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Perret C, Alvarelhão JJM, Pennington L, Ehlinger V, Duffaut C, Arnaud C, Vidart d'Egurbide Bagazgoïtia N. Assessing the Adequacy of the Physical, Social, and Attitudinal Environment to the Specific Needs of Young Adults With Cerebral Palsy: The European Adult Environment Questionnaire. Arch Phys Med Rehabil 2024; 105:906-920. [PMID: 38206241 DOI: 10.1016/j.apmr.2023.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/17/2023] [Accepted: 11/26/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES To present the development of the European Adult Environment Questionnaire (EAEQ), to assess to what extent it covers the International Classification of Functioning, Disability and Health (ICF), and to describe the adequacy of the physical, social, and attitudinal environment to the specific needs of young adults with cerebral palsy (CP). DESIGN Cross-sectional. SETTING Administrative regions in France, Germany, Italy, Portugal, and Sweden. PARTICIPANTS Young adults with CP (N=357), with varying severity profiles, aged 19-28 years at time of interview (2018-20). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Physical, social, and attitudinal environment unmet needs. RESULTS Relevant environmental factors (EFs) for young adults with CP were identified during focus groups in England and Portugal. EFs were mapped to the ICF environmental classification and the EAEQ analytical structure resulted from this linking procedure. It comprised 61 items, linked to 31 ICF environmental classification categories, and covered 4 of its 5 chapters. Content validity assessed with the bandwidth index (percentage coverage of ICF Core Sets for adults with CP) was satisfactory (79.3%). A descriptive analysis was carried out. Participants had a mean age of 24 years, 56% were men, 38% had severely limited mobility. Less than 16% reported unmet needs for EFs relating to home, college/work/day placement, and communication in the Products and technology chapter. Unmet needs were higher (>20%) for the other items in the Public use and Land development categories. Social support, attitudes, and understanding of relatives were often adequate to the participants' needs. The proportion of unmet needs varied by sex (women were more often concerned) and raised with increasing gross motor impairment. CONCLUSION The EAEQ describes in detail the adequacy of the environment to the specific needs of young adults with CP. Its ICF-based structure opens up possibilities for use in a universal conceptual framework.
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Affiliation(s)
- Célia Perret
- UMR 1295 CERPOP, Inserm, Université Toulouse III - Paul Sabatier, Team SPHERE, Toulouse, France
| | | | - Lindsay Pennington
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Virginie Ehlinger
- UMR 1295 CERPOP, Inserm, Université Toulouse III - Paul Sabatier, Team SPHERE, Toulouse, France
| | - Carine Duffaut
- UMR 1295 CERPOP, Inserm, Université Toulouse III - Paul Sabatier, Team SPHERE, Toulouse, France
| | - Catherine Arnaud
- UMR 1295 CERPOP, Inserm, Université Toulouse III - Paul Sabatier, Team SPHERE, Toulouse, France; Clinical Epidemiology Unit, University Hospital, Toulouse, France
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Macpherson RA, Amick BC, Collie A, Koehoorn M, Smith PM, McLeod CB. Do regional labor market conditions matter for temporary work disability duration? A multilevel analysis of workers' compensation claims in five Canadian provinces. Am J Ind Med 2023; 66:637-654. [PMID: 37245121 DOI: 10.1002/ajim.23489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Research has shown how regionally varying labor market conditions are associated with differences in work disability duration. However, the majority of these studies have not used multilevel models to appropriately account for the hierarchical clustering of individuals nested within contextual units (e.g., regions). Studies that have used multilevel models have focused on privately insured workers or on disability not specifically caused by work-related injury or illness. METHODS Using claims data from five Canadian provincial workers' compensation systems, linear random-intercept models were used to estimate how much variance in temporary work disability duration ('work disability duration' for brevity) for work-related injuries and musculoskeletal disorders was due to differences between economic regions, what economic region-level labor market characteristics were associated with work disability duration, and what characteristics best explained economic region differences in work disability duration. RESULTS Economic region characteristics, such as the unemployment rate and proportion of goods-producing employment, were independently associated with individual-level work disability duration. However, economic region variation only accounted for 1.5%-2% of total variation in work disability duration. The majority (71%) of economic region-level variation was explained by the provincial jurisdiction where the worker lived and was injured. Regional variation tended to be greater for female workers than males. CONCLUSIONS The findings suggest that while regional labor market conditions matter for work disability duration, system-level differences in workers' compensation and health care are more important factors influencing work disability duration. Furthermore, while this study includes both temporary and permanent disability claims, the work disability duration measure only captures temporary disability.
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Affiliation(s)
- Robert A Macpherson
- Partnership for Work, Health and Safety, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Benjamin C Amick
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Alex Collie
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mieke Koehoorn
- Partnership for Work, Health and Safety, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter M Smith
- Institute for Work & Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Monash Centre of Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher B McLeod
- Partnership for Work, Health and Safety, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Hajjioui A, Fourtassi M, Tachfouti N, Laaroussi Z, Boulman S, Boujraf S, Fekete C. People with spinal cord injury in Morocco: results from the very first systematic data collection. Disabil Rehabil 2022; 44:8054-8065. [PMID: 34793274 DOI: 10.1080/09638288.2021.2003451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To report on the methodology, participant characteristics, and associations of four most frequent environmental barriers with health conditions, general health and quality of life (QoL) in the very first systematic data collection in people with spinal cord injury (SCI) in Morocco. MATERIALS AND METHODS We obtained data from 385 participants of the cross-sectional Moroccan SCI community survey (MorSCI). We used descriptive statistics to describe participant characteristics and regression models to investigate associations of the five most frequently reported environmental barriers with health conditions (secondary conditions, pain intensity, mental health), general health and QoL. RESULTS The most frequently reported environmental barriers were "lack of public services" (92.5%), "financial strain" (93.0%), restricted access to "public transportation" (85.5%), "public places" (83.9%) and "private places" (84.7%). People who perceived those factors as barriers also reported more secondary conditions, higher pain intensity, lower mental health, lower general health, and lower QoL. CONCLUSIONS This study on Moroccans with SCI found that environmental barriers detract from health and QoL. Given that environmental barriers are potentially modifiable, policy interventions present powerful tools to reduce barriers and potentially increase health and QoL in this vulnerable population.IMPLICATIONS FOR REHABILITATIONPublic policy on the construction of transportation and public places is important to make the physical environment accessible for wheelchair users to support their participation in society.The provision of adequate rehabilitation services and specialized post-acute rehabilitation units for people with SCI in Morocco is urgently needed, not only to contribute to health and QoL but also to contribute to their abilities to overcome environmental barriers.Adequate state services including universal health coverage and access to rehabilitation services and assistive devices or adapted tools must be a priority on the policy level to facilitate activities of daily living and reduce barriers.Improving the skills and knowledge of health professionals in SCI rehabilitation and guide policy makers to promote patient education and self-advocacy in the meantime, may help reduce the gap between needs of people with SCI and available support.
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Affiliation(s)
- Abderrazak Hajjioui
- Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco.,Department of Physical and Rehabilitation Medicine, Hassan II University Hospital, Fez, Morocco
| | - Maryam Fourtassi
- Laboratory of Epidemiology, Clinical Research and Public Health, University Mohammed Premier, Oujda, Morocco
| | - Nabil Tachfouti
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Zainab Laaroussi
- Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Salma Boulman
- Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Said Boujraf
- Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Christine Fekete
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Schwab SM, Spencer C, Carver NS, Andrade V, Dugan S, Greve K, Silva PL. Personal factors understood through the Ecological-Enactive Model of Disability and implications for rehabilitation research. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:954061. [DOI: 10.3389/fresc.2022.954061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022]
Abstract
The International Classification of Functioning, Disability and Health (ICF) recognizes that disability arises from the interaction between an individual with a medical condition and the context in which they are embedded. Context in the ICF is comprised of environmental and personal factors. Personal factors, the background life and lifestyle of an individual, are poorly understood in rehabilitation. There is limited knowledge about how personal and environmental factors interact to shape the contextual conditions critical for explaining functioning and disability. In this paper, we explore how a newly proposed model of disability, the Ecological-Enactive Model of Disability, can enhance understanding of personal factors across multiple rehabilitation disciplines. We draw from a review of evidence and phenomenological interviews of individuals with Friedreich's Ataxia. We consider the practical impact of this understanding on disability and rehabilitation research and pathways for the future focusing on representative design.
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Anttila H, Tallqvist S, Muñoz M, Leppäjoki-Tiistola S, Mäkitie O, Hiekkala S. Towards an ICF-based self-report questionnaire for people with skeletal dysplasia to study health, functioning, disability and accessibility. Orphanet J Rare Dis 2021; 16:236. [PMID: 34022932 PMCID: PMC8141148 DOI: 10.1186/s13023-021-01857-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/06/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Little is known about the spectrum of everyday challenges that people with skeletal dysplasia face because of their health and functioning. We aimed to identify factors related to health, functioning and disability in people with skeletal dysplasia, and their challenges with accessibility in order to form a self-reported questionnaire for national data collection. The comprehensive musculoskeletal post-acute core set of the International Classification of Functioning, Disability and Health (ICF) was used as a framework. METHODS An iterative, participatory and qualitative process was used to formulate a questionnaire. Items were searched from Patient-Reported Outcomes Measurement Information System and from other self-report instruments, additional items were formulated using ICF linking rules. Expert panels from the target population assessed the face and content validity in thematic interviews. RESULTS The questionnaire demonstrated its relevance, comprehensiveness and feasibility for people with skeletal dysplasia. The ICF linkages showed the contents' correspondence to the construct. Expert panels added 15 categories and one on chapter level to the core set and confirmed content validity. The final survey covers 86 ICF categories and 173 ICF-linked items that were grouped to 33 questions. CONCLUSIONS The content of the questionnaire proved to be sufficiently valid for people with skeletal dysplasia. It can be used to explore their health, functioning, disability and accessibility to develop care and rehabilitation policies, to plan services and to provide information to various parties involved.
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Affiliation(s)
- Heidi Anttila
- Public Health and Welfare Department, Knowledge Management and Co-Creation Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, 01270, Helsinki, Finland.
| | | | - Minna Muñoz
- Validia Ltd, Validia Rehabilitation, Nordenskiöldinkatu 18 B, 00250, Helsinki, Finland
| | - Sanna Leppäjoki-Tiistola
- Lyhytkasvuiset - Kortväxta ry (Finnish Association for People with Restricted Growth and for Their Families), PO Box 14, 02601, Espoo, Finland
- Finnish Association of People With Physical Disabilities, Mannerheimintie 107, 00280, Helsinki, Finland
| | - Outi Mäkitie
- Children's Hospital, University of Helsinki and Helsinki University Hospital, P.O. Box 63, 00014, Helsinki, Finland
- Folkhälsan Institute of Genetics, Helsinki, Finland
| | - Sinikka Hiekkala
- Validia Ltd, Validia Rehabilitation, Nordenskiöldinkatu 18 B, 00250, Helsinki, Finland
- Finnish Association of People With Physical Disabilities, Mannerheimintie 107, 00280, Helsinki, Finland
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Van Doren S, Hermans K, Declercq A. Towards a standardized approach of assessing social context of persons receiving home care in Flanders, Belgium: the development and test of a social supplement to the interRAI instruments. BMC Health Serv Res 2021; 21:487. [PMID: 34022861 PMCID: PMC8140469 DOI: 10.1186/s12913-021-06453-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/23/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Apart from a person's physical functioning, the early identification of social context indicators which affect patient outcomes - such as environmental and psychosocial issues - is key for high quality and comprehensive care at home. During a home care assessment, a person's biomedical and functional problems are typically considered. Harder to define concepts, such as psychosocial well-being or living arrangements, are not routinely documented, even though research shows they also affect functioning and health outcomes. The purpose of this study is to develop and test a concise, integrated assessment (BelRAI Social Supplement) that evaluates these social context indicators for persons receiving home care to complement existing interRAI- instruments. METHODS The development of the BelRAI Social Supplement is a multi-stage process, based upon the revised MRC-framework, involving both qualitative and quantitative research with stakeholders such as; clients, informal caregivers, care professionals and policy makers. The developmental process encompasses four stages: (I) item generation based on multiple methods and content validation by a panel of stakeholders (II) assessing feasibility and piloting methods, (III) early evaluation, and (IV) final evaluation. Stage II and III are covered in this paper. RESULTS During Stages I and II, a testable version of the BelRAI Social Supplement was developed in an iterative process. In Stage III, 100 care professionals assessed 743 individuals receiving home care in Flanders between December 2018 and December 2019. Using inter-item correlation matrixes, frequency distributions and regular feedback from the participants, the BelRAI Social Supplement was improved and prepared for Stage IV. The updated version of the instrument consists of four main sections: (1) environmental assessment; (2) civic engagement; (3) psychosocial well-being; and (4) informal care and support. In total, the BelRAI Social Supplement contains a maximum of 76 items. CONCLUSIONS The BelRAI Social Supplement was reviewed and shortened in close collaboration with care professionals and other experts in Flanders. This study resulted in an instrument that documents need-to-know social context determinants of home dwelling adults.
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Affiliation(s)
- Shauni Van Doren
- LUCAS - Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium.
| | - Kirsten Hermans
- LUCAS - Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
| | - Anja Declercq
- LUCAS - Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
- CeSO - Center for Sociological Research, KU Leuven, Leuven, Belgium
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Grabowska I, Antczak R, Zwierzchowski J, Panek T. Individual quality of life and the environment - towards a concept of livable areas for persons with disabilities in Poland. BMC Public Health 2021; 21:740. [PMID: 33863294 PMCID: PMC8052840 DOI: 10.1186/s12889-021-10797-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/30/2021] [Indexed: 12/03/2022] Open
Abstract
Background The United Nations Convention on the Rights of Persons with Disabilities [1] highlights the need to create proper socioeconomic and political conditions for persons with disabilities, with a special focus on their immediate living conditions. According to the Convention, these conditions should be built to ensure that persons with disabilities have the potential to enjoy a high quality of life (QoL), and this principle is reflected in the notion of livable areas. The crucial aspect of this framework is the relationship between the individual QoL and the environment, broadly understood as the socioeconomic as well as the technical conditions in which persons with disabilities function. Methods The basic research problem was to assess the relationship between individual QoL for the population with disabilities as a dependent variable and livability indicators as independent variables, controlling for individual characteristics. The study used a dataset from the EU-SILC (European Union Statistics on Income and Living Conditions) survey carried out in 2015 in Poland. The research concept involved several steps. First, we created a variable measuring the QoL for the entire population with disabilities. To measure the multidimensional QoL, we used Sen’s capability approach as a general concept, which was operationalized by the MIMIC (multiple indicators multiple causes) model. In the second step, we identified the livability indicators available in the official statistics, and merged them with survey data. Finally, in the last step, we ran the regression analysis. We also checked the data for the nested structure. Results We confirmed that the general environmental conditions, focused on creating livable areas, played a significant role in shaping the QoL of persons with disabilities; i.e., we found that the higher the level of the local Human Development Index, the higher the quality of life of the individuals living in this area. This relationship held even after controlling for the demographic characteristics of the respondents. Moreover, we found that in addition to the general environmental conditions, the conditions created especially for persons with disabilities (i.e., services for this group and support for their living conditions) affected the QoL of these individuals. Conclusions The results illustrate the need to strengthen policies aimed at promoting the QoL of persons with disabilities by creating access to community assets and services that can contribute to improving the life chances of this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10797-7.
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Affiliation(s)
- Izabela Grabowska
- SGH Warsaw School of Economics, Institute of Statistics and Demography, Warsaw, Poland.
| | - Radosław Antczak
- SGH Warsaw School of Economics, Institute of Statistics and Demography, Warsaw, Poland
| | - Jan Zwierzchowski
- SGH Warsaw School of Economics, Institute of Statistics and Demography, Warsaw, Poland
| | - Tomasz Panek
- SGH Warsaw School of Economics, Institute of Statistics and Demography, Warsaw, Poland
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Newman-Griffis D, Fosler-Lussier E. Automated Coding of Under-Studied Medical Concept Domains: Linking Physical Activity Reports to the International Classification of Functioning, Disability, and Health. Front Digit Health 2021; 3:620828. [PMID: 33791684 PMCID: PMC8009547 DOI: 10.3389/fdgth.2021.620828] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/16/2021] [Indexed: 11/13/2022] Open
Abstract
Linking clinical narratives to standardized vocabularies and coding systems is a key component of unlocking the information in medical text for analysis. However, many domains of medical concepts, such as functional outcomes and social determinants of health, lack well-developed terminologies that can support effective coding of medical text. We present a framework for developing natural language processing (NLP) technologies for automated coding of medical information in under-studied domains, and demonstrate its applicability through a case study on physical mobility function. Mobility function is a component of many health measures, from post-acute care and surgical outcomes to chronic frailty and disability, and is represented as one domain of human activity in the International Classification of Functioning, Disability, and Health (ICF). However, mobility and other types of functional activity remain under-studied in the medical informatics literature, and neither the ICF nor commonly-used medical terminologies capture functional status terminology in practice. We investigated two data-driven paradigms, classification and candidate selection, to link narrative observations of mobility status to standardized ICF codes, using a dataset of clinical narratives from physical therapy encounters. Recent advances in language modeling and word embedding were used as features for established machine learning models and a novel deep learning approach, achieving a macro-averaged F-1 score of 84% on linking mobility activity reports to ICF codes. Both classification and candidate selection approaches present distinct strengths for automated coding in under-studied domains, and we highlight that the combination of (i) a small annotated data set; (ii) expert definitions of codes of interest; and (iii) a representative text corpus is sufficient to produce high-performing automated coding systems. This research has implications for continued development of language technologies to analyze functional status information, and the ongoing growth of NLP tools for a variety of specialized applications in clinical care and research.
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Affiliation(s)
- Denis Newman-Griffis
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, United States
- Epidemiology & Biostatistics Section, Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Eric Fosler-Lussier
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, United States
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Reinhardt JD, Middleton J, Bökel A, Kovindha A, Kyriakides A, Hajjioui A, Kouda K, Kujawa J. Environmental Barriers Experienced by People With Spinal Cord Injury Across 22 Countries: Results From a Cross-Sectional Survey. Arch Phys Med Rehabil 2020; 101:2144-2156. [PMID: 32502565 DOI: 10.1016/j.apmr.2020.04.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/21/2020] [Accepted: 04/26/2020] [Indexed: 11/27/2022]
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.
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Affiliation(s)
- Jan D Reinhardt
- 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.
| | - James Middleton
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical School, The University of Sydney, Sydney Australia
| | - Andrea Bökel
- Department of Rehabilitation Medicine, Hannover Medical School, Germany
| | - Apichana Kovindha
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Athanasios Kyriakides
- Spinal Cord Injuries Rehabilitation Department, Medical University of Patras, Patras, Greece
| | - Abderrazak Hajjioui
- Department of Rehabilitation Medicine, Clinical Neuroscience Laboratory, Faculty of Medicine, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Ken Kouda
- Department of Rehabilitation Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | | | - Jolanta Kujawa
- Medical Rehabilitation Clinic, Medical University of Lodz, Lodz, Poland
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Kongwattanakul K, Hiengkaew V, Jalayondeja C, Sawangdee Y. A structural equation model of falls at home in individuals with chronic stroke, based on the international classification of function, disability, and health. PLoS One 2020; 15:e0231491. [PMID: 32275692 PMCID: PMC7147784 DOI: 10.1371/journal.pone.0231491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/24/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To use structural equation model (SEM) to explain falls at home in individuals with chronic stroke, based on the International Classification of Functioning, Disability and Health (ICF). MATERIALS AND METHODS A cross sectional observation study was conducted in home-dwelling individuals with chronic stroke (N = 236; 148 non-fallers, 88 fallers). Participants were assessed; structural impairments using Modified Ashworth Scale, Fugl-Meyer Assessment upper (FMA-UE), lower (FMA-LE), and sensory function, ankle plantarflexor strength; activity limitations using Timed Up and Go Test, Step Test, Berg Balance Scale, Barthel Index (BI); participation restrictions using Stroke Impact Scale-participation (SIS-P); and contextual factors using home hazard environments, home safety surroundings, risk behaviors, and Fall-related Self Efficacy. The measurement model was analyzed by confirmatory factor analysis. The SEM was conducted to analyze a structural model of falls at home. RESULTS FMA-UE was significantly (p<0.01) associated with FMA-LE, combining as one variable in the structural impairments. In the measurement model, variables were fit to their domains, except variables of contextual factors, but the ICF domains did not correspond to disability. A structural model of falls at home demonstrated a significant (p<0.01) direct path of contextual factors and activity limitations with falls at home. The structural impairments showed a significant (p<0.01) direct path with activity limitations. All variables, except BI, SIS-P and risk behaviors, related to their domains in the structural model. CONCLUSIONS A structural model of falls at home proposes contextual factors being the strongest association with falls at home that home hazard environments seem the most influence in its domain. The activity limitations presented by balance ability are directed to falls at home. The structural impairments are associated with falls at home through activity limitations. Home assessment to decrease home hazard environments is suggested to prevent falls at home for individuals with chronic stroke.
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Affiliation(s)
| | - Vimonwan Hiengkaew
- Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, Thailand
- * E-mail:
| | - Chutima Jalayondeja
- Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - Yothin Sawangdee
- Institute for Population and Social Research, Mahidol University, Salaya, Nakhon Pathom, Thailand
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Mukaino M, Prodinger B, Okouchi Y, Mizutani K, Senju Y, Suzuki M, Saitoh E. Development and assessment of a home environment checklist to evaluate mismatch between patients' ability and home environment. Ann Phys Rehabil Med 2019; 63:288-295. [PMID: 31614219 DOI: 10.1016/j.rehab.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 08/27/2019] [Accepted: 09/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Modification of the home environment, together with rehabilitative interventions, is important for maximizing the level of functioning after an individual with disability undergoes rehabilitation in the hospital. OBJECTIVES We developed a simple screening scale - the home environment checklist (HEC) - to identify any mismatch between an individual's abilities and their home environment to help clinicians monitor the appropriateness of the home environment to which individuals with disability will be discharged. We also examined the psychometric properties of the HEC. METHODS The HEC was developed by a multidisciplinary panel of rehabilitation experts using information routinely collected in rehabilitation clinics before discharge. The reliability of the checklist was assessed in 60 individuals undergoing rehabilitation. The inter-rater agreement and internal consistency of the scale were assessed by weighted kappa statistics and Cronbach's alpha, respectively. Rasch analysis was performed with 244 rehabilitation individuals to evaluate the internal construct validity, and the known-groups validity was confirmed by a comparison of the daily activity levels of 30 individuals with disabilities under rehabilitation to the HEC score. RESULTS The HEC was developed as a simple, 10-item checklist. The weighted kappa statistics ranged from 0.73 to 0.93, indicating excellent inter-rater reliability. Cronbach's alpha was 0.92, indicating high internal consistency. Rasch analysis with a testlet approach on 3 subscales demonstrated a good fit with the Rasch model (χ2=13.2, P=0.153), and the demonstrated unidimensionality and absence of differential item functioning supported the internal construct validity of the HEC. HEC scores were significantly different (P<.01) among individuals with disability and 3 levels of restrictions in their activities (no limitation, home-bound, and bed-bound), which demonstrates the known-groups validity of the HEC. CONCLUSIONS The HEC has good reliability and validity, which supports its utility in rehabilitation clinics.
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Affiliation(s)
- Masahiko Mukaino
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, 470-1192, Toyoake, Aichi, Japan.
| | - Birgit Prodinger
- Faculty of Applied Health and Social Sciences, Technical University of Applied Sciences, Rosenheim, Germany; Swiss Paraplegic Research, Nottwil, Switzerland.
| | - Yuki Okouchi
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan.
| | - Kouji Mizutani
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan.
| | - Yuki Senju
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, Tsu, Japan.
| | - Megumi Suzuki
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan.
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, 470-1192, Toyoake, Aichi, Japan.
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Maric F, Nicholls D. A call for a new environmental physiotherapy - An editorial. Physiother Theory Pract 2019; 35:905-907. [DOI: 10.1080/09593985.2019.1632006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Dave Nicholls
- School of Clinical Sciences, Auckland University of Technology, Private Bag 92006, Auckland 1106, New Zealand
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Madden RH, Bundy A. The ICF has made a difference to functioning and disability measurement and statistics. Disabil Rehabil 2018; 41:1450-1462. [PMID: 29433362 DOI: 10.1080/09638288.2018.1431812] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS Fifteen years after the publication of the International Classification of Functioning, Disability and Health (ICF), we investigated: How ICF applications align with ICF aims, contents and principles, and how the ICF has been used to improve measurement of functioning and related statistics. METHODS In a scoping review, we investigated research published 2001-2015 relating to measurement and statistics for evidence of: a change in thinking; alignment of applications with ICF specifications and philosophy; and the emergence of new knowledge. RESULTS The ICF is used in diverse applications, settings and countries, with processes largely aligned with the ICF and intended to improve measurement and statistics: new national surveys, information systems and ICF-based instruments; and international efforts to improve disability data. Knowledge is growing about the components and interactions of the ICF model, the diverse effects of the environment on functioning, and the meaning and measurement of participation. CONCLUSION The ICF provides specificity and a common language in the complex world of functioning and disability and is stimulating new thinking, new applications in measurement and statistics, and the assembling of new knowledge. Nevertheless, the field needs to mature. Identified gaps suggest ways to improve measurement and statistics to underpin policies, services and outcomes. Implications for Rehabilitation The ICF offers a conceptualization of functioning and disability that can underpin assessment and documentation in rehabilitation, with a growing body of experience to draw on for guidance. Experience with the ICF reminds practitioners to consider all the domains of participation, the effect of the environment on participation and the importance of involving clients/patients in assessment and service planning. Understanding the variability of functioning within everyday environments and designing interventions for removing barriers in various environments is a vital part of rehabilitation planning.
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Affiliation(s)
- Rosamond H Madden
- a Faculty of Health Sciences , University of Sydney , Sydney , Australia
| | - Anita Bundy
- a Faculty of Health Sciences , University of Sydney , Sydney , Australia.,b Department of Occupational Therapy , Colorado State University , Fort Collins , CO , USA
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The influence of geographic variation in socio-cultural factors on length of work disability. Disabil Health J 2017; 10:308-319. [DOI: 10.1016/j.dhjo.2016.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/25/2016] [Accepted: 12/16/2016] [Indexed: 11/19/2022]
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Big Data and Urban Informatics: Innovations and Challenges to Urban Planning and Knowledge Discovery. SPRINGER GEOGRAPHY 2017. [DOI: 10.1007/978-3-319-40902-3_2] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Heinemann AW, Miskovic A, Semik P, Wong A, Dashner J, Baum C, Magasi S, Hammel J, Tulsky DS, Garcia SF, Jerousek S, Lai JS, Carlozzi NE, Gray DB. Measuring Environmental Factors: Unique and Overlapping International Classification of Functioning, Disability and Health Coverage of 5 Instruments. Arch Phys Med Rehabil 2016; 97:2113-2122. [PMID: 27343347 DOI: 10.1016/j.apmr.2016.05.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe the unique and overlapping content of the newly developed Environmental Factors Item Banks (EFIB) and 7 legacy environmental factor instruments, and to evaluate the EFIB's construct validity by examining associations with legacy instruments. DESIGN Cross-sectional, observational cohort. SETTING Community. PARTICIPANTS A sample of community-dwelling adults with stroke, spinal cord injury, and traumatic brain injury (N=568). INTERVENTIONS None. MAIN OUTCOME MEASURES EFIB covering domains of the built and natural environment; systems, services, and policies; social environment; and access to information and technology; the Craig Hospital Inventory of Environmental Factors (CHIEF) short form; the Facilitators and Barriers Survey/Mobility (FABS/M) short form; the Home and Community Environment Instrument (HACE); the Measure of the Quality of the Environment (MQE) short form; and 3 of the Patient Reported Outcomes Measurement Information System's (PROMIS) Quality of Social Support measures. RESULTS The EFIB and legacy instruments assess most of the International Classification of Functioning, Disability and Health (ICF) environmental factors chapters, including chapter 1 (products and technology; 75 items corresponding to 11 codes), chapter 2 (natural environment and human-made changes; 31 items corresponding to 7 codes), chapter 3 (support and relationships; 74 items corresponding to 7 codes), chapter 4 (attitudes; 83 items corresponding to 8 codes), and chapter 5 (services, systems, and policies; 72 items corresponding to 16 codes). Construct validity is provided by moderate correlations between EFIB measures and the CHIEF, MQE barriers, HACE technology mobility, FABS/M community built features, and PROMIS item banks and by small correlations with other legacy instruments. Only 5 of the 66 legacy instrument correlation coefficients are moderate, suggesting they measure unique aspects of the environment, whereas all intra-EFIB correlations were at least moderate. CONCLUSIONS The EFIB measures provide a brief and focused assessment of ICF environmental factor chapters. The pattern of correlations with legacy instruments provides initial evidence of construct validity.
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Affiliation(s)
- Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Ana Miskovic
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL
| | - Patrick Semik
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL
| | - Alex Wong
- Program in Occupational Therapy, Washington University in St Louis, St Louis, MO; Department of Neurology, Washington University in St Louis, St Louis, MO
| | - Jessica Dashner
- Program in Occupational Therapy, Washington University in St Louis, St Louis, MO; Department of Neurology, Washington University in St Louis, St Louis, MO
| | - Carolyn Baum
- Program in Occupational Therapy, Washington University in St Louis, St Louis, MO; Department of Neurology, Washington University in St Louis, St Louis, MO; Brown School of Social Work, Washington University in St Louis, St Louis, MO
| | - Susan Magasi
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL
| | - Joy Hammel
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL; Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL
| | - David S Tulsky
- The Center for Assessment Research and Translation, University of Delaware, Newark, DE; Department of Physical Therapy, University of Delaware, Newark, DE; Department of Psychological and Brain Sciences, University of Delaware, Newark, DE
| | - Sofia F Garcia
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sara Jerousek
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL
| | - Jin-Shei Lai
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Noelle E Carlozzi
- Center for Clinical Outcomes Development and Application, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - David B Gray
- Program in Occupational Therapy, Washington University in St Louis, St Louis, MO
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Fréz AR, Daniel CR, Kerppers II, Ruaro JA, Luz JPD, Ruaro MB. Incorporating environmental factors in gait assessments of persons following amputation. FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/0103-5150.029.001.ao12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Environmental factors have also been recognized to be a component of a multidimensional gait assessment of people living with disabilities, like persons following an amputation. Objective: To investigated whether the environmental factors outlined by the International Classification of Functioning, Disability, and Health (ICF) are considered when evaluating gait following lower limb amputations. Materials and methods: A literature search of the PubMed, EMBASE, CINAHL, and SPORTDiscus databases was performed. The keywords "amputation" and "gait" were combined with the keywords "barriers", "facilitators", and "environmental factors". Searches were performed without language restrictions. All articles containing data about environmental influences on gait functionality after lower limb amputations published during or after 2002, were included. Manuscripts that did not study adults and literature reviews were excluded. Two researchers identified potentially eligible articles and the methods used to assess gait. To make comparisons between scales, the 2 researchers selected the categories from the ICF chapter on environmental factors. Results: Fourteen studies were obtained from the search. Seven studies were duplicates and 4 were excluded. The remaining 3 articles were evaluated. We identified a total of 74 possibilities for categorization according to the ICF environmental factors, but only 7 ICF categories (9.45%) were considered in the studies analyzed. Conclusions: The influence of environmental factors is frequently not considered in the evaluation of gait following a lower limb amputation. Thorough evaluation of gait after lower limb amputation should reflect the complex nature of gait changes, including environmental factors.
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Stucki G, Reinhardt JD, Bickenbach J. Re: "Theoretical Foundations for the Measurement of Environmental Factors and Their Impact on Participation Among People With Disabilities". Arch Phys Med Rehabil 2015; 96:1739-40. [PMID: 26319593 DOI: 10.1016/j.apmr.2015.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
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Batorowicz B, King G, Mishra L, Missiuna C. An integrated model of social environment and social context for pediatric rehabilitation. Disabil Rehabil 2015; 38:1204-15. [PMID: 26358410 DOI: 10.3109/09638288.2015.1076070] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED This article considers the conceptualization and operationalization of "social environment" and "social context" with implications for research and practice with children and youth with impairments. We first discuss social environment and social context as constructs important for understanding interaction between external environmental qualities and the individual's experience. The article considers existing conceptualizations within psychological and sociological bodies of literature, research using these concepts, current developmental theories and issues in the understanding of environment and participation within rehabilitation science. We then describe a model that integrates a person-focused perspective with an environment-focused perspective and that outlines the mechanisms through which children/youth and social environment interact and transact. Finally, we consider the implications of the proposed model for research and clinical practice. This conceptual model directs researchers and practitioners toward interventions that will address the mechanisms of child-environment interaction and that will build capacity within both children and their social environments, including families, peers groups and communities. Health is created and lived by people within the settings of their everyday life; where they learn, work, play, and love [p.2]. IMPLICATIONS FOR REHABILITATION Understanding how social environment and personal factors interact over time to affect the development of children/youth can influence the design of services for children and youth with impairments. The model described integrates the individual-focused and environment-focused perspectives and outlines the mechanisms of the ongoing reciprocal interaction between children/youth and their social environments: provision of opportunities, resources and supports and contextual processes of choice, active engagement and collaboration. Addressing these mechanisms could contribute to creating healthier environments in which all children, including children with impairments, have experiences that lead to positive developmental benefits.
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Affiliation(s)
- Beata Batorowicz
- a Rehabilitation Science, McMaster University , Hamilton , Ontario , Canada
| | - Gillian King
- b Bloorview Research Institute , Toronto , Ontario , Canada , and
| | - Lipi Mishra
- c Department of Epidemiology, Biostatistics and Occupational Health, McGill University , Montreal , Quebec , Canada
| | - Cheryl Missiuna
- a Rehabilitation Science, McMaster University , Hamilton , Ontario , Canada
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Magasi S, Wong A, Gray DB, Hammel J, Baum C, Wang CC, Heinemann AW. Theoretical foundations for the measurement of environmental factors and their impact on participation among people with disabilities. Arch Phys Med Rehabil 2015; 96:569-77. [PMID: 25813889 DOI: 10.1016/j.apmr.2014.12.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 12/08/2014] [Accepted: 12/10/2014] [Indexed: 10/23/2022]
Abstract
The ascendance of the World Health Organization's International Classification of Functioning, Disability and Heath (ICF) as the global standard for describing and characterizing aspects of disability has refocused attention on the role that environmental factors (EFs) have on the health and participation of people with disabilities, both as individuals and as a group. There has been a rise in the development of instruments designed to measure EFs alone and in relation to participation. Some instrument developers have used the ICF as a theoretical base for instrument development and to substantiate content validity claims. We contend that this is a misapplication of the ICF. There is a need to step back and reexamine the role that environmental theories can play in developing a conceptually driven approach to measuring the interaction between EFs and participation. For this review, we draw on the fields of social, community, and developmental psychology; disability studies; gerontology; public health; and rehabilitation. We discuss different approaches to the measurement of EFs. We suggest that given the complex nature of EFs and their influence on participation, there is a need for a fresh approach to EF measurement. The thoughtful application of theories and the use of advanced psychometric, measurement, and e-technologies and data visualization methods may enable researchers and clinicians to better quantify, document, and communicate the dynamic interrelationship between EFs and participation and health outcomes for people with disabilities at the individual, group, and population levels.
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Affiliation(s)
- Susan Magasi
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Alex Wong
- Department of Occupational Therapy, Washington University, St. Louis, MO
| | - David B Gray
- Department of Occupational Therapy, Washington University, St. Louis, MO; Department of Neurology, Washington University, St. Louis, MO
| | - Joy Hammel
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL; Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL
| | - Carolyn Baum
- Department of Occupational Therapy, Washington University, St. Louis, MO; Department of Neurology, Washington University, St. Louis, MO; Department of Social Work, University of Illinois at Chicago, Chicago, IL
| | - Chia-Chiang Wang
- Department of Counseling, School, and Educational Psychology, University at Buffalo, The State University of New York, Buffalo, NY
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL
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Philibert M, Pampalon R, Daniel M. Conceptual and operational considerations in identifying socioenvironmental factors associated with disability among community-dwelling adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:3814-34. [PMID: 25854297 PMCID: PMC4410217 DOI: 10.3390/ijerph120403814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 11/23/2022]
Abstract
Disability is conceived as a person–context interaction. Physical and social environments are identified as intervention targets for improving social participation and independence. In comparison to the body of research on place and health, relatively few reports have been published on residential environments and disability in the health sciences literature. We reviewed studies evaluating the socioenvironmental correlates of disability. Searches were conducted in Medline, Embase and CINAHL databases for peer-reviewed articles published between 1997 and 2014. We found many environmental factors to be associated with disability, particularly area-level socioeconomic status and rurality. However, diversity in conceptual and methodological approaches to such research yields a limited basis for comparing studies. Conceptual inconsistencies in operational measures of disability and conceptual disagreement between studies potentially affect understanding of socioenvironmental influences. Similarly, greater precision in socioenvironmental measures and in study designs are likely to improve inference. Consistent and generalisable support for socioenvironmental influences on disability in the general adult population is scarce.
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Affiliation(s)
- Mathieu Philibert
- Département de Sexologie, Université du Québec à Montréal, Montréal, QC H3C 3P8, Canada.
- Institut National de Santé Publique du Québec, Montréal, QC H2P 1E2, Canada.
- Departement de Medecine Sociale et Preventive, Université de Montréal, Montréal, QC H3N 1X9, Canada.
| | - Robert Pampalon
- Institut National de Santé Publique du Québec, Montréal, QC H2P 1E2, Canada.
- Departement de Medecine Sociale et Preventive, Université Laval, Quebec, QC G1V 0A6, Canada.
| | - Mark Daniel
- Departement de Medecine Sociale et Preventive, Université de Montréal, Montréal, QC H3N 1X9, Canada.
- Spatial Epidemiology and Evaluation Research Group, School of Population Health, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5000, Australia.
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Fitzroy, VIC 3065, Australia.
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Kostanjsek N, Good A, Madden RH, Üstün TB, Chatterji S, Mathers CD, Officer A. Counting disability: global and national estimation. Disabil Rehabil 2014; 35:1065-9. [PMID: 23725494 DOI: 10.3109/09638288.2012.720354] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE How many people with disabilities are in the world? How is disability defined? How can we measure disability in an accurate and comparable way? These are some of the key questions which the recently published World Bank/WHO World Report on Disability (WRD) addresses. METHOD Multiple data sources and methods were used by WHO and the World Bank to estimate a global figure, with the ICF as the underlying data standard. Key international data sources were the World Health Survey of 2002-2004 and the 2004 updates from the Global Burden of Disease study. The World Report on Disability also includes a compilation of country-reported prevalence from census and surveys. This paper presents and discusses key findings of the Irish National Disability Survey (2006) to illustrate the value of the ICF framework for disability statistics and most especially the environmental factors component. RESULTS The World Report estimates that globally one billion people or 15% of the world's population experience disabilities. Between 110-190 million people (2% of the world's population) experience severe or extreme difficulties in functioning. Definitions and measures of disability vary widely across countries. The Irish Disability Survey shows the substantial impact of environmental factors on people's functioning. For example, attitudes, and the presence or absence of facilitating equipment, support services, flexible working arrangements and transport significantly affect participation of people with disabilities in Irish society. CONCLUSIONS To improve the quality of disability information, the World Report recommends the use of a common definition and concepts of disability based on WHO's International Classification of Functioning Disability and Health (ICF). Furthermore, disability measurement needs to apply a multidimensional approach, in particular, measuring disability in terms of the level of difficulty a person is experiencing in multiple areas of life, rather than head counting severe impairment types in a dichotomous way. Environmental factors have significant effects on individual functioning and should be considered as an integral part in disability measurement.
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Abstract
Walking outdoors is often difficult or impossible for many seniors and people with disabilities during winter. We present a novel approach for conducting winter accessibility evaluations of commonly used pedestrian facilities, including sidewalks, street crossings, curb ramps (curb cuts and dropped curbs), outdoor stairs and ramps, building and transit entrances, bus stops, and driveways. A total of 183 individuals, aged 18-85 completed our survey. The results show that cold weather itself had little impact on the frequency of outdoor excursions among middle-aged and older adults while the presence of snow and/or ice on the ground noticeably kept people, especially older adults at home. The survey found that the key elements decreasing winter accessibility were icy sidewalks and puddles at street crossings and curb ramps. While communities have recognized the need to improve snow and ice removal, little attention has been paid to curb ramp design which is especially ineffective in winter when the bottom of the ramps pool with rain, snow, and ice, making it hazardous and inaccessible to nearly all users. We conclude that investigations of alternative designs of curb ramp are needed.
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Quintas R, Raggi A, Bucciarelli P, Franco MG, Andreotti A, Caballero FF, Olaya B, Chatterji S, Galas A, Meriläinen-Porras S, Frisoni G, Russo E, Minicuci N, Power M, Leonardi M. The COURAGE Built Environment Outdoor Checklist: an objective built environment instrument to investigate the impact of the environment on health and disability. Clin Psychol Psychother 2013; 21:204-14. [PMID: 23897864 DOI: 10.1002/cpp.1858] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
UNLABELLED A tool to assess the built environment, which takes into account issues of disability, accessibility and the need for data comparable across countries and populations, is much needed. The Collaborative Research on Ageing in Europe (COURAGE) in Europe Built Environment Outdoor Checklist (CBE-OUT) helps us to understand when features of the neighbourhood environment have either a positive or negative impact on the accessibility of neighbourhoods for healthy ageing. The CBE-OUT is composed of 128 items that can be recorded when present in the evaluated environment. Audits were performed in households randomly selected from each cluster of the sample for Finland, Poland and Spain, following precise rules defined by experts. Global scores were computed both section by section and in the overall checklist, rescaling the resulting scores from 0 (negative environment) to 100 (positive). The total number of completed CBE-OUT checklists was 2452 (Finland, 245; Poland, 972; and Spain, 1235). Mean global score for our sample is 49.3, suggesting an environment composed both of facilitating and hindering features. Significant differences were observed in the built environment features of the three countries and in particular between Finland and the other two. The assessment of features of built environment is crucial when thinking about ageing and enhanced participation. The COURAGE in Europe project developed this tool to collect information on built environment in an objective evaluation of environmental features and is a recommended methodology for future studies. KEY PRACTITIONER MESSAGE The CBE-OUT checklist is an objective evaluation of the built environment and is centred on technical measurement of features present in the environment and has its foundations in the concepts of disability and accessibility operating in the International Classification of Functioning, Disability and Health (ICF) model. The CBE-OUT checklist can be analysed using both the total score and the single section score, allowing an evaluation of the facilitating or hindering role of the environment and is usable for predictive analysis of ageing trends. The CBE-OUT checklist makes it possible to collect information about the built environment by means of an objective evaluation of environment features and is a recommended methodology for future studies about the built environment.
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Affiliation(s)
- Rui Quintas
- Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy
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Raggi A, Quintas R, Bucciarelli P, Franco MG, Andreotti A, Miret M, Zawisza K, Olaya B, Chatterji S, Sainio P, Frisoni GB, Martinuzzi A, Minicuci N, Power M, Leonardi M. Validation of the COURAGE Built Environment Self-Reported Questionnaire. Clin Psychol Psychother 2013; 21:215-26. [PMID: 23861306 DOI: 10.1002/cpp.1859] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED The built environment (BE) impacts on people's disability and health, in terms of overweight, depression, alcohol abuse, poor self-rated health and presence of psychological symptoms; it is reasonable to assume that BE also impacts on participation levels. This paper presents the validation of the COURAGE Built Environment Self-Reported Questionnaire (CBE-SR), an instrument designed to evaluate BE in the context of health and disability. Subjects participating to COURAGE, a cross-sectional study conducted on 10,800 citizens of Poland, Finland and Spain, completed a protocol inclusive of the CBE-SR. Psychometric properties and factor structure were analysed, and factor scores created. Gender differences, differences between persons from different age groups and persons reporting the environment as facilitating, hindering or neutral were calculated. Eight items were deleted so that the final version of CBE-SR comprises 19 items. Cronbach's alpha ranged from 0.743 to 0.906, and test-retest stability was demonstrated for the majority of items. Four subscales were identified: Usability of the neighbourhood environment; Hindrance of walkable environment; Easiness of use of public buildings, places and facilities; and Risk of accidents and usability of the living place. Younger respondents reported their neighbourhood as more usable but perceived walkways as more hindering and public buildings as less easy to use; gender differences were almost inexistent. The CBE-SR is a four-scale instrument with good psychometric properties that measures the person-environment interaction. It is sensitive across age groups and is consistent with the subject's overall judgement of the degree to which the environment is facilitating or hindering. KEY PRACTITIONER MESSAGE Poor built environments have a negative impact on the level of a person's participation. However, instruments measuring the person-environment interaction are lacking. The CBE-SR is a valid and reliable instrument that researchers can use to assess the relationships between the intrinsic health state and the objective features of the environment. Understanding this relationship would provide further insight into the need of addressing the individual's functioning either by means of interventions directed to the individual or by making changes to the individual's environment.
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Affiliation(s)
- Alberto Raggi
- Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy
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King G, Rigby P, Batorowicz B. Conceptualizing participation in context for children and youth with disabilities: an activity setting perspective. Disabil Rehabil 2013; 35:1578-85. [PMID: 23311673 DOI: 10.3109/09638288.2012.748836] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED This article considers the conceptualization, operationalization and implications of "activity settings" for research on the recreation and leisure participation of children and youth with disabilities. Activity settings are contextualized settings that situate child and youth activities and their participation experiences. We discuss activity settings as an important construct for considering environmental qualities that provide opportunities for beneficial participation experiences for children and youth with disabilities. The article considers existing research using the concept of activity settings, the conceptualization of environment and contemporary issues in the measurement of participation and environment, indicating how these are addressed by an activity settings approach. We then describe the development of two quantitative measures of recreation and leisure activity settings - one assessing environmental qualities and the other assessing youth experiences - that have the potential to inform researchers, managers and clinicians about relationships between environmental qualities and participation experiences. Finally, we consider the implications of an activity settings approach for research, theory building and clinical practice. IMPLICATIONS FOR REHABILITATION An activity setting perspective can enhance understanding of the recreation and leisure participation of children and youth with disabilities. The Measure of Environmental Qualities of Activity Settings (MEQAS) and Self-reported Experiences of Activity Settings (SEAS) provide unique assessments of environmental qualities and experiences from an activity setting perspective. Clinicians might use the SEAS alone to understand particular youth experiences in certain types of settings, which may be limiting or facilitating development. The combined use of the SEAS and MEQAS can provide experiential profiles linked to activity setting qualities such as structure, type of activity and social partners, providing a valuable source of information about youth programs.
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Affiliation(s)
- Gillian King
- Bloorview Research Institute, Toronto, ON, Canada.
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Fellinghauer B, Reinhardt JD, Stucki G, Bickenbach J. Explaining the disability paradox: a cross-sectional analysis of the Swiss general population. BMC Public Health 2012; 12:655. [PMID: 22894722 PMCID: PMC3528470 DOI: 10.1186/1471-2458-12-655] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 07/03/2012] [Indexed: 11/25/2022] Open
Abstract
Background Disability can be broken down into difficulties in different components of functioning such as impairments and limitations in activities and participation (A&P). Previous studies have produced the seemingly surprising result that persons with severe impairments tend to report high quality of life (QoL) including perceived health regardless of their condition; the so-called “disability paradox”. We aim to study the role of contextual factors (i.e. the personal and environmental situation) in explaining the disability paradox. Methods The Swiss Health Survey provides information on the perceived health of 18,760 participants from the general population. We construct a conditional independence graph applying random forests and stability selection in order to represent the structure of impairment, A&P limitation, contextual factors, and perceived health. Results We find that impairment and A&P limitations are not directly related but only via a cluster of contextual factors. Similarly, impairment and perceived health are not directly related. On the other hand, perceived health is directly connected with A&P limitations. We hypothesize that contextual factors have a moderating and/or mediating effect on the relationship of impairment, A&P limitations, and perceived health. Conclusion The disability paradox seems to dissolve when contextual factors are put into consideration. Contextual factors may be responsible for some persons with impairments developing A&P limitations and others not. In turn, persons with impairments may only then perceive bad health when they experience A&P limitation. Political interventions at the level of the environment may reduce the number of persons who perceive bad health.
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Affiliation(s)
- Bernd Fellinghauer
- Swiss Paraplegic Research, Guido A, Zäch Str. 4, 6207 Nottwil, Switzerland
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