Wong Alex W K, Ng Sheryl, Dashner Jessica, Baum M Carolyn, Hammel Joy, Magasi Susan, Lai Jin-Shei, Carlozzi Noelle E, Tulsky David S, Miskovic Ana, Goldsmith Arielle, Heinemann Allen W
Program in Occupational Therapy and Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Ave, Campus Box 8505, St. Louis, MO, 63108, USA.
Qual Life Res. 2017 Oct;26(10):2633-2645. doi: 10.1007/s11136-017-1586-5. Epub 2017 Apr 25.
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.
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.
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.
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.
建立并评估创伤性脑损伤（TBI）、中风和脊髓损伤（SCI）患者的环境因素与参与度之间的关系模型，并检验该模型在三个诊断组以及其他人口统计学和临床特征方面是否存在差异。
一项横断面观察性研究纳入了在三个学术医疗中心招募的545名患有神经系统疾病的社区居住成年人（TBI = 166；中风 = 189；SCI = 190）。参与者完成了关于环境因素和参与度的患者报告测量。
最终的结构方程模型与数据拟合良好（CFI = 0.923；TLI = 0.898；RMSEA = 0.085；SRMR = 0.053），解释了社会角色和活动参与度方差的63%。系统、服务和政策对参与度有间接影响，这种关系由社会态度以及建筑和自然环境介导。信息和技术的获取与建筑和自然环境相关，进而影响参与度（p < 0.001）。该模型在性别、诊断、损伤严重程度/类型、教育程度、种族、年龄、婚姻状况、受伤年限、轮椅使用情况、保险覆盖范围、个人或家庭收入以及晶体认知方面保持一致。
社会和物理环境似乎介导了系统、服务和政策对后天性神经系统疾病后参与度的影响。这些关系在三个诊断组以及许多个人和临床因素中是稳定的。我们的研究结果为健康和残疾政策提供了信息，并为实施《健康人民2020》倡议提供了指导，特别是针对后天性神经系统疾病患者。
