title: Environmental barriers and subjective health among people with chronic spinal cord injury: A cohort study.
abstract: OBJECTIVE
  Although previous studies have found environmental barriers to be associated with social participation and life satisfaction after spinal cord injury (SCI), few studies exist reporting their effects on subjective health after SCI. Our purpose was to identify the prevalence of perceived environmental barriers and their effects on subjective health in persons with chronic SCI who completed two repeated measurements during a 5-year longitudinal study.
  
  
  METHODS
  This is a prospective cohort study. Environmental barriers were measured at baseline by the Craig Hospital Inventory of Environmental Factors-Short Form. Subjective health was measured at baseline and 5-year follow-up by days of physical and mental health not good. Other control variables included sex, race, age at injury, years since injury, and injury severity at baseline.
  
  
  METHODS
  Data were collected at a specialty hospital and analyzed at a medical university in the Southeastern USA.
  
  
  METHODS
  A total of 1635 participants completed both baseline and follow-up surveys.
  
  
  RESULTS
  Twenty per cent of participants reported at least one policy barrier, 46% at least one physical and structural barrier, 22% at least one attitudinal and support barrier, 26% at least one barrier to services and assistance, and 13% at least one barrier at work or school. After controlling for sex, race, age at injury, years since injury, and injury severity, the physical and structural barriers, and services and assistance barriers measured at baseline significantly predicted subjective physical and mental health measured at follow-up.
  
  
  CONCLUSIONS
  Environmental barriers are prevalent among people with chronic SCI. They are important predictors for future subjective health.
authors.forename: Yue
authors.initials: Y
authors.lastname: Cao
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Walker
authors.forename: James S
authors.initials: JS
authors.lastname: Krause
mesh_terms: D000328:Adult; D000367:Age Factors; D002908:Chronic Disease; D015331:Cohort Studies; D062309:Community Integration; D004780:Environment, Controlled; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012737:Sex Factors; D013119:Spinal Cord Injuries / Q000523:psychology / Q000534:rehabilitation*; D011795:Surveys and Questionnaires
keywords: Environment; Health; Spinal cord injuries