Abstract
Objectives
To investigate the experience of environmental barriers by people with spinal cord
injury (SCI) across 22 countries. Specific aims were to describe and compare the prevalence
of environmental barriers experienced across countries, and to analyze determinants
of environmental barriers at individual and country level.
Design
Cross-sectional community survey.
Participants
Individuals (N=12,591) living with SCI in the community.
Interventions
Not applicable.
Main Outcome Measure
Nottwil Environmental Factors Inventory–Short Form.
Results
Most barriers were experienced in relation to accessibility, climate, transportation,
finances, and state services. More severe barriers were experienced in settings with
lower gross domestic product (GDP), which especially refers to medical supplies (gamma=–0.38;
P<.001) and finances (gamma=–0.37; P<.001) in this study. However, in a multivariable negative binomial regression using
within-between estimation of the number of barriers experienced on the selected predictors,
the effect of GDP was reversed when it was adjusted for covariates. On the individual
level, the number of experienced barriers decreased with better mental health and
greater self-care ability. People with low income, with paraplegia, complete lesions,
and more health problems reported more barriers. On the country level, fewer barriers
were reported in countries with higher average age, better mental health, and greater
self-care ability, as well as in those with a higher percentage of traumatic SCI,
paraplegia, and complete lesions. More barriers were reported in countries with a
higher percentage of married individuals, lower average household income, higher average
time since injury, higher mean vitality scores, and greater income inequality.
Conclusions
Study participants reported a significant number of environmental barriers, many of
which are modifiable. Complementary interventions are recommended. Within and between
country effects of covariates sometimes pointed in different directions, suggesting
that countries with a different composition of SCI population also differed in environmental
contexts.
Keywords
List of abbreviations:
GDP (gross domestic product), InSCI (International Spinal Cord Injury Survey), IQR (interquartile range), IRR (incident rate ratio), NEFI–SF (Nottwil Environmental Factors Inventory–Short Form), SCI (spinal cord injury), SF-36 (Short Form-36)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 02, 2020
Footnotes
Disclosures: none.
The members of the InSCI group are Linamara Battistella, School of Medicine, University of São Paulo, São Paulo, Brazil; Jianan Li, Department of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China; Brigitte Perrouin-Verbe, University Hospital of Nantes, St Jacques Hospital, Nantes, France; Christoph Gutenbrunner, Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany; Christina-Anastasia Rapidi, Department of Physical and Rehabilitation Medicine, General Hospital of Athens “G. Gennimatas,” Athens, Greece; Luh Karunia Wahyuni, Medicine and Rehabilitation Department, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Mauro Zampolini, Department of Rehabilitation, San Giovanni Battista Hospital, Foligno, Perugia, Italy; Eiichi Saitoh, Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan; Bum Suk Lee, Department of Rehabilitation Medicine, National Rehabilitation Center & Hospital, Seoul, Korea; Alvydas Juocevicius, Rehabilitation, Physical and Sport Medicine Center Department of Vilnius University Hospital Santariskiu Klinikos, Medical Faculty Vilnius University, Vilnius, Lithuania; Nazirah Hasnan, Department of Rehabilitation Medicine, University of Malaya, Kuala Lumpur, Malaysia; Marcel W. Post, Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Johan K. Stanghelle, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Oslo, Oslo, Norway; Piotr Tederko, Department of Rehabilitation, First Faculty of Medicine, Medical University of Warsaw, Poland; Daiana Popa, Clinical Rehabilitation Hospital Felix-Spa Bihor County, Oradea, Romania; Conran Joseph, Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa; Mercè Avellanet, Research group in Health Sciences and Health Services, Universitat d’Andorra, Spain; Michael Baumberger, Swiss Paraplegic Center, Nottwil, Switzerland; Reuben Escorpizo, The University of Vermont, Department of Rehabilitation and Movement Science, Burlington, VT.
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Copyright
© 2020 by the American Congress of Rehabilitation Medicine
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- CorrectionArchives of Physical Medicine and RehabilitationVol. 102Issue 11
- PreviewIn the authorship listing for the InSCI group in “Describing functioning in people living with spinal cord injury across 22 countries: a graphic modeling approach” ( https://www.archives-pmr.org/article/S0003-9993 (20)30958-8/fulltext) Daniela Utiyama, PhD should be listed in that group in place of Prof. Liniamara Batistella.
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