Beyond disability: perceived participation in people with a chronic disabling condition

Objective: To describe the impact of a chronic disabling condition on participation and to identify variables that may explain perceived restrictions in participation. Study design: Cross-sectional. Setting: People were recruited from the outpatient clinics of two rehabilitation centres and the rehabilitation department of an academic hospital. Subjects: One hundred and twenty-six people from five diagnostic groups (neuromuscular disease, rheumatoid arthritis, spinal cord injury, stroke, fibromyalgia) participated in the study. Method: The IPA (impact on Participation and Autonomy) questionnaire was used to describe perceived participation. Explanatory variables were studied in terms of sociodemographic factors and health status variables. Results: Some restrictions in participation seem comparable among diagnostic groups, others are specific to one or two groups. People with stroke, rheumatoid arthritis or fibromyalgia perceived more restrictions in participation than people with spinal cord injury or neuromuscular disorders. Emotional distress was the most important factor contributing to restrictions in participation. Conclusions: Perceived participation remains a complex concept in which many factors are involved. To make a contribution to meaningful participation of people with a chronic disabling condition, rehabilitation treatment should address physical, social, emotional and environmental aspects.