Environmental factors and their role in participation and life satisfaction after spinal cord injury

OBJECTIVES: To investigate environmental barriers reported by people with spinal cord injury (SCI), and to determine the relative impact of environmental barriers compared with demographic and injury characteristics and activity limitations in predicting variation in participation and life satisfaction. DESIGN: Cross-sectional, follow-up survey. SETTING: Individuals rehabilitated at 16 federally designated Model Spinal Cord Injury Systems of care, now living in the community. PARTICIPANTS: People with SCI (N=2726) who completed routine follow-up research interviews between 2000 and 2002. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Craig Hospital Inventory of Environmental Factors-Short Form (CHIEF-SF), the Craig Handicap Assessment and Reporting Technique-Short Form, and the Satisfaction With Life Scale. RESULTS: The top 5 environmental barriers reported by subjects with SCI, in descending order of importance, were the natural environment, transportation, need for help in the home, availability of health care, and governmental policies. The CHIEF-SF subscales accounted for only 4% or less of the variation in participation; they accounted for 10% of the variation in life satisfaction. CONCLUSIONS: The inclusion of environmental factors in models of disability was supported, but were found to be more strongly related to life satisfaction than to societal participation.