Institute for Disaster Management and Reconstruction, Sichuan University and Hong Kong Polytechnic University, Chengdu, China; Swiss Paraplegic Research, Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
John Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical School, The University of Sydney, Sydney Australia.
Arch Phys Med Rehabil. 2020 Dec;101(12):2144-2156. doi: 10.1016/j.apmr.2020.04.027. Epub 2020 Jun 2.
To investigate the experience of environmental barriers by people with spinal cord injury (SCI) across 22 countries. Specific aims were to describe and compare the prevalence of environmental barriers experienced across countries, and to analyze determinants of environmental barriers at individual and country level.
Cross-sectional community survey.
Individuals (N=12,591) living with SCI in the community.
Not applicable.
Nottwil Environmental Factors Inventory-Short Form.
Most barriers were experienced in relation to accessibility, climate, transportation, finances, and state services. More severe barriers were experienced in settings with lower gross domestic product (GDP), which especially refers to medical supplies (gamma=-0.38; P<.001) and finances (gamma=-0.37; P<.001) in this study. However, in a multivariable negative binomial regression using within-between estimation of the number of barriers experienced on the selected predictors, the effect of GDP was reversed when it was adjusted for covariates. On the individual level, the number of experienced barriers decreased with better mental health and greater self-care ability. People with low income, with paraplegia, complete lesions, and more health problems reported more barriers. On the country level, fewer barriers were reported in countries with higher average age, better mental health, and greater self-care ability, as well as in those with a higher percentage of traumatic SCI, paraplegia, and complete lesions. More barriers were reported in countries with a higher percentage of married individuals, lower average household income, higher average time since injury, higher mean vitality scores, and greater income inequality.
Study participants reported a significant number of environmental barriers, many of which are modifiable. Complementary interventions are recommended. Within and between country effects of covariates sometimes pointed in different directions, suggesting that countries with a different composition of SCI population also differed in environmental contexts.
调查 22 个国家脊髓损伤（SCI）患者的环境障碍体验。具体目的是描述和比较各国经历的环境障碍的流行率，并分析个人和国家层面环境障碍的决定因素。
横断面社区调查。
居住在社区中的 SCI 患者（N=12591）。
无。
诺特威尔环境因素量表-短表。
大多数障碍与无障碍性、气候、交通、财务和国家服务有关。在国内生产总值（GDP）较低的环境中，障碍更为严重，尤其是在医疗用品（γ=-0.38；P<.001）和财务方面（γ=-0.37；P<.001）。然而，在使用所选预测因素的内部-外部估计来评估经历的障碍数量的多变量负二项回归中，当调整协变量时，GDP 的影响被逆转。在个体水平上，随着心理健康状况的改善和自我护理能力的提高，经历的障碍数量减少。收入较低、截瘫、完全损伤和更多健康问题的人报告了更多的障碍。在平均年龄较高、心理健康状况较好、自我护理能力较强的国家，以及创伤性 SCI、截瘫和完全损伤比例较高的国家，报告的障碍较少。在已婚人口比例较高、平均家庭收入较低、平均受伤时间较长、平均活力评分较高和收入不平等程度较大的国家，报告的障碍较多。
研究参与者报告了大量的环境障碍，其中许多是可以改变的。建议采取补充干预措施。协变量的内部和外部效应有时指向不同的方向，这表明 SCI 人群构成不同的国家在环境背景方面也存在差异。
