The impact of perceived environmental barriers on community integration in persons with traumatic brain injury

Earlier models of disability emphasized the impact of only injury-related factors impeding community integration. However, recent models incorporate the significance of physical and social environment on community integration. This study aimed to identify perceived environmental barriers that impact community integration among an ethnically diverse sample of persons with traumatic brain injury (TBI). A total of 167 patients with medically documented TBI, consecutively admitted to the Neurosurgery Service at a Level I trauma center, participated in this study. Participants completed assessments in their homes at least 6 months post injury. Environmental barriers were assessed using the Craig Hospital Inventory of Environmental Factors - Short Form (CHIEFSF). Community integration was evaluated using the Community Integration Measure (CIM) and the Craig Handicap Assessment and Reporting Technique - Short Form (CHART-SF). After accounting for injury severity, race and pre-injury productivity, MANCOVA results indicated that service/assistance barriers was significantly associated with decreased community integration. Trends were found for physical/structural and attitudinal/support barriers. Multiple regression analyses revealed that physical/structural barriers were associated with decreased independent participation, belonging, and occupation/productivity outcomes. Service/assistance barriers were associated with both decreased independent participation and mobility. Attitudinal/support barriers were associated with increased community mobility. Certain environmental barriers perceived by persons with TBI may negatively impact their reintegration to the community post injury. Identifying such barriers may help develop programs or policies to reduce barriers, while facilitating improved access to health care and other services after injury.