Environmental barriers and social participation in individuals with spinal cord injury.
I-Hsuan Tsai, Daniel E Graves, Wenyaw Chan and 3 others
PMID 28045281WHAT IT FOUND
Higher perceived environmental barriers are linked to lower social participation and employment in people with spinal cord injury.
Barriers related to assistance and services show the strongest negative association with participation. However, the overall effect is small, and the study cannot prove that removing barriers will improve outcomes.
Key findings
01For each one-point increase in the total environmental barrier score, there was an associated 0.83-point reduction in the total social participation score.
02Barriers related to assistance and services had the strongest negative association with social participation compared to other barrier types.
03For each one-point increase in the total environmental barrier score, there was an associated 4% reduction in the likelihood of being employed.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study is cross-sectional, so it cannot determine if environmental barriers cause lower participation or if people with lower participation perceive more barriers. The effect size was small, with environmental barriers explaining less variance in participation than personal characteristics like injury severity. Data were self-reported, which may introduce bias in how participants perceive and report barriers and participation. The work/school barrier dimension was excluded from the total score because it was only answered by those employed or in school, limiting the analysis of this specific barrier type. Generalizability is limited to individuals admitted to Model Spinal Cord Injury System regional centers in the United States.
Declared interests
The authors declared no conflicts of interest. The data were supplied under the approval of the Institutional Review Board of the University of Louisville.
The easy way to misread this
Do not assume that removing environmental barriers will significantly improve social participation. The study found a statistically significant but small association, and the design cannot prove causality. Personal factors like injury severity and age were stronger predictors of participation than perceived environmental barriers.