How are cognitive impairment, fatigue and signs of depression related to participation in daily life among persons with multiple sclerosis?

PURPOSE: 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.

Functional capacity evaluation of work performance among individuals with pelvic injuries following motor vehicle accidents.

OBJECTIVE: Pelvic injuries following motor vehicle accidents (MVA) cause disability and affect work capabilities. This study evaluated functional, self-report, and medical-based factors that could predict work capacity as was reflected in a functional capacity evaluation (FCE) among persons who sustained a pelvic injury. It was hypothesized that self-reported functional status and bio-demographic variables would predict work capacity. PARTICIPANTS: Sixty-one community-dwelling adults previously hospitalized following a MVA induced pelvic injury. METHODS: FCE for work performance was conducted using the Physical Work Performance Evaluation (PWPE). Additional data was collected through a demographics questionnaire and the Functional Status Questionnaire. All participants underwent an orthopedic medical examination of the hip and lower extremities. RESULTS: Most participants self-reported that their work capacity post-injury were lower than their job required. PWPE scores indicated below-range functional performance. Regression models predicted 23% to 51% of PWPE subtests. Participants' self-report of functioning (instrumental activities of daily living and work) and bio-demographic variables (gender and age) were better predictors of PWPE scores than factors originating from the medical examination. CONCLUSIONS: Results support the inclusion of FCE, in addition to self-report of functioning and medical examination, to evaluate work capacity among individuals' post-pelvic injury and interventions and discharge planning.

Pilot study of a cognitive intervention program for persons with multiple sclerosis.

Cognitive impairments are prevalent in multiple sclerosis (MS) and can significantly limit participation in daily activities. Although the clinical depiction of cognitive impairments in MS has been well investigated, strategies to manage cognitive difficulties are less well studied. This pilot study tested a 5-week, group-based community program addressing strategies to self-manage MS cognitive changes. The goals of the program were to increase participants' knowledge of cognitive impairments, increase levels of self-efficacy to manage cognitive difficulties and increase use of management strategies. Participants were taught various cognitive compensatory strategies and practiced their implementation between sessions. Thirty-five individuals with MS with mild-to-moderate cognitive impairments participated in the program. All participants exhibited increased knowledge of cognitive impairments and their daily impact. Participants significantly increased levels of self-efficacy in their ability to manage cognitive difficulties (chi(2)(2)=37.15, P < or = 0.0001). Self-efficacy scores were maintained at follow-up (chi(1)(2)=1.48, P = 0.2230). Although the number of strategies participants used did not change significantly (chi(2)(2)=2.82, P = 0.2446), they reported increased effectiveness of strategies and being able to generalize strategies to other activities. Study results point to the potential benefits of self-management programs to address cognitive symptoms in MS. Study limitations include no control group and use of non-standardized outcome measures.

Using virtual reality to evaluate executive functioning among persons with schizophrenia: a validity study.

Persons with Schizophrenia experience difficulties with Executive Functioning (EF) that affect independence and participation in activities. Specifically, EF impacts performance in Instrumental Activities of Daily Living (IADL) that require flexible thinking and accommodation to complex environments. However, less is known how schizophrenia affects EF and individuals' performance in activities. IADL performance can be tested using a virtual reality (VR) environment that simulates real life activities. The purpose of this study was: 1) to examine the feasibility and validity of the Virtual Action Planning-Supermarket (VAP-S) to assess EF in persons with schizophrenia as compared to a standardized EF measure (the Behavioral Assessment of Dysexecutive Syndrome, BADS); 2) to compare performance of persons with schizophrenia and healthy controls in the VAP-S; 3) to assess the ability of the VAP-S to differentiate between different levels of EF within schizophrenia; 4) to explore the relationships between negative and positive symptoms and performance on the tests. Thirty persons with schizophrenia were matched with 30 healthy controls. Significant differences in performance between research and control groups were detected on the VAP-S and BADS, with the research group performing worse. Large variations in number of purchases within the VAP-S by the research group point to level of task completion thus secondary analysis was conducted. There was a significant negative correlation between level of the negative signs and overall performance on the BADS and on most measures of the VAP-S. Results of this study support the use the VAP-S to assess EF among persons with Schizophrenia.

Perceptions of cognitive symptoms among people aging with multiple sclerosis and their caregivers.

OBJECTIVE: We sought to examine the nature and extent of agreement on cognitive symptoms reported by people aging with multiple sclerosis (MS) and their primary caregivers and the factors associated with disagreement. METHOD: Data were generated from telephone interviews with 279 dyads of people with MS and their caregivers. RESULTS: Eighty dyads (28.7%) disagreed about the presence of cognitive symptoms in the person with MS. Disagreeing dyads were of two types: a dyad in which the person with MS indicated no cognitive symptoms, but the caregiver did (41 dyads; 14.7%), and a dyad in which the person with MS indicated cognitive symptoms, but the caregiver did not (39 dyads, 14%). Multinomial regression showed that gender and the number of years the person with MS has experienced symptoms were associated with type of disagreement. CONCLUSION: The results point to the importance of discussing cognitive symptoms with people with MS and their caregivers.

Process evaluation of a self-management cognitive program for persons with multiple sclerosis.

OBJECTIVE: Cognitive changes are highly prevalent in multiple sclerosis (MS) however evidence-based research on cognitive rehabilitation programs for this population is only beginning to emerge. This article presents results from a process evaluation of a group-based, self-management cognitive intervention program developed specifically for people with MS. METHODS: Quantitative and qualitative data were collected using focus group interviews, facilitator reflection notes, and program evaluations. The data were used to identify the strengths and limitations of the program and to document recommendations for future development. Forty-one individuals met eligibility criteria and were enrolled in the program. RESULTS: Overall, participants reported that the program had a positive impact on their ability to manage cognitive symptoms. Program components that contributed to successful application of cognitive management strategies included increasing participant's knowledge of cognitive changes, problem-solving through cognitive challenges, practicing strategies through homework assignments, and conducting the program in a group format. Participants recommended that caregivers be included in future programs. CONCLUSION: Both content and structural components of the program facilitated participants' ability to manage cognitive changes and contributed to behavior changes made by the participants. PRACTICE IMPLICATIONS: This study points to the benefits of incorporating self-management programs into the cognitive rehabilitation process in MS.

Perceptions of persons with multiple sclerosis on cognitive changes and their impact on daily life.

PURPOSE: Cognitive changes occur in over 50% of persons diagnosed with multiple sclerosis (MS). Although previous research has provided information of the nature and severity of cognitive changes among persons with MS, it has offered relatively limited insight on the impact of these changes on levels of functioning and disability. The purpose of this study was to explore the impact of cognitive changes on the lives of four individuals with MS with different life roles (worker, parent, retired older adult). METHOD: Qualitative methodologies were used in the study and included multiple open-ended interviews with the study participants and the completion of Cognitive Experience Forms in between interviews. In addition, the Perceived Deficits Questionnaire and a demographics form were administered. Thematic analysis was used to analyse the study data. RESULTS: Participants described the types of cognitive changes they are experiencing and how these changes affect their ability to participate and engage in desired activities and maintain their primary roles. Participants also talked about how cognitive changes affect their quality of life. CONCLUSIONS: This study points to the complexity of cognitive changes and highlight the importance of addressing these changes in rehabilitation.

Multiple perspectives on the health service need, use, and variability among older adults with multiple sclerosis.

SUMMARY The purpose of this paper is to present the findings from the first phase of a large study that is examining the unmet health-related service needs of people aging with MS. Fifty-one volunteers participated in seven focus groups-five with individuals with MS and their family members, and two with health care professionals. Content analysis indicated health promotion (both physical and social), community accessibility, and support to remain at home as the most commonly identified health-related service needs. Differences were observed between the groups of individuals with MS/family members and health professionals. Findings point to the importance of using a client-centered approach when working with persons with multiple sclerosis and their family members.