A tale of two countries: Environmental impacts on social participation after spinal cord injury

Study design: Comparative analysis of survey data produced in two countries. Objectives: To assess the degree to which environmental barriers impact social participation, and to identify the aspects of participation most affected. Setting: Community-dwelling individuals with spinal cord injury in the USA and Turkey. Methods: Subjects completed the Functional Independence Measure (FIM) motor score, the Craig Hospital Inventory of Environmental Factors (CHIEF), and the Craig Handicap Assessment and Reporting Technique (CHART). Analysis of co-variance was used to analyze CHIEF and CHART differences within and between country. Results: US subjects reported higher participation scores (CHART) and lower barriers (CHIEF), however, when controls for age, gender, time since injury and motor ability (FIM) were applied, country differences in reports of barriers were limited. Motor ability was the major predictor of participation, which was minimally affected by barriers. Conclusion: Conceptualization and measurement issues may have been the reason for the minimal support for the hypothesis that environment affects participation. Suggestions for future research are made. Sponsorship: National Institute on Disability and Rehabilitation Research, Centers for Disease Control and Prevention.