Alex W K Wong1,2, Sheryl Ng3,4, Jessica Dashner5, M Carolyn Baum6, Joy Hammel7, Susan Magasi8, Jin-Shei Lai9, Noelle E Carlozzi10, David S Tulsky11, Ana Miskovic12, Arielle Goldsmith12, Allen W Heinemann12,13. 1. Program in Occupational Therapy and Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA. wongal@wustl.edu. 2. Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Ave, Campus Box 8505, St. Louis, MO, 63108, USA. wongal@wustl.edu. 3. Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Ave, Campus Box 8505, St. Louis, MO, 63108, USA. 4. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. 5. Program in Occupational Therapy and Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA. 6. Program in Occupational Therapy, Department of Neurology and George Warren Brown School of Social Work, Washington University, St. Louis, MO, USA. 7. Departments of Occupational Therapy and Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA. 8. Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA. 9. Departments of Medical Social Science and Pediatric, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 10. Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA. 11. Department of Physical Therapy, University of Delaware, Newark, DE, USA. 12. Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL, USA. 13. Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Abstract
PURPOSE: To develop and evaluate a model of environmental factors-participation relationships for persons with traumatic brain injury (TBI), stroke, and spinal cord injury (SCI), and test whether this model differed across three diagnostic groups, as well as other demographic and clinical characteristics. METHODS: A cross-sectional observational study included 545 community-dwelling adults with neurological disorders (TBI = 166; stroke = 189; SCI = 190) recruited at three academic medical centers. Participants completed patient-reported measures of environmental factors and participation. RESULTS: The final structural equation model had acceptable fit to the data (CFI = 0.923; TLI = 0.898; RMSEA = 0.085; SRMR = 0.053), explaining 63% of the variance in participation in social roles and activities. Systems, services, and policies had an indirect influence on participation and this relation 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 (ps < 0.001). 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. CONCLUSIONS: Social and physical environments appear to mediate the influence of systems, services, and policies on participation after acquired neurological disorders. These relations are stable across three diagnostic groups and many personal and clinical factors. Our 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.
PURPOSE: To develop and evaluate a model of environmental factors-participation relationships for persons with traumatic brain injury (TBI), stroke, and spinal cord injury (SCI), and test whether this model differed across three diagnostic groups, as well as other demographic and clinical characteristics. METHODS: A cross-sectional observational study included 545 community-dwelling adults with neurological disorders (TBI = 166; stroke = 189; SCI = 190) recruited at three academic medical centers. Participants completed patient-reported measures of environmental factors and participation. RESULTS: The final structural equation model had acceptable fit to the data (CFI = 0.923; TLI = 0.898; RMSEA = 0.085; SRMR = 0.053), explaining 63% of the variance in participation in social roles and activities. Systems, services, and policies had an indirect influence on participation and this relation 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 (ps < 0.001). 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. CONCLUSIONS: Social and physical environments appear to mediate the influence of systems, services, and policies on participation after acquired neurological disorders. These relations are stable across three diagnostic groups and many personal and clinical factors. Our 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.
Authors: Susan Magasi; Alex Wong; David B Gray; Joy Hammel; Carolyn Baum; Chia-Chiang Wang; Allen W Heinemann Journal: Arch Phys Med Rehabil Date: 2015-04 Impact factor: 3.966
Authors: Kaitlin B Casaletto; Anya Umlauf; Jennifer Beaumont; Richard Gershon; Jerry Slotkin; Natacha Akshoomoff; Robert K Heaton Journal: J Int Neuropsychol Soc Date: 2015-06-01 Impact factor: 2.892
Authors: Allen W Heinemann; Ana Miskovic; Patrick Semik; Alex Wong; Jessica Dashner; Carolyn Baum; Susan Magasi; Joy Hammel; David S Tulsky; Sofia F Garcia; Sara Jerousek; Jin-Shei Lai; Noelle E Carlozzi; David B Gray Journal: Arch Phys Med Rehabil Date: 2016-06-23 Impact factor: 3.966
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Authors: Alex W K Wong; Sofia F Garcia; Elizabeth A Hahn; Patrick Semik; Jin-Shei Lai; Susan Magasi; Joy Hammel; Kristian P Nitsch; Ana Miskovic; Allen W Heinemann Journal: Arch Phys Med Rehabil Date: 2020-10-22 Impact factor: 3.966
Authors: Marelise Badenhorst; James Craig Brown; Mike I Lambert; Willem Van Mechelen; Evert Verhagen Journal: BMJ Open Date: 2018-06-30 Impact factor: 2.692
Authors: Lauren C Bates; Ryan Conners; Gabriel Zieff; Nathan T Adams; Kyle M Edgar; Sandra Stevens; Mark A Faghy; Ross Arena; Amber Vermeesch; Rodney P Joseph; NiCole Keith; Lee Stoner Journal: Disabil Health J Date: 2021-07-24 Impact factor: 2.554