title: Perceived impact of environmental barriers on participation among people living with spinal cord injury in Switzerland.
abstract: OBJECTIVE
  To describe the impact of environmental barriers perceived by people living with spinal cord injury in the Swiss community and to compare this across subpopulations.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  A total of 1,549 participants in the community survey of the Swiss spinal cord injury Cohort study.
  
  
  METHODS
  The perceived impact of environmental barriers on participation was measured with the Nottwil Environmental Factors Inventory Short Form (NEFI-SF). Physical independence was measured with the Spinal Cord Independence Measure Self Report (SCIM-SR). Perceived barriers were compared across people with different demographic and lesion characteristics. Multivariable regression modelling applying fractional polynomials was used to evaluate the overall perceived impact of barriers in relation to demographics, spinal cord injury characteristics, and physical independence.
  
  
  RESULTS
  Most perceived barriers were climatic conditions and inaccessibility of public and private infrastructure. Older participants, those with longer time since injury and participants with complete lesions indicated more problems with access. Females reported more attitudinal barriers. Approximately one-third of participants with complete tetraplegia reported obstacles related to assistance with personal care. A higher level of physical independence was associated with fewer perceived barriers.
  
  
  CONCLUSIONS
  Despite living in a rich country with a well-developed social security system, many people with spinal cord injury in Switzerland experience participation restrictions due to environmental barriers; in particular women, people with non-traumatic spinal cord injury and limited physical independence.
authors.affiliation: Swiss Paraplegic Research, CH-6207 Nottwil, Switzerland. E-mail: jan.reinhardt@paraplegie.ch.
authors.forename: Jan D
authors.initials: JD
authors.lastname: Reinhardt
authors.forename: Carolina
authors.initials: C
authors.lastname: Ballert
authors.forename: Martin W G
authors.initials: MW
authors.lastname: Brinkhof
authors.forename: Marcel W M
authors.initials: MW
authors.lastname: Post
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004779:Environment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D012044:Regression Analysis; D013119:Spinal Cord Injuries / Q000523:psychology* / Q000534:rehabilitation; D011795:Surveys and Questionnaires; D013557:Switzerland