Research Article
Issue Date: July/August 2019
Published Online: June 10, 2019
Updated: April 30, 2020
Predictors of Participation and Autonomy in People With Multiple Sclerosis
Maarit E. Karhula; Asko Tolvanen; Päivi I. Hämäläinen; Juhani Ruutiainen; Anna-Liisa Salminen; Pertti Era
Author Affiliations
  • Maarit E. Karhula, MSc, OT, is Research Manager, Department of Sustainable Well-Being, South Eastern Finland University of Applied Sciences, Mikkeli, Finland; PhD Student, Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland; and Researcher, GeroCenter Foundation for Aging Research and Development, Jyväskylä, Finland; maarit.karhula@gmail.com
  • Asko Tolvanen, PhD, is Professor, Department of Psychology, University of Jyväskylä, Jyväskylä, Finland.
  • Päivi I. Hämäläinen, PhD, is Adjunct Professor and Head, Masku Neurological Rehabilitation Center, Masku, Finland.
  • Juhani Ruutiainen, MD, is Adjunct Professor and Director of Rehabilitation Services, Finnish Neuro Society, Masku, Finland.
  • Anna-Liisa Salminen, PhD, OT, is Adjunct Professor and Research Professor, Social Insurance Institution of Finland, Helsinki.
  • Pertti Era, PhD, is Adjunct Professor, Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
Article Information
Multiple Sclerosis / Neurologic Conditions / Research Articles
Research Article   |   June 10, 2019
Predictors of Participation and Autonomy in People With Multiple Sclerosis
American Journal of Occupational Therapy, 06 2019, Vol. 73, 7304205070. https://doi.org/10.5014/ajot.2019.030221
American Journal of Occupational Therapy, 06 2019, Vol. 73, 7304205070. https://doi.org/10.5014/ajot.2019.030221
Abstract

Importance: Because multiple sclerosis (MS) affects many life areas, it is important to know how participation and autonomy are associated with the perceived impact of MS on everyday life.

Objective: To investigate how perceived quality of life, disease impact, gender, and disease severity predict participation and autonomy in people with MS.

Design: Cross-sectional study in which structural equation modeling was used to evaluate relationships between measured variables.

Settings: Outpatient clinics in three areas and one inpatient rehabilitation center in Finland.

Participants: Convenience sample of 194 people with MS.

Outcomes and Measures: Participants completed the Impact on Participation and Autonomy (IPA), the World Health Organization Quality of Life–Brief measure (WHOQOL–BREF), and the Multiple Sclerosis Impact Scale (MSIS–29). The Expanded Disability Status Scale (EDSS) was administered by a neurologist.

Results: The final model showed good fit to the data. All the goodness-of-fit indexes except χ2 supported the model, χ2(30, N = 194) = 46.729, p < .026; comparative fit index = .983; Tucker–Lewis index = .969; root mean square error of approximation = .054; standardized root mean square residual = .039. Quality of life (WHOQOL–BREF) and the impact of multiple sclerosis (MSIS–29) were the main predictors of participation and autonomy. Disease severity influenced only the IPA Autonomy Indoors domain. Gender was not associated with participation and autonomy.

Conclusion and Relevance: Experiences of participation and autonomy appear to be closely associated with perceived quality of life and impact of the disease. Findings support the importance of assessing participation and autonomy and planning interventions using this information.

What This Article Adds: The IPA appears to be an appropriate measure for assessing participation and autonomy and planning occupational therapy interventions for people with MS. In particular, environmental factors affecting participation and autonomy should be considered when planning interventions to promote participation and autonomy.