title: How are cognitive impairment, fatigue and signs of depression related to participation in daily life among persons with multiple sclerosis?
abstract: OBJECTIVE
  Factors that impact participation are of scientific and clinical importance. Participation in everyday activities among persons with multiple sclerosis (MS) can be compromised by various factors however the combined contribution of these factors to participation has not been explored. The aim of this study was to describe the relationship between cognitive impairment, physical disability and signs of depression and participation in daily life among persons with MS.
  
  
  METHODS
  Data from 200 participants were collected in an observational, prospective study. The majority was female, had mild physical disability, and an average age of 48.7. The impact of independent variables, including demographic and disease related data, levels of cognitive impairment, signs of depression and fatigue, on participation was investigated using path analysis.
  
  
  RESULTS
  Cognitive impairment was associated with restricted participation in domestic, leisure and outdoor domains. Restrictions in leisure and outdoor activities, but not domestic activities were related to signs of depression. Cognitive impairment was associated with the level of education and the level of physical disability.
  
  
  CONCLUSIONS
  Increasing participation is an important outcome of rehabilitation. The results of this study suggest a multifactorial approach to intervention that considers physical, mental and emotional component to maximize participation among persons with MS. Implications for Rehabilitation Rehabilitation for persons living with multiple sclerosis (MS) should incorporate careful evaluation of physical disability, cognitive impairment and depression and their impact on participation. Clinicians need to evaluate participation in a variety of daily activities, including activities within and outside of the home, and leisure activities. Signs of depression may have a greater impact on participation in outdoor and leisure activities then on other activities.
authors: Department of Occupational Therapy, Tel Aviv University , Tel Aviv , Israel .
authors: Eynat
authors: E
authors: Ben Ari Shevil
authors: Sverker
authors: S
authors: Johansson
authors: Charlotte
authors: C
authors: Ytterberg
authors: Jakob
authors: J
authors: Bergström
authors: Lena
authors: L
authors: von Koch
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D003072:Cognition Disorders / Q000503:physiopathology / Q000523:psychology*; D003863:Depression / Q000503:physiopathology / Q000523:psychology*; D004185:Disability Evaluation; D005221:Fatigue / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D006801:Humans; D007899:Leisure Activities; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation*; D010358:Patient Participation / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life; D018434:Sickness Impact Profile; D016896:Treatment Outcome; D055815:Young Adult
keywords: Activities of daily living; cognition; depression; fatigue; multiple sclerosis