Identifying environmental factors that influence the outcomes of people with traumatic brain injury.

OBJECTIVES: To determine the types of environmental barriers reported by persons with traumatic brain injury (TBI) and to identify the relations between environmental barriers and such components of societal participation as employment, community mobility, social integration, and life satisfaction.
DESIGN: Seventy-three persons with TBI who were participating in the TBI Model Systems program at Craig Hospital were surveyed at 1 year, using a new measure of the environment, the Craig Hospital Inventory of Environmental Factors (CHIEF), which rates frequency and impact of 25 barriers.
RESULTS: Transportation, the surroundings, government policies, attitudes, and the natural environment were the environmental barriers with the greatest reported impact. Those who were married, older, and unemployed or not in school reported the most barriers overall. Additionally, those reporting a greater impact from environmental barriers also reported lower levels of participation and life satisfaction.
CONCLUSIONS: Although environmental barriers affect TBI survivors and play a role in their outcomes, their interplay with other, perhaps as yet unidentified, factors requires continued research. CHIEF may be a valuable tool for understanding the environment's role in the lives of people with TBI, and identifying the general environmental domains where interventions are needed to reduce their negative impact.