Disability-related Variables Research Articles

Comparing Competitive Integrated Employment Outcomes in The State-federal Vocational Rehabilitation Program Among Individuals with Cognitive, Physical, and Sensory Functional Impairments

Background State-Federal vocational rehabilitation (VR) services are available for eligible individuals with disabilities (IWD) who are interested in pursuing, obtaining, and maintaining gainful employment. Despite availability of VR services, employment outcomes of IWD compared to those without disabilities continue to be limited. Objective To examine effects of receipt of VR services on the employment outcomes of individuals with cognitive impairments (CI) compared to people with other impairments (i.e., physical and sensory impairments) while accounting for individual characteristics and patterns of VR service use. Methods Secondary data analysis using Rehabilitation Services Administration (RSA) 911 data covering cases in 2019. Hypothesized covariates and predictors of employment outcomes were divided into four groups: demographic variables, environmental/social variables, disability related variables, and receipt of VR services. The target outcome variables from the RSA 911 database were competitive integrated employment (CIE) employment outcome, hourly wage at case closure, and hours worked in a week at case closure. A hierarchical logistic regression analysis was performed using CIE as the criterion. Results Findings suggest that (a) the group including CI individuals was at a disadvantage in terms of CIE outcomes; (b) from the logistic regression, gender, education level, significance of disability, and receipt of some VR services were significantly associated with CIE outcomes (yes/no); and (c) when we examined the percentages of individuals receiving VR services, higher percentages of individuals with CI received varieties of VR services, but less assistive technology services. Conclusions Individuals with disabilities continue to experience disparate employment outcomes. The receipt of varieties of VR services facilitates IWDs to successfully obtain CIE. Receipt of VR services alone may not be the only factor that supports IWD in obtaining successful CIE. A critical investigation of the quality and type of these VR services, difference by impairment, and the economic impact of societal/environmental trends is warranted.

Prevalence and Predictors of Stress Among Caregivers of Children with Developmental Disorders.

Medical care advances pose challenges with rising caregiving costs and fewer informal caregivers, shifting healthcare responsibilities to families. Healthcare systems adapt to technological changes, stressing person-centered care but lack support for caregivers. Addressing parental stress is crucial, given its impact on both parent and child well-being, highlighting the necessity for customized support. The study aimed to evaluate caregivers' perceived stress and its connection with socio-demographic factors and children's characteristics. Conducted at a Rehabiltation Institute's Psychology Outpatient Department, 200 mothers were enrolled using non-probability consecutive sampling. Ethical clearance was obtained, and demographic data were collected. The mean perceived stress score (PSS-10) was 31.94, indicating a positive correlation between stress and socio-demographic and disability-related variables. Significant differences in stress levels were observed between joint and nuclear family caregivers, p < .01, and those with daughters versus sons with disabilities < 0.001. Pearson's correlation analysis revealed positive correlations between perceived stress and caregiver p = < 0.001 and child age p = < 0.001, number of children p = < 0.001, and time since diagnosis p = < 0.001, with negative correlations with caregiver education p = < .001and income p = < 0.001. Multiple linear regression indicated that caregiver and child age, time since diagnosis, and the number of children positively predicted while income and education of the caregiver negatively predicted perceived stress. No significant association was found between other variables like family volunteers' education, disability type, and caregiver stress. Caregivers exhibited high perceived stress levels, highlighting the reciprocal relationship between child characteristics and parental stress, emphasizing the need for comprehensive family interventions.

Identification of Health Characteristics of People with Physical Disability by Applying the PRECEDE Model.

This study aimed to diagnose the health characteristics of people with grade 1-4 physical disability (but without intellectual disability) by analyzing factors affecting their health through social, epidemiological, behavioral, and ecological diagnoses by partially applying the PRECEDE model. Those registered with physical disability in 2022 and attending a welfare center were selected, with samples extracted from Seoul, Gyeonggi-do, Chungcheong-do, Jeolla-do, and Gyeongsang-do. A total of 1200 people were selected, and the data of 1000 people were finally analyzed. A frequency analysis was performed to identify the participants' characteristics. An independent t-test and one-way analysis of variance were performed to verify the hypotheses. To clarify the relationship between each variable, normality verification, confirmatory factor analysis, and structural equation model analysis were performed. First, the differences in factors influencing health promotion according to personal background variables (gender, age, and income level), including quality of life, showed partial differences according to age and income level. Second, according to disability-related variables (time of onset and disability grade), quality of life and health status showed partial differences. These results can be used as basic data or indicators to build a health promotion system that considers the health characteristics of individuals with a physical disability.

"To Be Treated as a Person and Not as a Disease Entity"-Expectations of People with Visual Impairments towards Primary Healthcare: Results of the Mixed-Method Survey in Poland.

Primary care is the core part of the Polish healthcare system. Improving its quality for vulnerable populations is among the principal goals of global and national health policies. Identifying patients’ needs is critical in this process. People who are blind or have low vision often demonstrate comorbidities and require more specific healthcare. The aim of this study was to explore the needs of Polish persons with visual impairments when they use primary care services. 219 respondents answered the “Patient value” questionnaire from the project Quality and Costs of Primary Care in Europe (QUALICOPC) and an open question regarding additional patients’ needs. Statistical and content analyses were used. The expectations of the study group regarding primary care appeared to be higher than those described in studies among other populations. Equity and accessibility were the most valued dimensions of care. Among particular aspects of care, those connected with psychosocial competencies and awareness of disability among medical staff appeared most frequently. Some personal characteristics were associated with preferences, including age, gender, longstanding conditions, quality of life, and disability-related variables. Our study indicates a need for multilevel interventions in legislation, economics, and medical staff training, with the people-centered approach as the option maximizing chances to meet diverse healthcare needs arising from particular disabilities.

A Systematic Review of the Association Between Perceived Injustice and Pain-Related Outcomes in Individuals with Musculoskeletal Pain.

A growing body of literature shows that justice-related appraisals are significant determinants of pain-related outcomes and prolonged trajectories of recovery. We conducted a systematic review of the literature assessing the relationship between perceived injustice and pain-related outcomes in individuals with musculoskeletal pain. A search of published studies in English in PubMed, PsychInfo, Embase, and Cochrane Database of Systematic Reviews from database inception through May 2019 was performed. Search terms included "perceived injustice," "injustice appraisals," "perceptions of injustice," and "pain" or "injury." Thirty-one studies met inclusion criteria. Data for a total of 5,969 patients with musculoskeletal pain were extracted. Twenty-three studies (71.9%) reported on individuals with persistent pain lasting over three months, and 17 studies (53.1%) reported on individuals with injury-related musculoskeletal pain. Significant associations were found between perceived injustice and pain intensity, disability and physical function, symptoms of depression and anxiety, post-traumatic stress disorder, quality of life and well-being, and quality of life and social functioning. This systematic review summarizes the current evidence for the association between perceived injustice and pain-related outcomes. There is strong evidence that perceived injustice is associated with pain intensity, disability-related variables, and mental health outcomes. Implications and directions for future research are discussed.

A Systematic Review of Factors Related to Employment Outcomes for Adults with Visual Impairments

Introduction: The purpose of this study was to conduct a systematic review of survey-based research on predictors or correlates of employment outcomes for individuals with visual impairments (i.e., those who are blind or have low vision). Methods: We used a three-pronged systematic search process to identify quantitative, English, peer-reviewed articles published from 1990 to August 2018 that included analyses of factors related to employment in American adults with visual impairments. We coded all included articles for sample parameters, participant characteristics, quality indicators (QIs), and study outcomes. Results: Thirteen articles were included in the review. The majority of studies met few, if any, QIs. Education level, braille reading medium, and attending integrated or public schools were significantly associated with employment outcomes in most analyses in which those variables were included. Other demographic and disability-related variables were generally not associated with employment or yielded inconsistent results across studies. Psychosocial, service, and miscellaneous variables were included less frequently and were generally not associated with employment or yielded mixed results, with a few exceptions. Discussion: Based on our quality indicator ratings, there were consistent methodological weaknesses in this body of literature. Small samples ( N = 200 or fewer) were prevalent across studies, which limits both generalizability and statistical power. Use of nonrepresentative and nonnational samples further limits generalizability of the results, and a lack of longitudinal studies hinders our ability to draw causal inferences. More high-quality employment research is needed, particularly in the areas of braille, transportation self-efficacy, and other psychosocial factors. Implications for practitioners: Despite the methodological issues identified in the included studies, results support findings from other systematic reviews regarding the importance of educational advancement for individuals with visual impairments. Practitioners should encourage individuals with visual impairments who do not have college degrees to explore options for postsecondary education.

State-Federal Vocational Rehabilitation in Traumatic Brain Injury: What Predictors Are Associated With Employment Outcomes?

This study identified predictors of employment for individuals with traumatic brain injury (TBI). Data from 4,923 individuals with TBI were extracted from the Rehabilitation Services Administration’s Case Service Report (RSA-911) database. A multiple logistic regression model using demographics, disability-related variables, vocational rehabilitation (VR) service variables, and their interactions correctly classified 69.5% of the cases as successfully employed or not successfully employed. The model explained approximately 27.1% of the variance in employment outcomes. Results indicated that level of education, race/ethnicity, age at application, preemployment status, Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), comorbid depression, and case expenditure were significantly associated with employment outcomes (all p ≤ .05). VR variables that showed the most significant positive effect on employment outcomes were on-the-job support, job placement, and on-the-job training. Race/ethnicity moderated the effect of college training, supported employment, transportation, and extended evaluation or work trial assessment services on employment outcomes. The findings have implications for promoting the use of those VR services that are strongly related to employment outcomes for persons with TBI. They also point to the need for rehabilitation personnel to address some of the demographic and disability-related barriers to successful employment.

Primary and secondary disability appraisal – Predictive role of sociodemographic and disability-related variables

Disability appraisal is a cognitive category examined mainly in the context of adjustment to living with disability. Its significance is usually determined as part of stress and coping theory applied in disability studies. The article presents the findings of a study on primary and secondary disability appraisal expressed by people with acquired motor impairments. Participants were people with spinal cord injuries and with lower limb amputation. Primary and secondary disability appraisal was analyzed with consideration of sociodemographic and disability-related variables. The findings suggest that these categories of variables make it possible to explain primary disability appraisal better than secondary disability appraisal. Also, it was found that disability-related variables had greater predictive significance than sociodemographic variables in explaining the intensity of both primary and secondary appraisal. The type of disability, its duration, and a sense of control over the consequences of one's motor impairment play a significant role in determining the intensity of both forms of disability appraisal.

A Study on the Factors Affecting the Period of Job Maintenance of Persons with Cerebral Palsy

본 연구는 취업한 뇌성마비인의 직업유지기간에 영향을 미치는 요인들을 실증적인 분석을 통하여 구명하고 이를 바탕으로 뇌성마비근로자가 직업을 지속적으로 유지하기 위한 방안을 모색하는 것이다. 이를 위해 뇌성마비근로자의 일반적인 특성을 파악하고, 인구학적 요인, 장애관련 요인, 취업관련 요인, 사회환경 요인들이 뇌성마비근로자의 직업유지기간에 미치는 영향을 검증하고자 한다. 분석을 위하여 뇌성마비근로자 233명을 대상으로 빈도분석과 기술통계 그리고 t-test와 일원배치 분산분석을 실시하였다. 뇌성마비근로자의 직업유지기간에 영향을 미치는 요인분석 결과를 살펴보면, 직업유지기간에 영향을 미치는 4요인 17개 변수 가운데 15개 변수가 통계적으로 정적으로 유의미한 결과를 나타내었다, 인구학적 요인에서 직업유지기간에 유의미한 영향을 미치는 변수는 연령, 가구소득, 결혼상태, 교육수준으로 나타났다. 장애관련 요인에서는 장애등급, 장애원인, 의사소통능력이었으며, 취업관련 요인에서는 임금, 고용형태, 장애관련기관 및 기업, 직무형태, 직업훈련, 자격증이었고, 사회환경요인에서는 보조공학기기, 근로지원인서비스가 영향요인이었다.The purpose of this study is to identify through empirical analysis about factors affecting the period of job maintenance of workers with cerebral palsy. Based on this, workers with cerebral palsy are looking for ways to maintain their job continuously. For this purpose, this study identifies the general characteristics and verify the affect of demographic factors, disability-related factors, employment-related factors, and social environment factors on the job maintenance period of workers with cerebral palsy. For the analysis, frequency analysis, descriptivel analysis, T-test and One-way Anova was conducted for 233 persons with cerebral palsy. The results of the study, of 17 variables of the four factors affecting the job maintenance period, 15 variables obtained statistically significant results. First, the demographic variables were age, household income, marital status, and education level. Second, the disability-related variables were disability grade, disability cause, and communication ability. Third, the employment-related variables were wage, employment type, disability-related organizations and companies, job type, job training, and qualification. Fourth, the social environment variables were assistive technology devices, and labor support personnel services.

Association between perceived discrimination and healthcare–seeking behavior in people with a disability

BackgroundExperiences of discrimination lead people from vulnerable groups to avoid medical healthcare. It is yet to be known if such experiences affect people with disabilities (PWD) in the same manner. ObjectivesTo determine the association between perceived discrimination and healthcare-seeking behavior in people with disabilities and to explore differences of this association across disability types. MethodsWe performed a cross-sectional study with data from a national survey of people with disabilities. Perceived discrimination and care-seeking behavior were measured as self-reports from the survey. Dependence for daily life activities, possession of health insurance, and other disability-related variables were included and considered as confounders. We used Poisson regression models and techniques for multistage sampling in the analyses. A stratified analysis was used to explore effects of discrimination across types of disability. ResultsMost of PWD were 65 years or older (67.1%). Prevalence of healthcare seeking was 78.8% in those who perceived discrimination, and 86.1% in those who did not. After adjusting for potential confounders, the probability of not seeking care was higher in people who reported perceived discrimination (adjusted PR = 1.15; 95%CI: 1.04–1.28). In a stratified analysis, significant effects of discrimination were found in people with communication disability (adjusted PR = 1.34, 95%CI: 1.07–1.67) and with physical disability (adjusted PR = 1.17, 95%CI: 1.03–1.34). ConclusionsPeople with disabilities who perceive discrimination are less likely to seek healthcare. This association was higher for people with communication and physical disabilities. These results provide evidence to institutions who attempt to tackle discrimination.

Cognitive function alone is a poor predictor of health-related quality of life in employed patients with MS: results from a cross-sectional study

Objective: Depression, anxiety, disease severity, and cognitive functions impact on the quality of life of people with MS. However, the majority of studies were not based on multivariate models and did not target employed patients. The aim of this study was to investigate predictors of HRQoL in persons with MS in the workforce considering cognitive, psychological, disease severity, and disability-related variables. Methods: Cross-sectional study. Hierarchical block regression analyses were conducted to identify predictors of physical and mental components of HRQoL, measured with the MSQOL-54. Candidate predictors included cognitive functioning (a selection of Rao’s BRB-NT), sample features (age, education, MS duration), depressive symptoms (BDI-II), anxiety (STAI-Y), disability (WHODAS 2.0), and MS severity (EDSS): those that correlated with PCS and MCS with p < .250 and those that correlated with other predictors with coefficients >.800 were excluded from regression analyses. Results: In total, 181 patients (60.8% females, mean age 39.6, median EDSS 1.5) were included. In both models, cognitive variables had a poor explicative power. The models improved significantly when psychological, as well as, disease severity and disability variables were added. R2 of complete models was 0.732 for the physical component, 0.697 for the mental one: BDI-II, STAI-State and, some WHODAS 2.0 scales were significant predictors of HRQoL. Conclusions: Monitoring anxiety, depressive symptoms, and level of disability through self-reported questionnaires may provide useful suggestions to improve the HRQoL of persons with MS in the workforce, permitting to address possible problems in the work context and plan corrective actions.

Delegating home care for the elderly to external caregivers? An empirical study on Italian data

We study care arrangement decisions in Italy, where families are increasingly delegating the role of primary caregiver to external (paid) people also for the provision of home care. We consider a sample of households with a dependent elderly person cared for either at home or in a residential home, extracted from a survey representative of the population of Italy’s Emilia-Romagna region. We investigate the determinants of a household’s decision to opt for one of the following three alternatives: the institutionalisation of elderly family members, informal home care, or paid home care. We estimate two model specifications, based on a simultaneous and a sequential decision process respectively, the results of which are fairly consistent. Disability related variables, rather than family characteristics, emerge as the main determinants of institutionalisation. On the other hand, household characteristics and socio-economic variables are more influential when it comes to choosing between informal and formal home care provisions.

Delegating Home Care for the Elderly to External Caregivers? An Empirical Study on Italian Data

We study care arrangement decisions in Italy, where families are increasingly delegating the role of primary caregiver to external (paid) people also for the provision of home care. We consider a sample of households with a dependent elderly person cared for either at home or in a residential home, extracted from a survey representative of the population of Italy’s Emilia-Romagna region. We investigate the determinants of a household’s decision to opt for one of the following three alternatives: the institutionalisation of elderly family members, informal home care, or paid home care. We estimate two model specifications, based on a simultaneous and a sequential decision process respectively, the results of which are fairly consistent. Disability related variables, rather than family characteristics, emerge as the main determinants of institutionalisation. On the other hand, household characteristics and socio-economic variables are more influential when it comes to choosing between informal and formal home care provisions.

Barriers to sexual activity: counselling spinal cord injured women in Malaysia

This study is a cross-sectional, face-to-face interview. To examine the sexual activity in a sample of Malaysian women with traumatic spinal cord injuries (SCIs), identify the physical and psychological barriers to it, and explore their experiences with sexual counseling and rehabilitation. This study was conducted at the Spinal Rehabilitation Unit of a teaching hospital. All women who attended scheduled check-ups, over 1 year, and who met the inclusion criteria (age above 18 years, spinal injury of traumatic aetiology, living in the community and having completed the rehabilitation) were consecutively included in a face-to-face interview using a self-constructed questionnaire. Sociodemographic and disability-related variables, barriers to sexual activity/satisfaction and experiences of sexual rehabilitation services were obtained. During the study period, 33/36 subjects were recruited. Although 67% indicated interest in sexual activity, only 24% was sexually active. The frequency of sexual activity declined after the injury, from 4.6 times per month to 1.5 times per month. Feeling unattractive, unable to satisfy the partner and less confident about sexual ability were top three psychological barriers to sexual activity, and the top three physical barriers were impaired genital sensation, positioning and vaginal lubrication. In all, 50% received some sexual information during rehabilitation. Rehabilitation professionals were expected to initiate sexual counseling by 62.5% of subjects. The effect of SCIs on sexual function is tremendous. Sexual counseling services must be improved and take into account the impact of psychological factors.

Clinical and radiological features of rheumatoid arthritis in British black Africans

The objective of this study was to determine whether radiographic damage is different in British black African patients with rheumatoid arthritis compared to Caucasian patients. Data on demographics, disease- and disability-related variables were obtained from all black African patients and their age-, gender- and disease-duration-matched Caucasian controls. After all features identifying the patients were concealed, X-rays of hands and feet were scored by using the Sharp/van der Heijde method. Data were analysed using Mann-Whitney U test, t test and chi (2) test. Sixty-four patients (32 in each ethnic group) were studied. The median age was 52 years and median disease duration 6 years. Seventy-two percent of patients were female. Black Africans and Caucasians did not differ significantly in rheumatoid factor positivity, disease-modifying anti-rheumatic drugs and biological treatment use. British black African patients had significantly more tender joints and disability. Joint space narrowing was significantly greater in Caucasian patients [48 (27-85) vs 56 (34-107), p = 0.01]. Caucasian patients had more number of erosions (172 vs 220) and higher erosion score; however, the difference in the erosion scores was not statistically significant [2 (0-48) vs 4.5 (0-46), p = 0.17]. Radiographic damage was less severe in black African patients with rheumatoid arthritis compared to their age-, gender- and disease-duration-matched Caucasian controls. A large prospective study is required to confirm the findings of this study and to establish the factors which might be accountable for any differences in the expression of rheumatoid arthritis in this ethnic group.

Reactions to diabetes and their relationship to time orientation

The purpose of this study was to explore the relationships between psychosocial adaptation to chronic illness and time orientation among the individuals diagnosed with insulin-dependent diabetes mellitus. Participants (N=106) were recruited via an on-line survey and an on-site health fair. Data were obtained from responses to the Reactions to Impairment and Disability Inventory and the Zimbardo Time Perspective Inventory. A series of hierarchical multiple regression analyses were performed to examine the influence of demographic- and disability-related variables, followed by a set of five time-perspective scales, on a series of psychosocial reactions to disability (anxiety, depression, anger, denial and adjustment). Findings indicated that reactions of anxiety, depression and anger were best predicted by negative perceptions of the past, whereas reactions of depression and anger also were predicted by negative views of the present. In addition, anger was associated with a decreased future orientation. Denial was best predicted by fatalistic perception of the present and, to a lesser extent, by restricted view of the future. Finally, adjustment was best predicted by positive perceptions of the present, by an expanded view of the future and by avoiding a negative view of the present. Challenging negative perceptions of the past and present, whereas facilitating a future time orientation, could be beneficial in helping clients to cope successfully with their medical conditions.

Quality of Life and Menopause in Women with Physical Disabilities

The goal of this cross-sectional study was to explore quality of life (QOL) in a sample of postmenopausal women with physical disabilities due to polio contracted in childhood. A structural equation model was used to confirm that menopause symptoms will have a minimal effect on QOL when disability-related variables are taken into account. A sample of 752 women who were postmenopausal completed a written survey. The structural equation model contained two measured predictors (age, severity of postpolio sequelae) and one latent predictor (menopause symptoms defined by four measured indicators). Functional status (defined by two measured indicators) was included as a mediator, with QOL (defined by three measured indicators) as the outcome. The original model yielded acceptable fit indices (CFI = 0.96, RMSEA = 0.055) but resulted in a number of unexpected relationships that proved to be artifacts after model respecification. The respecified model yielded a nonsignificant chi-square value, which indicated no significant discrepancy between the proposed model and the observed data (chisquare = 18.5, df = 13, p = 0.138). All fit indices indicated a good fit: CFI = 0.997, NNFI = 0.987, chi-square/df = 1.43, and RMSEA = 0.024. When the effects of postpolio sequelae and functional status are included in the structural equation model, only the psychological symptoms of menopause play a prominent role in explaining QOL in this sample. The clinical implications of these findings suggest that attention to psychological symptoms and an exclusive focus on the physical aspects of menopause to the exclusion of other midlife life stressors and influences on a woman's psychological well-being ignore the larger context of life in which they live. In particular, many women with disabilities may contend with additional or exacerbated stressors related to their disability.

Angst und Depressionen nach einer Amputation der unteren Extremität

A good number of psychosocial-, disease-, and disability-related variables influence the adaptation process after the loss of a lower limb. In this case psychological problems, as a result of a failed adaptation process, are common. Of the 75 patients examined who had an amputation of a lower extremity 27% showed increased depression and 25% increased anxiety scores; 18.3% showed higher than normal scores in both categories. Regression analysis showed that in addition to pain reception poor acceptance of the prosthesis is an important predictive factor for the development of psychological disorders and diseases like anxiety and depression. Therefore, measures for psychological diagnostics and care should be initiated soon after the amputation to prevent psychological abnormalities. Here interdisciplinary management and cooperation of the professions involved in the care of the patient are recommended.

Impact of Permanent Supportive Housing on the Use of Acute Care Health Services by Homeless Adults

Impact of Permanent Supportive Housing on the Use of Acute Care Health Services by Homeless Adults

Perceived Uncertainty, Spiritual Well-Being, and Psychosocial Adaptation in Individuals With Multiple Sclerosis.

Objective: To examine the role of spiritual well-being as a mediator and moderator between perceived uncertainty and psychosocial adaptation to multiple sclerosis (MS). Participants and Design: Fifty individuals (40 women, 10 men) diagnosed with multiple sclerosis. Main Outcome Measures: Selfreport measures on illness uncertainty, spiritual (religious and existential) well-being, and psychosocial adjustment to illness were analyzed by a series of hierarchical multiple regression analyses. Results: Both uncertainty and spiritual well-being independently predicted psychosocial adjustment to MS after the influence of demographic and disability-related variables were considered. Spiritual well-being demonstrated a mediator effect but, mostly, failed to show a moderator effect. Conclusion: Spiritual well-being exerts an appreciable influence on adaptation to MS and also acts to mitigate the impact of uncertainty on adaptation. Rehabilitation psychologists may wish to consider its beneficial role as part of their clinical work. Multiple sclerosis (MS), one of the most common disabling diseases of young adults, is an inflammatory demyelinating disorder of the central nervous system with an estimated prevalence of about 250,000‐350,000 individuals in the United States (Devins & Shnek, 2000; Kalb, 1996; Schapiro, 1998). First symptoms usually appear at the young adult age, but the disease may also become evident later in life. The course of MS is highly variable and makes studies of etiology and possible mechanisms of treatment challenging. Because of MS’s highly variable clinical course, individual outcomes cannot be reliably predicted. For many individuals, MS starts with a relapsing‐remitting pattern with episodic exacerbations of neurological dysfunction, which remit completely or partially. Over the years, for most individuals, the disease develops into the secondary progressive form with accumulated disability (Lublin & Reingold, 1996).