Environmental barriers and subjective health among people with chronic spinal cord injury: A cohort study

Abstract

Objective: Although previous studies have found environmental barriers to be associated with social participation and life satisfaction after spinal cord injury (SCI), few studies exist reporting their effects on subjective health after SCI. Our purpose was to identify the prevalence of perceived environmental barriers and their effects on subjective health in persons with chronic SCI who completed two repeated measurements during a 5-year longitudinal study. Design: This is a prospective cohort study. Environmental barriers were measured at baseline by the Craig Hospital Inventory of Environmental Factors-Short Form. Subjective health was measured at baseline and 5-year follow-up by days of physical and mental health not good. Other control variables included sex, race, age at injury, years since injury, and injury severity at baseline. Setting: Data were collected at a specialty hospital and analyzed at a medical university in the Southeastern USA. Participants: A total of 1635 participants completed both baseline and follow-up surveys. Results: Twenty per cent of participants reported at least one policy barrier, 46% at least one physical and structural barrier, 22% at least one attitudinal and support barrier, 26% at least one barrier to services and assistance, and 13% at least one barrier at work or school. After controlling for sex, race, age at injury, years since injury, and injury severity, the physical and structural barriers, and services and assistance barriers measured at baseline significantly predicted subjective physical and mental health measured at follow-up. Conclusion: Environmental barriers are prevalent among people with chronic SCI. They are important predictors for future subjective health.

Perceived impact of environmental barriers on participation among people living with spinal cord injury in Switzerland

“…Most studies that provided similar data used the Craig Hospital Environmental Factors Inventory Short Form (CHIEF-SF) and featured US samples of people with traumatic SCI (9,10,14) with the exception of 1 study that also examined a Turkish sample (31). In accordance with our findings, the main barriers in those studies included natural environmental conditions (including climate), transportation, and governmental policies and services.…”

“…In spinal cord injury (SCI) research, environmental factors have been shown to be associated with overall social participation (9-11), physical activity (12), life satisfaction (10), quality of life (13), subjective health (14) and mortality (15). Environmental barriers have been found to be reported more often by people with complete lesions (16) and those with decreased physical independence (10).…”

Psychosocial aspects of spinal cord injury pain: a meta-analysis

“…Attitudinal barriers and service accessibility are key barriers that can predict both physical and mental wellbeing, post SCI. 54 Temporal fluctuations in the stability of structural and perceived social support can also influence postinjury adjustment outcomes. 55,56 However, the relative impact of specific support constructs (i.e.…”

Environmental barriers, functioning and quality of life in 2008 Wenchuan earthquake victims with spinal cord injury eight years after the disaster: A cross-sectional study

“…No previous study on the role of environmental barriers in the Wenchuan earthquake population has been conducted so far, although research from other contexts suggests that environmental factors may importantly be associated with relevant outcomes, such as participation (9, 10), physical activity (11), subjective health (12) and QoL (13,14). Ideally, in the case of disabilityinclusive recovery after a disaster ("building back better") (15), communities should be characterized by minimum physical, social and attitudinal barriers.…”