Measuring Environmental Factors: Unique and Overlapping International Classification of Functioning, Disability and Health Coverage of 5 Instruments

Arch Phys Med Rehabil. 2016 Dec;97(12):2113-2122. doi: 10.1016/j.apmr.2016.05.021. Epub 2016 Jun 23.

Abstract

Objectives: To describe the unique and overlapping content of the newly developed Environmental Factors Item Banks (EFIB) and 7 legacy environmental factor instruments, and to evaluate the EFIB's construct validity by examining associations with legacy instruments.

Design: Cross-sectional, observational cohort.

Setting: Community.

Participants: A sample of community-dwelling adults with stroke, spinal cord injury, and traumatic brain injury (N=568).

Interventions: None.

Main outcome measures: EFIB covering domains of the built and natural environment; systems, services, and policies; social environment; and access to information and technology; the Craig Hospital Inventory of Environmental Factors (CHIEF) short form; the Facilitators and Barriers Survey/Mobility (FABS/M) short form; the Home and Community Environment Instrument (HACE); the Measure of the Quality of the Environment (MQE) short form; and 3 of the Patient Reported Outcomes Measurement Information System's (PROMIS) Quality of Social Support measures.

Results: The EFIB and legacy instruments assess most of the International Classification of Functioning, Disability and Health (ICF) environmental factors chapters, including chapter 1 (products and technology; 75 items corresponding to 11 codes), chapter 2 (natural environment and human-made changes; 31 items corresponding to 7 codes), chapter 3 (support and relationships; 74 items corresponding to 7 codes), chapter 4 (attitudes; 83 items corresponding to 8 codes), and chapter 5 (services, systems, and policies; 72 items corresponding to 16 codes). Construct validity is provided by moderate correlations between EFIB measures and the CHIEF, MQE barriers, HACE technology mobility, FABS/M community built features, and PROMIS item banks and by small correlations with other legacy instruments. Only 5 of the 66 legacy instrument correlation coefficients are moderate, suggesting they measure unique aspects of the environment, whereas all intra-EFIB correlations were at least moderate.

Conclusions: The EFIB measures provide a brief and focused assessment of ICF environmental factor chapters. The pattern of correlations with legacy instruments provides initial evidence of construct validity.

Keywords: Attitude; Environment; Rehabilitation.

Publication types

  • Observational Study
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Brain Injuries / psychology
  • Brain Injuries / rehabilitation
  • Community Health Services / organization & administration*
  • Community Health Services / standards
  • Cross-Sectional Studies
  • Disabled Persons / psychology*
  • Disabled Persons / rehabilitation*
  • Environment*
  • Female
  • Humans
  • International Classification of Functioning, Disability and Health / organization & administration*
  • International Classification of Functioning, Disability and Health / standards
  • Male
  • Middle Aged
  • Psychometrics
  • Quality of Life
  • Social Environment
  • Social Work / organization & administration*
  • Social Work / standards
  • Socioeconomic Factors
  • Spinal Cord Injuries / psychology
  • Spinal Cord Injuries / rehabilitation
  • Stroke Rehabilitation / psychology