Environmental Barriers Experienced by People With Spinal Cord Injury Across 22 Countries: Results From a Cross-Sectional Survey.

Journal: Archives of physical medicine and rehabilitation

Volume: 101

Issue: 12

Year of Publication: 2021

Affiliated Institutions:  Institute for Disaster Management and Reconstruction, Sichuan University and Hong Kong Polytechnic University, Chengdu, China; Swiss Paraplegic Research, Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland. Electronic address: reinhardt@scu.edu.cn. John Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical School, The University of Sydney, Sydney Australia. Department of Rehabilitation Medicine, Hannover Medical School, Germany. Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. Spinal Cord Injuries Rehabilitation Department, Medical University of Patras, Patras, Greece. Department of Rehabilitation Medicine, Clinical Neuroscience Laboratory, Faculty of Medicine, Sidi Mohammed Ben Abdallah University, Fez, Morocco. Department of Rehabilitation Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan. Medical Rehabilitation Clinic, Medical University of Lodz, Lodz, Poland.

Abstract summary 

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.Cross-sectional community survey.Individuals (N=12,591) living with SCI in the community.Not applicable.Nottwil Environmental Factors Inventory-Short Form.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.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.

Authors & Co-authors:  Reinhardt Jan D JD Middleton James J Bökel Andrea A Kovindha Apichana A Kyriakides Athanasios A Hajjioui Abderrazak A Kouda Ken K Kujawa Jolanta J

Study Outcome 

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Statistics
Citations : 
Authors :  9
Identifiers
Doi : 10.1016/j.apmr.2020.04.027
SSN : 1532-821X
Study Population
Male,Female
Mesh Terms
Activities of Daily Living
Other Terms
Comorbidity;Environment;Income;Mental health;Rehabilitation;Socioeconomic factors;Spinal cord injuries;Surveys and questionnaires
Study Design
Cross Sectional Study
Study Approach
Country of Study
Publication Country
United States