Participation Restriction in People With Multiple Sclerosis : Prevalence and Correlations With Cognitive, Walking, Balance, and Upper Limb Impairments

Objectives: To calculate the percentage of participation restrictions according to disability level in multiple sclerosis (MS), and to assess the relationship between participation restrictions and cognitive, gait, balance, and upper limb deficits. Design: Cross-sectional study. Setting: Rehabilitation unit. Participants: Participants (N=125) consisted of people with MS (n=105) and healthy subjects (HS; n=20). Interventions: Not applicable. Main outcome measures: The Community integration Questionnaire was used to assess participation in home, social, and productive activities. Percentages of people with MS having Community Integration Questionnaire scores lower than the 10th percentile of those of HS were calculated for each subscale to categorize the persons with participation restrictions. Cognitive deficits (Symbol Digit Modalities Test), walking disability (25-ft walking test/Expanded Disability Status Scale [EDSS]), balance disorders (Bohannon Standing Balance Test), and manual dexterity (Nine Hole Peg Test) were recorded. Results: Seventy-seven percent of participants showed participation restrictions, which increased with higher EDSS scores from 40% (EDSS<4) to 82% (EDSS>5.5). Social participation was more restricted than home integration, with <20% of participants shopping for groceries alone. Cognitive deficits were more highly associated (r=.60) with participation restrictions than balance (r=.47), gait (r=-.45), and hand dexterity (r=.45) limitations. Conclusions: Participation restrictions are present in MS and increase with disability level. However, the results also show that MS does not restrict participation in all domains. Participation restrictions at home are less restricted compared with social participation. Cognitive disorders are more associated with participation restrictions than physical limitations.