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Relationships between environmental factors and participation in adults with traumatic brain injury, stroke, and spinal cord injury: a cross-sectional multi-center study

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Abstract

Purpose

To develop and evaluate a model of environmental factors-participation relationships for persons with traumatic brain injury (TBI), stroke, and spinal cord injury (SCI), and test whether this model differed across three diagnostic groups, as well as other demographic and clinical characteristics.

Methods

A cross-sectional observational study included 545 community-dwelling adults with neurological disorders (TBI = 166; stroke = 189; SCI = 190) recruited at three academic medical centers. Participants completed patient-reported measures of environmental factors and participation.

Results

The final structural equation model had acceptable fit to the data (CFI = 0.923; TLI = 0.898; RMSEA = 0.085; SRMR = 0.053), explaining 63% of the variance in participation in social roles and activities. Systems, services, and policies had an indirect influence on participation and this relation was mediated by social attitudes and the built and natural environment. Access to information and technology was associated with the built and natural environment which in turn influence on participation (ps < 0.001). The model was consistent across sex, diagnosis, severity/type of injury, education, race, age, marital status, years since injury, wheelchairs use, insurance coverage, personal or household income, and crystallized cognition.

Conclusions

Social and physical environments appear to mediate the influence of systems, services, and policies on participation after acquired neurological disorders. These relations are stable across three diagnostic groups and many personal and clinical factors. Our findings inform health and disability policy, and provide guidance for implementing the initiatives in Healthy People 2020 in particular for people with acquired neurological disorders.

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Notes

  1. RStudio Team (2015). RStudio: Integrated Development for R. RStudio, Inc., Boston, MA URL: http://www.rstudio.com/.

  2. Muthén, L. K., & Muthén, B. O. (1998–2011). Mplus User's Guide. Sixth Edition. Los Angeles, CA: Muthén & Muthén.

Abbreviations

ADA:

Americans with Disabilities Act

AIT:

Access to information and technology

BNE:

Built and natural environment

CFA:

Confirmatory factor analysis

CFI:

Comparative Fit Index

CPI:

Community Participation Indicators

EFIB:

Environmental Factors Item Banks

GCS:

Glasgow Coma Scale

ICF:

International Classification of Functioning, Disability and Health

PROM:

Patient-Reported Outcomes Measures

PROMIS:

Patient-Reported Outcomes Measurement Information System

QOL:

Quality of life

RMSEA:

Root mean square error of approximation

SCI:

Spinal cord injury

SEM:

Structural equation modeling

SRA:

Social roles and activities

SRMR:

Standardized Root Mean Square Residual

SSP:

Systems, Services and Policies

TBI:

Traumatic brain injury

TLI:

Tucker-Lewis index

WHO:

World Health Organization

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Acknowledgements

The contents do not necessarily represent the policy of the Department of Health and Human Services or the Craig H. Neilsen Foundation. We certify that all financial and material support for this research and work are clearly identified in the title page of the manuscript. The first and last authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. We acknowledge Patrick Semik, BS at the Rehabilitation Institute of Chicago for data management and analysis. Additionally, we would like to acknowledge Megen Devine, MA, and Ojoyi Agbo, BS at Washington University School of Medicine for their editorial assistance.

Funding

This study was supported by the National Institute on Disability, Independent Living, and Rehabilitation Research, the Administration on Community Living, the U.S. Department of Health and Human Services to the Rehabilitation Institute of Chicago (Grant No. H133B090024) and to Washington University in St. Louis (Grant No. H133F140037), and by the Craig H. Neilsen Foundation to Washington University in St. Louis (Grant No. 290474).

Author information

Authors and Affiliations

  1. Program in Occupational Therapy and Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA

    Alex W. K. Wong & Jessica Dashner

  2. Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Ave, Campus Box 8505, St. Louis, MO, 63108, USA

    Alex W. K. Wong & Sheryl Ng

  3. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

    Sheryl Ng

  4. Program in Occupational Therapy, Department of Neurology and George Warren Brown School of Social Work, Washington University, St. Louis, MO, USA

    M. Carolyn Baum

  5. Departments of Occupational Therapy and Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA

    Joy Hammel

  6. Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA

    Susan Magasi

  7. Departments of Medical Social Science and Pediatric, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Jin-Shei Lai

  8. Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA

    Noelle E. Carlozzi

  9. Department of Physical Therapy, University of Delaware, Newark, DE, USA

    David S. Tulsky

  10. Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL, USA

    Ana Miskovic, Arielle Goldsmith & Allen W. Heinemann

  11. Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Allen W. Heinemann

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  1. Alex W. K. Wong
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Corresponding author

Correspondence to Alex W. K. Wong.

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All authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Wong, A.W.K., Ng, S., Dashner, J. et al. Relationships between environmental factors and participation in adults with traumatic brain injury, stroke, and spinal cord injury: a cross-sectional multi-center study. Qual Life Res 26, 2633–2645 (2017). https://doi.org/10.1007/s11136-017-1586-5

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