Associations between perceptions of environmental barriers and participation in persons with late effects of polio

Perception of autonomy among people who use wheeled mobility assistive devices: dependence on environment and contextual factors

PURPOSE

To evaluate and compare the perceived autonomy of people using wheeled mobility assistive devices (WMADs) in five community-based environments. To evaluate how personal, environmental, and assistive device-related factors impact the perceived autonomy of WMAD users.

METHOD

A study-specific questionnaire was used to evaluate perceived satisfaction of WMAD users with their autonomy in five environments: the Home Environment, Buildings Outside of the Home Environment, Outdoor Built Environment, Outdoor Natural Environment, and Transportation. For each environment, participants rated their satisfaction with autonomy about 15 personal, environmental, and assistive device-related factors. Qualitative perceptions were also collected with open-ended questions.

RESULTS

Participants included 123 full- and part-time community-dwelling WMAD users. Participants' overall satisfaction with autonomy in the Outdoor Natural Environment was statistically significantly lower compared to the other four environments (p < 0.05). In all environments, the top factor respondents were most satisfied with was WMAD ease of use. Their least satisfaction was when negotiating stairs, curbs, or obstacles in the Home, Buildings Outside of the Home, and the Outdoor Built Environments. In the Outdoor Natural Environment, the most dissatisfaction was with manoeuvring on different terrains. Responses to open-ended questions supported the quantitative findings and highlighted the effects of various factors on autonomy (e.g., subject-environment familiarity).

CONCLUSIONS

WMAD users reported the greatest restriction to their autonomy in outdoor environments. Different context-specific factors were found to impact autonomy in different environments. Understanding how environment-specific contextual factors contribute to overall perception of autonomy may inform the development of future strategies to overcome identified limitations and challenges.Implications for RehabilitationWheeled mobility assistive device (WMAD) users experienced the highest autonomy in their home environments, specifically, when having access to home modification services.WMAD users had the lowest autonomy in the outdoor natural environment, with manoeuvrability on different terrains being the main predictor of the overall satisfaction with autonomy in this environment.Environment-specific contextual factors with significant impacts on perceived autonomy were identified that can inform the design and development of future WMADs (e.g., distance travelled, safety).

A scoping review of public building accessibility

BACKGROUND

The built environment needs to be designed so that all people can participate in the activities they want and need to do. Yet, accessibility is difficult to put into practice, and accessibility issues tend to be overlooked in the building and planning processes.

OBJECTIVES

The aim of this scoping review was to summarize the research front in the area of accessibility to public buildings. Specific aims were to identify knowledge gaps, to identify access activities in relation to environmental features and to link to predominant activities in terms of the International Classification of Functioning, Disability and Health (ICF).

METHODS

A literature search was performed in PubMed, PsycINFO, Inspec, Embase and Cochrane databases. Articles in English based on original empirical studies investigating accessibility of public buildings for adults aged ≥18 years with functional limitations were considered.

RESULTS

Of the 40 articles included, ten involved study participants, while 30 only examined buildings using instruments to assess accessibility. In addition, the psychometric properties were only tested for a few of them. All articles concerned mobility and several visual limitations, while few addressed cognitive or hearing limitations. Ten main access activities were identified, from using parking/drop-off area to exiting building.

CONCLUSIONS

By using the ICF and theoretically relating the accessibility problems to activities, the results revealed that there are large knowledge gaps about accessibility to public buildings for older people and people with functional limitations and that there is a need for more methodological considerations in this area of research.

Assessing environmental barriers by means of the swedish craig hospital inventory of environmental factors among people post-stroke

BACKGROUND

When occupational therapists address environmental barriers to occupational engagement, some barriers might not be possible to reduce for single individuals, because decisions have to be taken at community or societal level, for example changes in public transport. Investigating environmental barriers by means of the Swedish Craig Hospital Inventory of Environmental Factors (CHIEF-S) may increase our understanding of the environmental impact on occupation engagement and the methodological challenges to assess environmental barriers.

AIMS

To investigate and describe the magnitude of encountered environmental barriers in a group of people post-stroke and to assess psychometric properties of the CHIEF-S.

MATERIAL AND METHODS

In total, 34 participants, who had sustained a stroke in Sweden were recruited.

RESULTS

The participants reported in average 2,7 barriers and the total frequency-magnitude score of barriers (CHIEF-S score) was 0.45. The Cronbach's α for the total CHIEF-S was 0.80 and the analysis of test-retest reliability revealed ICC = 0.86. The entire instrument demonstrated better psychometric properties than the single sub-scales.

CONCLUSION

In this study, the frequency-magnitude of environmental barriers encountered by people post-stroke are reported at a group level and adds information to the cumulative knowledge generation on perceived environmental barriers in the society. However, to inform which interventions are needed at a more detailed level, other data collection methods have to be added.

Predictors of Participation and Autonomy in People With Multiple Sclerosis

IMPORTANCE

Because multiple sclerosis (MS) affects many life areas, it is important to know how participation and autonomy are associated with the perceived impact of MS on everyday life.

OBJECTIVE

To investigate how perceived quality of life, disease impact, gender, and disease severity predict participation and autonomy in people with MS.

DESIGN

Cross-sectional study in which structural equation modeling was used to evaluate relationships between measured variables.

SETTINGS

Outpatient clinics in three areas and one inpatient rehabilitation center in Finland.

PARTICIPANTS

Convenience sample of 194 people with MS.

OUTCOMES AND MEASURES

Participants completed the Impact on Participation and Autonomy (IPA), the World Health Organization Quality of Life-Brief measure (WHOQOL-BREF), and the Multiple Sclerosis Impact Scale (MSIS-29). The Expanded Disability Status Scale (EDSS) was administered by a neurologist.

RESULTS

The final model showed good fit to the data. All the goodness-of-fit indexes except χ² supported the model, χ²(30, N = 194) = 46.729, p < .026; comparative fit index = .983; Tucker-Lewis index = .969; root mean square error of approximation = .054; standardized root mean square residual = .039. Quality of life (WHOQOL-BREF) and the impact of multiple sclerosis (MSIS-29) were the main predictors of participation and autonomy. Disease severity influenced only the IPA Autonomy Indoors domain. Gender was not associated with participation and autonomy.

CONCLUSION AND RELEVANCE

Experiences of participation and autonomy appear to be closely associated with perceived quality of life and impact of the disease. Findings support the importance of assessing participation and autonomy and planning interventions using this information.

WHAT THIS ARTICLE ADDS

The IPA appears to be an appropriate measure for assessing participation and autonomy and planning occupational therapy interventions for people with MS. In particular, environmental factors affecting participation and autonomy should be considered when planning interventions to promote participation and autonomy.

BUS TRIPS-A Self-Management Program for People with Cognitive Impairments after Stroke

Stroke is a major cause of disability worldwide and different types of impairments can affect the individual’s ability to manage everyday activities such as travel that is essential for participation in society. The purpose of this study was to investigate the feasibility of a new self-management intervention (BUS TRIPS) focusing on travelling by bus, and potential contributions to an improved ability to travel by bus for people with cognitive impairments after stroke. This is a pilot study of five individuals, utilizing a multiple case study design with a mixed methods approach. Assessments (Stroke Impact Scale, General Self-Efficacy Scale and Life Satisfaction Scale-11, Item 1) were performed before, two weeks after, and three months after the program. The data collection also comprised reflection notes from the group leaders (an occupational therapist and a physiotherapist), a semi-structured group interview and an individual phone survey. The feasibility of the intervention was presented in four sub-categories: (1) appreciated group format despite too short sessions; (2) the importance of skilled leaders and motivated participants; (3) session material adequate but needs minor revision to fit the target group; and (4) homework is valuable but reflective group discussions must be supported. The narratives of each case showed that all participants made some progress related to travelling by bus, but the overall positive results could not be verified by all of the quantitative assessments. We conclude that the BUS TRIPS intervention is feasible and can potentially contribute to an improved ability to travel by bus for the target group. Future studies is called for, and should focus on recruitment challenges, to clarify assessments that would be suitable to use in larger scale clinical trials and during subsequent implementation in clinical practice.

Polio survivors perceptions of a multi-disciplinary rehabilitation programme

PURPOSE

Post-polio syndrome refers to a late complication of the poliovirus infection. Management of post-polio syndrome is complex due to the extensive symptomology. European and United Kingdom guidelines have advised the use of rehabilitation programmes to manage post-polio syndrome. There is a paucity of research in relation to the effectiveness of rehabilitation interventions. The objective of this study is to explore polio survivor's perceptions of an in-patient multi-disciplinary rehabilitation programme.

METHODS

Semi-structured interviews of community dwelling polio survivors who attended in-patient rehabilitation programme in the United Kingdom. Thematic analysis was used to describe and interpret interview data.

RESULTS

Participants' experiences were influenced by past experiences of polio and their self-concept. Participants generally had a positive experience and valued being with other polio survivors. Positive strategies, such as pacing and reflection changed their mind-sets into their lives after the programme, though they still faced challenges in daily living. Some participants supported others with post-polio syndrome after completing the programme.

CONCLUSIONS

Our research identified that participants experienced long term positive benefits from attending a rehabilitation programme. Strategies that users found helpful that explored the effectiveness of interventions to manage polio are not cited within a Cochrane review. If we are to recognise the lived experience and service user empowerment within a model of co- production it is essential that patient preferences are evaluated and used as evidence to justify service provision. Further research is required with polio survivors to explore how best rehabilitation programmes can adopt the principles of co-production. Implications for Rehabilitation The patients' expertise and lived experience must be at the centre of a rehabilitation programme. Strategies such as pacing and reflection are perceived as important strategies to enable self-management of polio and post-polio syndrome despite the limited evidence base to support these interventions. Polio rehabilitation programmes should not be time limited and commissioners and therapists need to ensure that follow up support is provided. When measuring outcomes patient preferences and views must be evaluated.

The Person-Environment Profile: Preliminary Development of a Clinical Tool for Enhancing Goal-Based Rehabilitation Programs

The World Health Organization's International Classification of Functioning, Disability and Health identifies environmental and personal factors as contextually relevant to functioning following disability. Goal setting is also central to rehabilitation practice and enhances functioning. No current assessment exists that recognizes the interaction of environmental factors as they relate to goal setting in rehabilitation. The person-environment profile (PEP) was developed to explore an individual's subjective view of personal and environmental factors on the achievement of rehabilitation goals. A draft PEP underwent initial face validity testing, and the resulting version was then piloted with 13 participants across 34 rehabilitation goals within a goal-based community rehabilitation setting. Results of this pilot suggest that PEP may have the ability to detect differences in perceived barriers and facilitators across personal and environmental factors for different rehabilitation goals. While showing promise as a clinical tool, the pilot identified feasibility concerns over implementation as a standardized assessment. Substantial additional psychometric evaluation and testing needs to be undertaken before the tool can be recommended for clinical use.

Empirical analysis of the International Classification of Functioning, Disability and Health (ICF) using structural equation modeling

Objective:

To empirically test the relationships proposed by the International Classification of Functioning, Disability and Health (ICF) among its domains.

Method:

The cross-sectional study was completed with 226 adult patients with different health conditions who attended a Brazilian rehabilitation unit. The ICF components were measured with the following instruments: World Health Organization Disability Assessment Instrument II, Functional Independence Measure, Participation Scale, Craig Hospital Inventory of Environmental Factors, and a protocol designed to gather information on body structure and function and personal factors.

Results:

Structural equation modeling showed good model adjustment, GFI=0.863; AGFI=0.795; RMSEA=0.028 (90% CI=0.014-0.043). Significant relationships were found between activity and both body structure and function (standard coefficient=0.32; p<0.0001) and participation components (standard coefficient=–0.70; p<0.0001). Environmental and personal factors had a significant effect on the three functioning components (standard coefficient =0.39; p<0.0001; standard coefficient =-0.35; p<0.001, respectively). In contrast, body structure and function had no significant effect on participation (standard coefficient=–0.10; p=0.111) and health conditions had no significant effect on any of the functioning components, i.e., body structure and function, activity, and participation (standard coefficient=–0.12; p=0.128).

Conclusion:

Some of the ICF’s proposed relationships across domains were confirmed, while others were not found to be significant. Our results reinforce the contextual dependency of the functioning and disability processes, in addition to putting into perspective the impact of health conditions.

Autonomy and Housing Accessibility Among Powered Mobility Device Users

OBJECTIVE

To describe environmental barriers, accessibility problems, and powered mobility device (PMD) users' autonomy indoors and outdoors; to determine the home environmental barriers that generated the most housing accessibility problems indoors, at entrances, and in the close exterior surroundings; and to examine personal factors and environmental components and their association with indoor and outdoor autonomy.

METHOD

This cross-sectional study was based on data collected from a sample of 48 PMD users with a spinal cord injury (SCI) using the Impact of Participation and Autonomy and the Housing Enabler instruments. Descriptive statistics and logistic regression were used.

RESULTS

More years living with SCI predicted less restriction in autonomy indoors, whereas more functional limitations and accessibility problems related to entrance doors predicted more restriction in autonomy outdoors.

CONCLUSION

To enable optimized PMD use, practitioners must pay attention to the relationship between client autonomy and housing accessibility problems.

Perceived Participation and Health-Related Quality of Life in 85 Year Olds in Sweden

This study explores how 85 year olds in Sweden perceive participation and autonomy in their life situations in relation to health-related quality of life and gender. A postal questionnaire included questions on sociodemographics, social network, assistive technology, community assistance, and the EQ-5D. During a home visit, an occupational therapist evaluated perceived participation and autonomy using the Impact on Participation and Autonomy Questionnaire. Most perceived their participation as sufficient. Women had greater limitations than men in indoor and outdoor autonomy. Only a few individuals reported many or severe problems with participation, mainly in mobility and leisure. Not having friends nearby, no close contact with neighbors, and living in community housing increased the risk of perceived problems. Sufficient participation was positively associated with higher health-related quality of life, and facilitating participation is an area of interest for occupational therapists.

Intersection of participation and environmental factors: a complex interactive process

The objective was to review contemporary and historical rehabilitation-focused literature on conceptualizations of the environment, broadly defined, and environmental measures. Data sources included historical nonempirical American-based literature from 1935 to the present and descriptive and empirical rehabilitation articles worldwide, retrieved from computerized databases predominantly from past 10 years depicting a participation-environment association. Literature selection required relevance to 3 combined topics: physical disability rehabilitation, participation/community integration, and impact of environmental barriers and facilitators. The ultimate focus was on spinal cord injury for recent literature and measures reviewed. Data extraction was based on author-assessed relevance to both participation and environmental considerations. Nonempirical literature from last three quarters of a century suggests an environmental impact on participation, focusing on "person-environment fit." Recent empirical evidence supports environmental contributions to participation, but the magnitude of the contribution is low. Despite the obvious theoretic impact of the environment, scientific demonstration of environmental contribution to participation restriction or facilitation has yet to be achieved. Participation-environment interaction could be illustrated better by (1) taking into account critical elements in environmental measures (eg, comprehensiveness of approach to environment, scales describing spectrum of environmental influence, subjective vs objective perspectives), (2) addressing the concept of participation in a dimension-specific approach, and (3) avoiding environmental features in construction of participation measures.