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Title: Environmental barriers and participation restrictions in community-dwelling individuals with spinal cord injury in Jiangsu and Sichuan provinces of China : results from a cross-sectional survey
Authors: Yang, Y
Gong, Z
Reinhardt, JD 
Xu, G
Xu, Z
Li, J
Issue Date: 2021
Source: Journal of spinal cord medicine, 2021, Ahead-of-print,
Abstract: Objective: (1) to describe environmental barriers and participation restrictions experienced by people with spinal cord injury (SCI) from China, (2) to examine associations between lesion characteristics and participation restrictions, considering a mediating role of environmental barriers, (3) to identify those environmental barriers that have the largest influence on participation.
Design: Cross-sectional study. This study is part of the International Spinal Cord Injury Survey (InSCI).
Setting: Community, Jiangsu and Sichuan Province, China.
Participants: 1355 persons with SCI.
Interventions: Not applicable.
Outcome Measures: Participation restrictions were measured with items from the Model Disability Survey, Environmental Barriers were measured with the Nottwil Environmental Factors Inventory-Short Form.
Results: Participants experienced a median of five (IQR 1-9) environmental barriers and five (IQR 0-9) participation restrictions. Environmental barriers were mainly reported in relation to climate, insufficient resources and accessibility, and participation restrictions mainly occurred in using public transportation, taking care of others, and getting to places. In an adjusted zero-inflated Poisson model, people with more severe injuries reported a greater number of environmental barriers (complete injury: IRR = 1.31, 95%CI = [1.24,1.38]) and participation restrictions (tetraplegia: IRR = 1.15, 95%CI = [1.10,1.21]; complete injury: IRR = 1.25, 95%CI = [1.18,1.31]). Moreover, environmental barriers (IRR = 1.07, 95%CI = [1.06,1.08]) were a significant predictor of participation restrictions and partially mediated the association of lesion completeness with participation restrictions. Barriers related to accessibility of public places (IRR = 1.47, 95%CI = [1.33,1.62]), accessing homes (IRR = 1.32, 95%CI = [1.21,1.44]), long distance transportation (IRR = 1.11, 95%CI = [1.04,1.20]), communication devices (IRR = 1.07, 95%CI = [1.01,1.15]) and state services (IRR = 1.10, 95%CI = [1.02,1.19]) had the greatest negative impact on participation.
Conclusion: Social participation of people with SCI is seriously restricted in China. Removing environmental barriers will be an important element of programs to address this problem.
Keywords: Community survey
Environmental barriers
Spinal cord injury
Publisher: American Paraplegia Society
Journal: Journal of spinal cord medicine 
ISSN: 1079-0268
EISSN: 2045-7723
DOI: 10.1080/10790268.2021.1935094
Rights: © 2021 The Author(s). Published with license by Taylor & Francis Group, LLC This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
The following publication Yang, Y., Gong, Z., Reinhardt, J. D., Xu, G., Xu, Z., & Li, J. (2021). Environmental barriers and participation restrictions in community-dwelling individuals with spinal cord injury in Jiangsu and Sichuan Provinces of China: Results from a cross-sectional survey. The Journal of Spinal Cord Medicine, 1-14 is available at
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