Quantifying environmental factors: A measure of physical, attitudinal, service, productivity, and policy barriers

doi:10.1016/j.apmr.2003.09.027

Archives of Physical Medicine and Rehabilitation

Volume 85, Issue 8, August 2004, Pages 1324-1335

https://doi.org/10.1016/j.apmr.2003.09.027 Get rights and content

Abstract

Objective

To develop and test a new instrument to assess environmental barriers encountered by people with and without disabilities by using a questionnaire format.

Design

New instrument development.

Setting

A rehabilitation hospital and community.

Participants

Two convenience samples: (1) 97 subjects, 50 with disabilities and 47 without disability, and (2) 409 subjects with disabilities from spinal cord injury, traumatic brain injury, multiple sclerosis, amputation, or auditory or visual impairments. In addition, a population-based sample in Colorado of 2269 people (mean age, 44y; 57% men) with and without disabilities.

Interventions

Not applicable.

Main outcome measures

Item development; factor structure; test-retest, subject-proxy and internal consistency reliability; content, construct, and discriminant validity; and subscale and abbreviated version development.

Results

Panels of experts on disability developed items for the Craig Hospital Inventory of Environmental Factors (CHIEF). The instrument measured the frequency and magnitude of environmental barriers reported by individuals. Five subscales were derived from factor analysis measuring (1) attitudes and support, (2) services and assistance, (3) physical and structural, (4) policy, and (5) work and school environmental barriers. The CHIEF total score had high test-retest reliability (intraclass correlation coefficient [ICC]=.93) and high internal consistency (Cronbach α=.93), but lower participant-proxy agreement (ICC=.62). Significant differences were found in CHIEF scores among groups of people with known differences in disability levels and disability categories.

Conclusions

The CHIEF has good test-retest and internal consistency reliability with evidence of content, construct, and discriminant validity resulting from its development strategy and psychometric assessments in samples of the general population and among people with a variety of disabilities.

Section snippets

Item development and content validity

The item development strategy was designed to ensure the content validity of the items and to reflect environmental factors as conceptualized in the current models of disability. To help identify relevant environmental factors, draft items, and select appropriate metrics, we convened 4 separate advisory panels. Panel members had a wide and varied range of abilities, disabilities, attitudes, philosophies, knowledge, and skills. The 4 panels consisted of 32 participants with expertise in 4

Discussion

The CHIEF survey adds a new tool for assessing the perceived impact of environmental barriers in research targeted toward people with disabilities, where few broad measures of environmental factors exist. The development and testing of the CHIEF featured multiple methods that strengthen its credibility. Four expert panels with broad disability representation were used to develop relevant CHIEF items, increasing content validity. A pilot test evaluated alternative formats before establishing

Conclusions

Continuing to collect CHIEF data along with data on measures of societal participation will test an underlying tenet of disability rights that environmental barriers reduce full participation in society, above and beyond the impact of impairments themselves. This research can be a step toward improving the lives of people with disability by turning environmental barriers into environmental facilitators.

Acknowledgements

We thank Donald Lollar, PhD, for his insights and suggestions that contributed to this research and instrument development.

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To develop a multivariable falls risk prediction model for people with MS (PwMS) who use a wheelchair or scooter full-time.
This prospective cohort study is a secondary data analysis that recruited PwMS from the community across the US. Forty-eight adults with MS who use a wheelchair or scooter as their main form of mobility were included. Dependent variable was fall incidence over 3-month recorded through diaries. Dependent variable was categorized as fallers (≥ 1 fall) and non-fallers (0 fall). Predictors were demographics, history of falls in the past 6 months, measures of fear of falling, Spinal Cord Injury- Falls Concern Scale, California Verbal Learning Test II, and Multiple Sclerosis Quality of Life- mental health. Multivariable logistic regression analyses were conducted to identity predictors of future falls.
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Citation Excerpt :
These factors represent physical and psychological domains that may influence walking outcomes. Additionally, these factors were selected because they are stable and unlikely to change substantially after an acute SCI, making them more likely to be useful in a longitudinal CPR.56,60,70-75 Because the activity during sleep was being assessed, measures of subjective sleep quality and daily fatigue were included.64-69
To determine if functional measures of ambulation can be accurately classified using clinical measures; demographics; personal, psychosocial, and environmental factors; and limb accelerations (LAs) obtained during sleep among individuals with chronic, motor incomplete spinal cord injury (SCI) in an effort to guide future, longitudinal predictions models.
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Ambulatory ability based on the 10-m walk test (10MWT) or 6-minute walk test (6MWT) categorized as nonambulatory, household ambulator (0.01-0.44 m/s, 1-204 m), or community ambulator (>0.44 m/s, >204 m). A random forest model classified ambulatory ability using input features including clinical measures of strength, sensation, and spasticity; demographics; personal, psychosocial, and environmental factors including pain, environmental factors, health, social support, self-efficacy, resilience, and sleep quality; and LAs measured during sleep. Machine learning methods were used explicitly to avoid overfitting and minimize the possibility of biased results.
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^☆: Supported by the US Centers for Disease Control and Prevention (CDC; grant no. R04/CCR814132). Craig Hospital was awarded a subcontract for data collection with the Colorado Department of Public Health and Environment (CDPHE), Survey Research Unit. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or the CDPHE.

¹: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.

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ArticlesQuantifying environmental factors: A measure of physical, attitudinal, service, productivity, and policy barriers1☆,

Abstract

Objective

Design

Setting

Participants

Interventions

Main outcome measures

Results

Conclusions

Section snippets

Item development and content validity

Discussion

Conclusions

Acknowledgements

Health Place

Soc Sci Med

Arch Phys Med Rehabil

Health promotion for people with disabilitiesthe emerging paradigm shift from disability prevention to prevention of secondary conditions

Phys Ther

Expanding the disablement model

International classification of functioning, disability and health

Enabling Americaassessing the role of rehabilitation science and engineering

Documenting environmental factors for preventing the handicap creation process. Quebec contributions relating to the ICIDH and social participation of people with functional differences

Disabil Rehabil

Explanatory models of the consequences of disease and traumathe handicap creation process

ICIDH International Network

Elaborating the model of disablement

Toward an experimental ecology of human development

Am Psychologist

The American with Disabilities Act. Checklist for readily achievable barrier removal. Checklist for existing facilities. Version 2.1

Shopping for architectural barriers

Rehabil Nurs

Wheelchair accessibility of public buildings in Utica, New York

Am J Occup Ther

The architectural accessibility of urban facilities to the disableda summary of descriptive survey results

Paraplegia

Food store accessibility

Am J Occup Ther

Restaurant wheelchair accessibility

Am J Occup Ther

Shopping center wheelchair accessibilityongoing advocacy to implement the Americans with Disabilities Act of 1990

Public Health Nurs

Articles
Quantifying environmental factors: A measure of physical, attitudinal, service, productivity, and policy barriers¹☆,