An in-depth understanding of the impact of the environment on participation among people with spinal cord injury

To identify environmental factors associated with participation and gain an in-depth understanding of relationships between environmental factors and participation among people with spinal cord injury.Six focus groups (n= 30) with individuals with spinal cord injury were conducted. Two independent coders thematically analyzed the transcribed data.Twenty environmental factors were identified, all of which were classified into eight categories: built environment; natural environment; assistive technology; transportation; information and technology access; economics; social support and social attitudes; and systems, services and policies. While all factors had direct impacts on individuals' participation outcomes, factors within the categories of societal attitudes, policies and economics also affected participation through affecting other environmental factors. Some factors together also showed cumulative or countering effects on participation. Accordingly, a conceptual model of the relationships between environmental factors and participation was constructed.This study highlighted key environmental factors and their impacts on participation of people with spinal cord injury. The findings support previous research findings but also suggest that different factors may have different levels of impact on participation. Based on our findings, rehabilitation practitioners and policymakers can prioritize intervention plans to optimize the environment for people with spinal cord injury and improve their societal participation. Implications for rehabilitation Environmental factors are critical contributors to participation among people with spinal cord injury (SCI) and need to be addressed in rehabilitation programs. Factors with broader impacts on participation, such as societal attitudes and policies, should be treated as priorities in intervention plans aimed at improving participation among people with SCI. Rehabilitation practitioners should not only consider how the community supports people with SCI but also consider how rehabilitation programs change the community.