title: Environmental factors item development for persons with stroke, traumatic brain injury, and spinal cord injury.
abstract: OBJECTIVE
  To describe methods used in operationalizing environmental factors; to describe the results of a research project to develop measures of environmental factors that affect participation; and to define an initial item set of facilitators and barriers to participation after stroke, traumatic brain injury, and spinal cord injury.
  
  
  METHODS
  Instrument development included an extensive literature review, item classification and selection, item writing, and cognitive testing following the approach of the Patient-Reported Outcomes Measurement Information System.
  
  
  METHODS
  Community.
  
  
  METHODS
  Content area and outcome measurement experts (n=10) contributed to instrument development; individuals (n=200) with the target conditions participated in focus groups and in cognitive testing (n=15).
  
  
  METHODS
  None.
  
  
  METHODS
  Environmental factor items were categorized in 6 domains: assistive technology; built and natural environment; social environment; services, systems, and policies; access to information and technology; and economic quality of life.
  
  
  RESULTS
  We binned 2273 items across the 6 domains, winnowed this pool to 291 items for cognitive testing, and recommended 274 items for pilot data collection.
  
  
  CONCLUSIONS
  Five of the 6 domains correspond closely to the International Classification of Functioning, Disability and Health taxonomy of environmental factors; the sixth domain, economic quality of life, reflects an important construct that reflects financial resources that affect participation. Testing with a new and larger sample is underway to evaluate reliability, validity, and sensitivity.
authors.affiliation: Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address: a-heinemann@northwestern.edu.
authors.forename: Allen W
authors.initials: AW
authors.lastname: Heinemann
authors.affiliation: Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL.
authors.forename: Susan
authors.initials: S
authors.lastname: Magasi
authors.affiliation: Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL; Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL.
authors.forename: Joy
authors.initials: J
authors.lastname: Hammel
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
authors.forename: Noelle E
authors.initials: NE
authors.lastname: Carlozzi
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Sofia F
authors.initials: SF
authors.lastname: Garcia
authors.affiliation: Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hahn
authors.affiliation: Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Jin-Shei
authors.initials: JS
authors.lastname: Lai
authors.affiliation: Departments of Rehabilitation Medicine, Orthopedic Surgery, and General Medicine, Langone Medical Center Ambulatory Care Center, New York University, New York, NY; Kessler Foundation, West Orange, NJ.
authors.forename: David
authors.initials: D
authors.lastname: Tulsky
authors.affiliation: Program in Occupational Therapy, Washington University, St Louis, MO.
authors.forename: David B
authors.initials: DB
authors.lastname: Gray
authors.affiliation: Program in Occupational Therapy, Washington University, St Louis, MO.
authors.forename: Holly
authors.initials: H
authors.lastname: Hollingsworth
authors.affiliation: Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL.
authors.forename: Sara
authors.initials: S
authors.lastname: Jerousek
mesh_terms: D001930:Brain Injuries / Q000523:psychology* / Q000534:rehabilitation; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology* / Q000534:rehabilitation; D004777:Environment; D017144:Focus Groups; D006801:Humans; D064702:International Classification of Functioning, Disability and Health; D057766:Policy; D011594:Psychometrics; D011788:Quality of Life; D015203:Reproducibility of Results; D012931:Social Environment; D013119:Spinal Cord Injuries / Q000523:psychology* / Q000534:rehabilitation; D020521:Stroke / Q000523:psychology*; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires
keywords: Environment; Qualitative research; Questionnaires; Rehabilitation