESULTS

Self-efficacy is a significant predictor of self-reported physical, cognitive, and social functioning in MS after controlling for variance due to disease-related factors and depressive symptomatology.

CONCLUSIONS

Self-efficacy plays a significant role in individual adjustment to MS across multiple areas of functional outcome beyond that which is accounted for by disease-related variables and symptoms of depression.

Physical activity and depression in middle and older-aged adults with multiple sclerosis

BACKGROUND

Depression is common among people with multiple sclerosis (MS), and research shows that individuals, including individuals with MS, who are more physically active report lower rates of depression. However, little is known about the relative importance of level of physical activity (e.g., moderate versus vigorous) in relationship to depression, or the role that age might play in this relationship among people with MS. The current study sought to (1) clarify the associations between moderate and vigorous physical activity and depression in a sample of individuals with MS, (2) determine the associations between age and physical activity, and (3) test for the potential moderating influence of age on the associations between physical activity and depression.

OBJECTIVE/HYPOTHESIS

Cross-sectional survey.

METHODS

112 individuals with MS completed a survey assessing demographic variables, amount of moderate and vigorous physical activity, and depression.

RESULTS

There was a gradual decrease in the amount of moderate and vigorous physical activity as age increased, but this decrease was not statistically significant. Moderate physical activity was significantly (negatively) associated with depression across all age cohorts. Time spent in vigorous physical activity was significantly (negatively) associated with depression among the middle-aged but not younger or older participants who are physically active.

CONCLUSIONS

The findings support a link between moderate physical activity and depression and, for middle-aged individuals, vigorous physical activity and depression in persons with MS. The findings indicate that research examining the impact of activity enhancing treatments on depression in individuals with MS is warranted.

Satisfaction with participation in multiple sclerosis and spinal cord injury

PURPOSE

To validate a single item self-report of satisfaction with participation in two groups with differing patterns of symptoms and disease progress, multiple sclerosis (MS) and spinal cord injury (SCI).

METHOD

Community-dwelling adults with MS (N = 1,271) or SCI (N = 620) completed a battery of self-report questionnaires covering demographic information, disease specific measures, symptoms, psychological distress, social-environmental issues, and overall well-being. They were also asked to rate satisfaction with participation: How satisfied are you with your ability to take part in activities that are important to you: not satisfied, somewhat satisfied, satisfied, or very satisfied. Kendall's tau rank correlation coefficient and χ(2) tests were used to examine the strength and direction of associations between demographic and symptom variables and responses to the participation item.

RESULTS

Although the demographics of the MS and SCI differed in predictable ways, younger participants and those employed report more satisfaction with participation. Ratings of satisfaction with participation were also consistently associated with a number of variables including less fatigue, pain, depression, stress, anxiety, as well as higher overall measures of well-being across the two populations.

CONCLUSIONS

More research is needed to better understand the multiple dimensions that comprise participation and to develop robust and sensitive measurement tools. A global rating of satisfaction with participation using one item has a number of potentially useful applications including description of case mix in clinical trials.

Acquired dysarthria in conversation: methods of resolving understandability problems

BACKGROUND

People with acquired progressive dysarthria typically experience increased problems with intelligibility in everyday conversation as their disease progresses. Such problems are likely to impact on both the person with dysarthria and those with whom they interact. If this is the case then we may ask questions not just about the nature of these problems but how it is that such problems are dealt with by participants when they occur.

AIMS

To investigate ways through which problems resulting from dysarthria in everyday conversation are resolved by participants. Further, to examine some of the features of repair resolution, particularly where understanding of self-repair attempts themselves prove difficult.

METHODS & PROCEDURES

Video data of natural conversation from two dyads were selected for this paper. One dyad features a 58 year-old man with multiple sclerosis and moderate intelligibility problems, the other a 79 year-old woman with motor neurone disease with mild to moderate intelligibility problems. Both elected to be recorded in conversation with their spouses. The dyads were video-recorded at home with no researcher present. Using the methods of Conversation Analysis (CA) a collection of sequences was identified and transcribed. The sequences were analysed with reference to how the participants resolve problems in the understanding of dysarthric speech.

OUTCOMES & RESULTS

It is shown how some problems resulting from dysarthria in conversation can be resolved relatively quickly, particularly where a specific element of a prior turn is highlighted by the recipient as problematic. In other instances, the recipient's understanding problem may be more global. These result in longer repair sequences in which problematic elements are addressed individually. Such a resolution method is ultimately successful but may also be characterised by additional understanding problems. These findings draw attention to an important distinction between intelligibility and understandability.

CONCLUSIONS & IMPLICATIONS

It is concluded that problems resulting from dysarthria in conversation can require extensive repair work involving both parties. This has implications for the assessment of dysarthria in everyday conversation and also the promotion of intervention strategies that encompass the activities of both participants when dealing with dysarthria in interaction. These findings may be usefully employed in informing both direct clinical work and through training those who work with this client group and their significant others.

Variables associated with communicative participation in people with multiple sclerosis: a regression analysis

PURPOSE

To explore variables associated with self-reported communicative participation in a sample (n = 498) of community-dwelling adults with multiple sclerosis (MS).

METHOD

A battery of questionnaires was administered online or on paper per participant preference. Data were analyzed using multiple linear backward stepwise regression. The dependent variable was an item response theory score of communicative participation measured by a subset of items from the Communicative Participation Item Bank asking respondents to rate how much their health condition interfered with participation in real-life speech communication situations. Thirteen independent variables were included in the model as self-reported symptoms: problems thinking, slurred speech, vision loss, pain, mobility, depression, fatigue, perceived social support, age, education level, employment status, gender, and MS duration.

RESULTS

Fatigue, slurred speech, depression, problems thinking, employment status, and social support were significantly associated with communicative participation, accounting for 48.7% of the variance.

CONCLUSIONS

Communicative participation is significantly associated with multiple variables, only some of which reflect communication disorders. If the goal of intervention is to improve communicative participation, intervention may need to extend beyond traditional speech-language pathology boundaries to include other health symptoms as well as personal, social, and physical environments.