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Using the ICF’s environmental factors framework to develop an item bank measuring built and natural environmental features affecting persons with disabilities

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Abstract

Objectives

To develop a measure of natural environment and human-made change features (Chapter 2 of the international classification of functioning, disability, and health) and evaluate the influence of perceived barriers on health-related quality of life.

Methods

A sample of 570 adults with stroke, spinal cord injury, and traumatic brain injury residing in community settings reported their functioning in home, outdoor, and community settings (mean age = 47.0 years, SD = 16.1). They rated 18 items with a 5-point rating scale to describe the influence of barriers to moving around, seeing objects, hearing sounds, hearing conversations, feeling safe, and regulating temperature and indicated whether any difficulties were due to environmental features. We used Rasch analysis to identify misfitting items and evaluate differential item functioning (DIF) across impairment groups. We computed correlations between barriers and patient-reported outcomes measurement information system (PROMIS) social domain measures and community participation indicators (CPI) measures.

Results

The 18 items demonstrated person reliability of .70, discriminating nearly three levels of barriers. All items fit the Rasch model; impairment-related DIF was negligible. Ceiling effects were negligible, but 25 % of the respondents were at the floor, indicating that they did not experience barriers that they attributed to the built and natural environment. As anticipated, barriers correlated moderately with PROMIS and CPI variables, suggesting that although this new item bank measures a construct that is related to participation and health-related quality of life, it also captures something unique. Known-groups validity was supported by wheelchair users reporting a higher level of barriers than did ambulatory respondents.

Conclusions

Preliminary evidence supports the reliability and validity of this new measure of barriers to the built and natural environment. This measure allows investigators and clinicians to measure perceptions of the natural environment and human-made changes, providing information that can guide interventions to reduce barriers. Moderate relationships between barriers and PROMIS and CPI variables provide support for the measurement and theory of environmental influences on social health and participation.

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Funding

This study was funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (H133B090024) through a Rehabilitation Research and Training Center on Improving Measurement of Medical Rehabilitation Outcomes grant awarded to the Rehabilitation Institute of Chicago. The National Institute on Disability, Independent Living, and Rehabilitation Research (H133F140037) and Craig H. Neilsen Foundation (290474) supported a portion of Alex Wong’s effort.

Author information

Authors and Affiliations

  1. Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL, USA

    Allen W. Heinemann, Sara Jerousek, Patrick Semik & Ana Miskovic

  2. Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 345 E. Superior St., Chicago, IL, 60611, USA

    Allen W. Heinemann

  3. Department of Medical Social Sciences, Northwestern University, 633 N St Clair, 19th Floor, Chicago, IL, 60611, USA

    Jin-Shei Lai

  4. Program in Occupational Therapy, Department of Neurology, Washington University School of Medicine, 4444 Forest Park Ave, Campus Box 8505, St. Louis, MO, 63108, USA

    Alex Wong, Jessica Dashner & David B. Gray

  5. Department of Occupational Therapy, University of Illinois at Chicago, 1919 W. Taylor St., Room 327, Chicago, IL, 60612, USA

    Susan Magasi

  6. Department of Medical Social Sciences, Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Elizabeth A. Hahn

  7. Physical Medicine and Rehabilitation, Center for Clinical Outcomes, Development and Application (CODA), University of Michigan Health System, Ann Arbor, MI, USA

    Noelle E. Carlozzi

  8. North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 48109-2800, USA

    Noelle E. Carlozzi

  9. College of Health Sciences, Center for Assessment Research and Translation, University of Delaware, Newark, DE, USA

    David S. Tulsky

  10. Departments of Physical Therapy, University of Delaware, Newark, DE, USA

    David S. Tulsky

  11. Psychological and Brain Sciences, University of Delaware, Newark, DE, USA

    David S. Tulsky

  12. Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA

    David S. Tulsky

Authors
  1. Allen W. Heinemann
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  2. Jin-Shei Lai
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  3. Alex Wong
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  4. Jessica Dashner
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  5. Susan Magasi
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  6. Elizabeth A. Hahn
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  7. Noelle E. Carlozzi
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  8. David S. Tulsky
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  9. Sara Jerousek
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  10. Patrick Semik
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  11. Ana Miskovic
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  12. David B. Gray
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Corresponding author

Correspondence to Allen W. Heinemann.

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The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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All participants included in the study provided informed consent.

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Heinemann, A.W., Lai, JS., Wong, A. et al. Using the ICF’s environmental factors framework to develop an item bank measuring built and natural environmental features affecting persons with disabilities. Qual Life Res 25, 2775–2786 (2016). https://doi.org/10.1007/s11136-016-1314-6

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  • DOI: https://doi.org/10.1007/s11136-016-1314-6

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