title: Pain acts through fatigue to affect participation in individuals with multiple sclerosis.
abstract: OBJECTIVE
  The symptoms of multiple sclerosis (MS) often cause physical and mental dysfunction, which interferes with a person's ability to participate in life's roles. Identification of the strength of the contributors to participation would help prioritize intervention approaches for its improvement. The objective of this study was to estimate the extent to which pain and other MS-related symptoms, physical function, psychological variables, and individual characteristics predict participation in people with MS.
  
  
  METHODS
  This was a cross-sectional study. Study sample was a center-stratified random sample of 188 persons with MS. Subjects completed a battery of self-report and performance-based measures that assessed participation and domains affecting participation. To model the relationships among variables, a conceptual framework based on the Wilson and Cleary model was tested. Structural equation modeling aimed at identification of the predictors of participation within the hypothesized theoretical model.
  
  
  RESULTS
  Fatigue (β = 0.63, p < 0.0001), physical function (β = 0.37, p < 0.0001), and psychological variables (β = 0.15, p = 0.04) were found to be as significant direct predictors of participation. Pain (β = 0.4, p < 0.0001) and age (β = 0.12, p < 0.0001) were significant indirect predictors through fatigue and physical function, respectively. Together these effects explained 88 % of the variance of participation, 35 % of the variance in psychological variables, and 29 % of the variance in physical function.
  
  
  CONCLUSIONS
  Fatigue, physical function, pain, and psychological variables were most important contributors for participation in persons with MS.
authors.affiliation: Faculty of Medicine, School of Physical and Occupational Therapy, McGill University Health Center, McGill University, Royal Victoria Hospital Site, Ross Pavilion R4.27, 687 Pine Ave W, Montreal, QC, H3A 1A1, Canada. shahnaz.shahrbanian@mail.mcgill.ca.|Faculty of Physical Education and Sport Science, Buali Sina University, Hamedan, Iran. shahnaz.shahrbanian@mail.mcgill.ca.
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Shahrbanian
authors.affiliation: Notre-Dame Hospital (CHUM), University of Montreal, Montreal, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Duquette
authors.affiliation: Faculty of Medicine, School of Physical and Occupational Therapy, McGill University Health Center, McGill University, Royal Victoria Hospital Site, Ross Pavilion R4.27, 687 Pine Ave W, Montreal, QC, H3A 1A1, Canada.|Division of Clinical Epidemiology, McGill University Health Center, Royal Victoria Hospital, Montreal, Canada.
authors.forename: Sara
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Faculty of Medicine, School of Physical and Occupational Therapy, McGill University Health Center, McGill University, Royal Victoria Hospital Site, Ross Pavilion R4.27, 687 Pine Ave W, Montreal, QC, H3A 1A1, Canada.|Division of Clinical Epidemiology, McGill University Health Center, Royal Victoria Hospital, Montreal, Canada.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Mayo
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D015444:Exercise; D005221:Fatigue / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000523:psychology*; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement / Q000379:methods*; D010809:Physical Fitness; D011788:Quality of Life / Q000523:psychology*
keywords: Fatigue; Multiple sclerosis; Pain; Participation; Rehabilitation; Structural equation modeling; Wilson–Cleary model