Environmental barriers and participation restrictions in community-dwelling individuals with spinal cord injury in Jiangsu and Sichuan Provinces of China: Results from a cross-sectional survey

J Spinal Cord Med. 2023 Mar;46(2):277-290. doi: 10.1080/10790268.2021.1935094. Epub 2021 Jun 17.

Abstract

Objective: (1) to describe environmental barriers and participation restrictions experienced by people with spinal cord injury (SCI) from China, (2) to examine associations between lesion characteristics and participation restrictions, considering a mediating role of environmental barriers, (3) to identify those environmental barriers that have the largest influence on participation.

Design: Cross-sectional study. This study is part of the International Spinal Cord Injury Survey (InSCI).

Setting: Community, Jiangsu and Sichuan Province, China.

Participants: 1355 persons with SCI.

Interventions: Not applicable.

Outcome measures: Participation restrictions were measured with items from the Model Disability Survey, Environmental Barriers were measured with the Nottwil Environmental Factors Inventory-Short Form.

Results: Participants experienced a median of five (IQR 1-9) environmental barriers and five (IQR 0-9) participation restrictions. Environmental barriers were mainly reported in relation to climate, insufficient resources and accessibility, and participation restrictions mainly occurred in using public transportation, taking care of others, and getting to places. In an adjusted zero-inflated Poisson model, people with more severe injuries reported a greater number of environmental barriers (complete injury: IRR = 1.31, 95%CI = [1.24,1.38]) and participation restrictions (tetraplegia: IRR = 1.15, 95%CI = [1.10,1.21]; complete injury: IRR = 1.25, 95%CI = [1.18,1.31]). Moreover, environmental barriers (IRR = 1.07, 95%CI = [1.06,1.08]) were a significant predictor of participation restrictions and partially mediated the association of lesion completeness with participation restrictions. Barriers related to accessibility of public places (IRR = 1.47, 95%CI = [1.33,1.62]), accessing homes (IRR = 1.32, 95%CI = [1.21,1.44]), long distance transportation (IRR = 1.11, 95%CI = [1.04,1.20]), communication devices (IRR = 1.07, 95%CI = [1.01,1.15]) and state services (IRR = 1.10, 95%CI = [1.02,1.19]) had the greatest negative impact on participation.

Conclusion: Social participation of people with SCI is seriously restricted in China. Removing environmental barriers will be an important element of programs to address this problem.

Keywords: Community survey; Environmental barriers; Impairment; Participation; Spinal cord injury.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cross-Sectional Studies
  • Disabled Persons*
  • Humans
  • Independent Living
  • Social Participation
  • Spinal Cord Injuries* / epidemiology
  • Surveys and Questionnaires

Associated data

  • ChiCTR/ChiCTR1800018559

Grants and funding

The Chinese branch of InSCI was funded by the Institute of Disaster Management and Reconstruction of Sichuan University and Hong Kong Polytechnic University, Sichuan University, Chengdu, China supported by the Fundamental Research Funds for the Central Universities, China to JDR (2101014401003) and the First Affiliated Hospital of Nanjing Medical University, Jiangsu, China supported by National Natural Science Foundation of China (81071604).