Relationships between environmental factors and participation in adults with traumatic brain injury,stroke, and spinal cord injury: a cross-sectional multi-center study |
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Authors: | Alex W. K. Wong Sheryl Ng Jessica Dashner M. Carolyn Baum Joy Hammel Susan Magasi Jin-Shei Lai Noelle E. Carlozzi David S. Tulsky Ana Miskovic Arielle Goldsmith Allen W. Heinemann |
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Affiliation: | 1.Program in Occupational Therapy and Department of Neurology,Washington University School of Medicine,St. Louis,USA;2.Program in Occupational Therapy,Washington University School of Medicine,St. Louis,USA;3.Saw Swee Hock School of Public Health,National University of Singapore,Singapore,Singapore;4.Program in Occupational Therapy, Department of Neurology and George Warren Brown School of Social Work,Washington University,St. Louis,USA;5.Departments of Occupational Therapy and Disability and Human Development,University of Illinois at Chicago,Chicago,USA;6.Department of Occupational Therapy,University of Illinois at Chicago,Chicago,USA;7.Departments of Medical Social Science and Pediatric,Northwestern University Feinberg School of Medicine,Chicago,USA;8.Department of Physical Medicine and Rehabilitation,University of Michigan Medical School,Ann Arbor,USA;9.Department of Physical Therapy,University of Delaware,Newark,USA;10.Center for Rehabilitation Outcomes Research,Rehabilitation Institute of Chicago,Chicago,USA;11.Department of Physical Medicine and Rehabilitation,Northwestern University Feinberg School of Medicine,Chicago,USA |
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Abstract: | PurposeTo develop and evaluate a model of environmental factors-participation relationships for persons with traumatic brain injury (TBI), stroke, and spinal cord injury (SCI), and test whether this model differed across three diagnostic groups, as well as other demographic and clinical characteristics.MethodsA cross-sectional observational study included 545 community-dwelling adults with neurological disorders (TBI = 166; stroke = 189; SCI = 190) recruited at three academic medical centers. Participants completed patient-reported measures of environmental factors and participation.ResultsThe final structural equation model had acceptable fit to the data (CFI = 0.923; TLI = 0.898; RMSEA = 0.085; SRMR = 0.053), explaining 63% of the variance in participation in social roles and activities. Systems, services, and policies had an indirect influence on participation and this relation was mediated by social attitudes and the built and natural environment. Access to information and technology was associated with the built and natural environment which in turn influence on participation (ps < 0.001). The model was consistent across sex, diagnosis, severity/type of injury, education, race, age, marital status, years since injury, wheelchairs use, insurance coverage, personal or household income, and crystallized cognition.ConclusionsSocial and physical environments appear to mediate the influence of systems, services, and policies on participation after acquired neurological disorders. These relations are stable across three diagnostic groups and many personal and clinical factors. Our findings inform health and disability policy, and provide guidance for implementing the initiatives in Healthy People 2020 in particular for people with acquired neurological disorders. |
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