Short Title:Quality of Life Research
Year, Volume, Issue, Page(s):17, 26, 10, 2633-2645
Study developed and evaluated a model to describe relationships between environmental factors and participation for people with traumatic brain injury (TBI), stroke, and spinal cord injury (SCI). Researchers also examined whether this model differed across the three diagnostic groups, as well as other demographic and clinical characteristics. A cross-sectional observational study included 545 community-dwelling adults with neurological disorders (166 with TBI, 189 with stroke, and 190 with SCI) recruited at three academic medical centers. Participants completed patient-reported measures of environmental factors and participation. The final structural equation model had acceptable fit to the data, explaining 63 percent of the variance in participation in social roles and activities. Systems, services, and policies had an indirect influence on participation and this relationship 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. 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. Social and physical environments appear to mediate the influence of systems, services, and policies on participation after acquired neurological disorders. These relationships are stable across the three diagnostic groups and many personal and clinical factors. The 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.