Intersection of participation and environmental factors: a complex interactive process.

The objective was to review contemporary and historical rehabilitation-focused literature on conceptualizations of the environment, broadly defined, and environmental measures. Data sources included historical nonempirical American-based literature from 1935 to the present and descriptive and empirical rehabilitation articles worldwide, retrieved from computerized databases predominantly from past 10 years depicting a participation-environment association. Literature selection required relevance to 3 combined topics: physical disability rehabilitation, participation/community integration, and impact of environmental barriers and facilitators. The ultimate focus was on spinal cord injury for recent literature and measures reviewed. Data extraction was based on author-assessed relevance to both participation and environmental considerations. Nonempirical literature from last three quarters of a century suggests an environmental impact on participation, focusing on "person-environment fit." Recent empirical evidence supports environmental contributions to participation, but the magnitude of the contribution is low. Despite the obvious theoretic impact of the environment, scientific demonstration of environmental contribution to participation restriction or facilitation has yet to be achieved. Participation-environment interaction could be illustrated better by (1) taking into account critical elements in environmental measures (eg, comprehensiveness of approach to environment, scales describing spectrum of environmental influence, subjective vs objective perspectives), (2) addressing the concept of participation in a dimension-specific approach, and (3) avoiding environmental features in construction of participation measures. Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.