<p>Background:</p><p>Multiple sclerosis (MS) is a neurological autoimmune disease characterized by demyelination occurring in the central nervous system.</p><p>The disease can follows one of four patterns:  relapse-remitting  secondary progressive  primary progressive  progressive relapsing </p><p>Participation, a key component of health is defined as “involvement in a life situation” by the International Classification of Functioning, Disability and Health (ICF).</p><p>Participation restrictions are often a byproduct of coping with a chronic illness such as Multiple Sclerosis (MS) (Yorkston et al., 2003).</p><p>Personal factors in the ICF model include lifestyle or health habits. These are posited to impact the functioning/participation and health-related quality of life of persons with chronic illnesses like MS. (Stuifbergen, et al 2006).</p><p>Further information is needed to clarify to clarify these relationships.</p><p>Research Questions: 1. What are the health promoting behavior patterns of women diagnosed with multiple sclerosis? 2. Is there a relationship between health promoting behaviors and health-related quality of life? 3. Is there a relationship between health promoting behaviors and role participation?</p><p>Sample: Women with MS were solicited through the local National MS Society Newsletter and two internet-based programs (n=48). Instrumentation: Health-promoting behaviors HPLP-II (Health-promoting Lifestyle Profile II) scored as either: (never = 1, sometimes = 2, often = 3, routinely = 4)  physical activity  spirituality growth  interpersonal relationships  stress management  nutrition  spiritual growth  health responsibility </p><p>Health-Related Quality of Life (HR-QOL) SF-36  Physical Component Summary (PCS)  Mental Component Summary (MCS)</p><p>Participation (work or regular daily activities)  Role physical scale (SF-36). Effect of physical health limitations on: Time, Productivity, Kind or Difficulty with activity.  Role emotional scale (SF-36). Effect of emotional health limitations on: Time, Productivity or Carefulness with activity  Role emotional (SF-36). Social function</p><p>Results:</p><p>The Relationship Between Health Promoting Behaviors, Health-Related Quality of Life and Role Participation (N=48)</p><p>HPLP-II PCS36 MCS36 Role Role Social Physical Emotional Functioning Health .033 .007 .003 .005 .012 Responsibility Physical .395** .224 .387** .283 .225 Activity Nutrition .199 .121 .290* .111 .064 Spiritual .217 .563** .427** .433** .431** Growth Interpersonal .160 .401** .211 .456** .379** Relations Stress .082 .365* .119 .235 .208 Management Overall Score .272 .417** .362* .376** .328*</p><p>** p < .01 * p < .05</p><p>Conclusions:  Women who engaged more frequently in physical exercise, practiced good nutrition and spiritual growth, had a higher degree of physical role performance. </p><p> Women who more frequently reported positive interpersonal relations and greater spiritual growth reported a higher degree of social functioning and emotional role performance. </p><p> Women who participated in spiritual growth activities, positive interpersonal relationships and stress management had a higher perception of mental health- related quality of life. </p><p>Applications for Rehabilitation Practitioners Rehabilitation practitioners may facilitate participation in life roles for women with MS, by providing information in the five areas correlated with improved HR-QOL and participation:</p><p>Physical Activity:  Although beneficial it must be carefully monitored to avoid adverse effects such as exacerbations of symptoms (e.g. heat intolerance, fatigue) in persons with MS.  It should be individualized, incremental & dynamic to accommodate for ever changing degrees of ability/disability.  Adaptations could include: ◦ Appropriate pool temperature (80 – 84 degrees) ◦ Early AM or dusk workouts to avoid the heat ◦ Exercise in an air conditioned environment ◦ Circuit training ◦ Use a cooling vest or cooling cloth while working out ◦ MS exercise groups or adaptive sports ◦ ADL's or ROM as activity for those with greater physical disability </p><p>Nutrition: What are your client's barriers to good nutrition?  Related to cooking tasks ◦ Energy conservation ◦ Activity/environmental adaptations  Related to shopping ◦ Online ordering ◦ Delivery  Related to financial burden ◦ NMSS as a support system </p><p>Stress Management:  Modification of traditional methods ◦ Yoga for MS ◦ Tai chi for MS ◦ Meditation ◦ Music/aromatherapy  Novel methods ◦ Quote boards ◦ Reframing ◦ Author's with MS (see weblinks)</p><p>Interpersonal Relations: There are unique challenges individuals with MS face in their interpersonal relations, such as:  Invisible impairment  Unpredictability inherent in a relapsing-remitting condition  Illness disclosure  Self advocacy & accommodations (504/ADA)  Asking for and accepting help comfortably, as well as graciously refusing unsolicited assistance</p><p>Spiritual Growth:  Given the significant correlations between spirituality and mental health- related quality of life, as well as all three measures of participation - the usefulness of cultivating a sense of spirituality in occupational therapy intervention warrants further scholarship. </p><p> Suggestions for intervention include: ◦ Gratitude journals ◦ Intention boards ◦ I highly recommend Sharon Gutman's book available from AOTA Press (see weblinks) ◦ Author's with MS</p><p>Limitations and Future Research:  Further research is suggested with a larger sample and control for the type of MS.  Current study uses a correlational design describing relationships, not causality.  Further research using prediction to examine the causality is suggested.</p><p>References Stuifbergen, A. K., Blozis, S. A., Harrison, T. C., & Becker, H. A. (2006). Exercise, functional limitations, and quality of life: A longitudinal study of people with multiple sclerosis. Archives of Physical Medicine and Rehabilitation, 87, 935–943. doi:10.1016/j.apmr.2006.04.003</p><p>Tyszka, A. C., & Farber, R. S. (2010). Exploring the relation of health-promoting behaviors to role participation and health- related quality of life in women with multiple sclerosis: A pilot study. American Journal of Occupational Therapy, 64, 650–659. doi: 10.5014/ajot.2010.07121</p><p>Yorkston, K. M., Johnson, K., Klasner, E. R., Amtmann, D., Kuehn, C. M., & Dudgeon, B. (2003). Getting the work done: A qualitative study of individuals with multiple scle- rosis. Disability and Rehabilitation, 25, 369–379. doi: 10.1080/0963828031000090506 </p><p>“Diseases can be our spiritual flat tires - disruptions in our lives that seem to be disasters at the time but end by redirecting our lives in a meaningful way.” ~Bernie S. Siegel Weblinks</p><p>AJOT article http://ajot.aotapress.net/content/64/4/650.full.pdf+html?sid=85426241-348a-4817- a9eb-fce3e2cfbe68</p><p>Dr. Sharon Gutman - Living with Illness or Disability http://www.aota.org/Pubs/ProductCat10/2011-Catalog.aspx</p><p>Dr. Laina Turner-Molaski – The MS Project Volume 1 ORANGE is the new pink http://www.lainaturner.com/about/multiple-sclerosis/f-ms-the-book/</p><p>Shelly Peterman Schwarz – Multiple Sclerosis 300 tips for Making Life Easier http://www.demoshealth.com/prod.aspx?prod_id=9781932603217</p><p>Jackie Waldman - People with MS with the Courage to Give http://www.couragetogive.com/index.html</p><p>Chris Tatevosian – Life Interrupted No Longer www.lifeinterrupted-nolonger.com/</p><p>Dean Kramer - Life on Cripple Creek www.mscare.org/cmsc/News/Book-Reviews-Life-on-Cripple-Creek.html</p><p>Terry Garr – Speed Bumps Flooring it Through Hollywood http://www.nationalmssociety.org/multimedia-library/books/flooring-it-through- hollywood/index.aspx</p><p>David Lander – Fall Down Laughing http://davidllander.com/about_david/david_book.htm</p><p>David Osmond www.nationalmssociety.org/online-community/personal-stories/david-osmond/index.aspx www.davidosmond.com</p><p>MS World http://www.msworld.org/ Live Fully/Live Well http://www.nationalmssociety.org/living-with-multiple-sclerosis/live-fully-live- well/index.aspx</p><p>Contact Information</p><p>Andrea Carr Tyszka, MS, OTR 1905 W. High St. Haddon Heights, NJ 08035 [email protected]</p><p>Ruth S. Farber, PhD, OTR/L Associate Professor Department of Rehabilitation Sciences Program in Occupational Therapy College of Health Professions & Social Work Temple University 3307 North Broad Street Philadelphia, PA 19140 215-707-4880 [email protected]</p><p>SF-36 ordering information Quality Metric Incorporated SF-36.org 640 George Washington Highway Lincoln, RI 02865 USA</p><p>HPLP-II ordering information Susan Noble Walker Ed.D., R.N., F.A.A.N. College of Nursing University of Nebraska Medical Center 985330 Nebraska Medical Center Omaha, Nebraska 68198-5330 </p>