Research Article
Pilot study exploring quality of life and barriers to leisure-time physical activity in persons with moderate to severe multiple sclerosis

https://doi.org/10.1016/j.dhjo.2007.11.001Get rights and content

Abstract

Background

We sought to assess how impairment (physiological/psychological) and disability (social/environmental) are associated with physical and leisure/recreation activity levels and quality of life (QOL) in people with moderate/severe multiple sclerosis (MS). We conducted a cross-sectional survey at the MS Comprehensive Care Center, Stony Brook University Hospital, Stony Brook, NY, of a convenience sample of 43 people (50 eligible) with MS and Expanded Disability Status Scale scores of 6.0 to 8.0. The main outcome measures were QOL measured by MSQOL-54, physical activity measured by Physical Activity Disability Scale, and leisure/recreation activity measured by Nottingham Leisure Questionnaire. We analyzed the canonical correlations among physical and leisure/recreation activity levels and (1) impairment and (2) QOL.

Results

Higher levels of physical and leisure/recreation activity were associated with lower levels of apathy and depression and higher levels of cognition, self-efficacy, and QOL (physical and mental). Major barriers reported included fatigue, lack of motivation, and cost.

Conclusion

Impairments and social/environmental disabilities create barriers to physical and leisure/recreation activity. Additional research is needed to determine, for people with MS, what supports might increase participation in physical and leisure/recreation activities and whether this increase yields improved QOL.

Section snippets

Study participants

Researchers sequentially (February-August 2004) recruited a convenience sample of 43 participants from among 50 eligible people at the MS Comprehensive Care Center, Stony Brook University Hospital, Stony Brook, NY, USA. The study was approved by the university's Committee on Research Involving Human Subjects. Inclusion criteria were a diagnosis of MS and an Expanded Disability Status Scale (EDSS) score of 6.0 (unilateral assistance required to walk 100 m), 6.5 (bilateral assistance required to

Results

Table 3 shows that the bivariate correlations of the impairment variables with the PADS and NLQ are quite different. The PADS' relationship was statistically significant with the NLQ and the 2 cognition measures (positively correlated) and depression (negatively correlated). The NLQ's relationship was statistically significant with apathy and depression (negatively correlated), self-efficacy, and physical and mental QOL (positively correlated). Neither the PADS nor the NLQ had a statistically

Discussion

The results suggest that lower levels of impairment-related barriers (depression, cognitive impairment, apathy, and reduced self-efficacy but not fatigue) are associated with higher physical and leisure/recreation activity levels. This is consistent with existing research on MS which indicates that higher self-efficacy is associated with higher levels of physical activity while depression and apathy are associated with lower activity levels [1], [2], [3], [4], [5]. The results also suggest that

Conclusion

There is preliminary evidence that impairments (physiological/psychological barriers) combined with disabilities (social/environmental barriers) might reduce participation in physical and leisure/recreation activities to the detriment of QOL for people with moderate/severe MS. Results indicate that higher levels of physical and leisure/recreation activity are associated with lower levels of apathy and depression and higher levels of cognition, self-efficacy, QOL-physical, and QOL-mental. To

Acknowledgments

Supported by a 2003 pilot grant (PP0950) from the National Multiple Sclerosis Society.

The authors thank the following individuals for their assistance in research design, data collection, and analysis for this study: former occupational therapy students, Christine M. Badalamenti, M.S., OTR/L, Hoknang Cheung, M.S., OTR/L, and Amy Liu, M.S. (SBU OT Program); Patricia Melville, R.N., and William MacAllister, Ph.D. (SBU Hospital Department of Neurology); and Marcia Finlayson, Ph.D. (Department of

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