Investigating Environmental Barriers Affecting Participation in Patient With Multiple ‎Sclerosis

Objective: The participation, Based on International Classification of Functioning, Disability And Health (ICF), is part of healthy function that leads to the development of skills and a sense of competence and confidence in them. People with multiple sclerosis experience problems in various areas of participation. Environmental factors can create serious restrictions in the level of participation of people with multiple sclerosis, in some cases, the effect of these factors on restricting the participation of people with multiple sclerosis can be more than the effects of weakness and the defects of systems and organs that result from the disease. the barriers in the physical environment can reduce mobility of people with multiple sclerosis to transfer, that leads consequences such as weakening functional status, physical and mental health, quality of life, happiness, loss of life satisfaction; Therefore, due to high prevalence of multiple sclerosis in the city of Isfahan, the aim of this study was to Identifying the environmental barriers affecting the participation of people with multiple sclerosis in Isfahan.  Materials & Methods: In this cross-sectional study, the study population was all patients with multiple sclerosis in Isfahan City in February 2018. That was conducted in Isfahan province, 96 patients with MS (22.9%male and 77.1% female) were selected with convenience sampling method. To collect the data, after informing the participants about the subject and purpose of the study, obtaining informed consent letter, and also ensuring confidentiality of the information to the researcher, a demographic questionnaire was completed. The Mini Mental State Examination questionnaire was completed by participants, and then the Expanded Disability Status Scale scores were recorded for each person by the neurologist. At the end, Craig hospital inventory of environmental factors were provided to the participants. Finally, Data were analyzed by SPSS software version 16. In order to describe the data, the mean and standard deviation were used. The normal distribution of data was done by Shapiro-Wilk test. Pearson correlation coefficient, ANOVA and post hoc by LSD method test were used to analyze the data at a significance level of 0.05. Also, considering that the ANOVA test is susceptible to variance inequality, Levin test was conducted to evaluate the equality of variances. Results: Physical and structural barriers are the major barriers to participation of multiple sclerosis patients (12.05 ± 8.62) and the field of work and school is the minor barrier of participation (2.24 ± 4.16). Furthermore, the findings Also result showed there is no statistical relationship between the demographic variables (such as age, sex, disability status and cognitive status) and level of confrontation with the environmental barriers of participation (p> 0.05). Comparison of the mean of confrontation to environmental barriers to participation Based on education level showed that there is a significant difference between the services and assistance subscale and different levels of education. The highest mean score was for the under diploma education group and the lowest was for the Bachelor's degree and higher group. There is no significant difference in other subscales of participation. Conclusions: According to this findings among the environmental factors that can potentially affect the participation of patients with MS, field of physical and structural barriers were strongest factor which can restrict their participation in personal and social activities. Physical and structural barriers have been introduced in various studies as the most important limiting factor for participation in people with disabilities, especially those with neurological disorders. Therefore, maintaining the participation of these people in the community is a priority in adopting special measures in the field of removing physical and structural barriers.