| Quality of life (QoL) proxies as outcome measures have historically placed more emphasis on health status, as opposed to psychosocial variables associated with health conditions such as multiple sclerosis (MS). A classical psychosocial outcome is employment status, a marker of financial self-sufficiency. Recently, participation, a construct under the International Classification of Functioning (ICF) that describes involvement in life situations and valued roles, and subjective well-being (SWB), a measure of individual satisfaction, have received more attention. These outcomes have a global focus and have been reported as having more personal value to patients with MS.;The objective of this study was to explore factors within the ICF framework, including body-system impairment, functional limitation, psychological, environmental, and social factors, associated with less commonly studied measures of QoL in a community-based population with MS in order to better understand the similarities and differences between employment, SWB, and participation.;A cross-sectional mailed survey of community-dwelling individuals with MS (n=1014) was conducted. Participants provided demographic information, including employment status, and completed measures of ambulation limitation (AL; Expanded Disability Status Scale), pain interference (Brief Pain Inventory), fatigue (Modified Fatigue Impact Scale), depression (Center for Epidemiologic Studies Depression Rating Scale), anxiety (Hospital Anxiety and Depression Scale), environmental barriers (Craig Hospital Inventory of Environmental Factors-Short Form), social support (Multidimensional Scale of Perceived Social Support), participation (Community Participation Index), and SWB (Satisfaction with Life Scale). Hierarchical multiple regression was conducted.;Participants were 97% white and 81% female. The final hierarchical regression model for participation explained 52.8% of variance, with significant contributions from lower fatigue, depression, AL, and environmental barriers, and higher social support (p<0.001); younger age, (p<0.01); and lower pain interference (p<0.05). Logistic regression of employment status demonstrated significant associations with young age, shorter duration of MS, and lower AL and environmental barriers (p<0.001), pain interference, and social support (p<0.05). The final hierarchical regression model for SWB explained 51.6% of variance, with significant contributions from lower depression, higher social support, and higher participation (p<0.001); lower AL (p<0.01); and lower pain interference (p<0.05).;Implications of this work for clinical practice, research, and the further development of the ICF are discussed. |
