Jan D Reinhardt1,2,3,4, Carolina S Fellinghauer5, Marcel W M Post5,6,7. 1. Institute for Disaster Management and Reconstruction of Sichuan University and Hong Kong Polytechnic University, Chengdu, China. reinhardt@scu.edu.cn. 2. Swiss Paraplegic Research, Nottwil, Switzerland. reinhardt@scu.edu.cn. 3. Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland. reinhardt@scu.edu.cn. 4. Xi Dian Group Hospital, Xi'an, Shaanxi, China. reinhardt@scu.edu.cn. 5. Swiss Paraplegic Research, Nottwil, Switzerland. 6. Center of Excellence for Rehabilitation Medicine, Brain Center University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands. 7. University Medical Center Groningen, Center for Rehabilitation, University of Groningen, Groningen, the Netherlands.
Abstract
STUDY DESIGN: Cohort study with two measurement occasions. OBJECTIVES: To investigate change in environmental barriers experienced by people living with spinal cord injury (SCI) over a 5-year period. SETTING: Community, Switzerland. METHODS: Data were from the Swiss spinal cord injury (SwiSCI) survey. Main outcome measure was the Nottwil Environmental Factors Inventory-Short Form. Random-effects Poisson regression featuring between-within estimation was used to examine predictors of the number of environmental barriers and of its change over time. RESULTS: One thousand five hundred and forty-nine persons participated in Survey 2012 and 1530 participated in Survey 2017; 761 participated in both surveys. In both surveys most participants reported at least three barriers. Leading issues were unfavorable climate, inaccessibility of buildings and public spaces, and lack of or insufficiently adapted means of transportation. Reporting of barriers related to climate, finances, and state services declined over time. Between subjects, having more health problems, lesser physical independence, poorer mental health, and a lower household income were related to a higher number of barriers experienced. Within subjects, improvements in income, physical independence, and mental health over time were related to a reduction in barriers. CONCLUSIONS: Inaccessibility of buildings and places and problems with transportation remained major barriers over a 5-year period and should be priorities of Swiss disability policy. People with reduced mental and physical health, and those with lower income are vulnerable groups deserving specific attention. Policies targeting income and life-long rehabilitation targeting health promotion and maintenance may be suitable means to reduce the experience of environmental barriers.
STUDY DESIGN: Cohort study with two measurement occasions. OBJECTIVES: To investigate change in environmental barriers experienced by people living with spinal cord injury (SCI) over a 5-year period. SETTING: Community, Switzerland. METHODS: Data were from the Swiss spinal cord injury (SwiSCI) survey. Main outcome measure was the Nottwil Environmental Factors Inventory-Short Form. Random-effects Poisson regression featuring between-within estimation was used to examine predictors of the number of environmental barriers and of its change over time. RESULTS: One thousand five hundred and forty-nine persons participated in Survey 2012 and 1530 participated in Survey 2017; 761 participated in both surveys. In both surveys most participants reported at least three barriers. Leading issues were unfavorable climate, inaccessibility of buildings and public spaces, and lack of or insufficiently adapted means of transportation. Reporting of barriers related to climate, finances, and state services declined over time. Between subjects, having more health problems, lesser physical independence, poorer mental health, and a lower household income were related to a higher number of barriers experienced. Within subjects, improvements in income, physical independence, and mental health over time were related to a reduction in barriers. CONCLUSIONS: Inaccessibility of buildings and places and problems with transportation remained major barriers over a 5-year period and should be priorities of Swiss disability policy. People with reduced mental and physical health, and those with lower income are vulnerable groups deserving specific attention. Policies targeting income and life-long rehabilitation targeting health promotion and maintenance may be suitable means to reduce the experience of environmental barriers.