Investigating the impact of pain and environmental barriers on participation

The ultimate goal of disability legislation, rehabilitation programs, research, and consumers is full participation. As such, it is central to the ecological theory of disability, which describes participation as the interaction between person and environmental factors. Our research was designed to increase understanding of how personal factors like pain interact with environmental barriers like physical accessibility to influence community participation in adults with mobility and sensory impairments living in the community. We will report on baseline findings from a population-based longitudinal study of working age adults (n = 301) who experience both disability and pain conditions. We will present regression models that explore participation (measured in times of activities per week) as a function of person (such as disability type, pain level, and pain coping style) and environmental (such as transportation access and barriers in the community) factors. Preliminary results indicate that factors like average pain levels, pain coping style, and barriers in the community account for 12% of the variance in participation after controlling for disability type. We will also describe the development of an ecological momentary assessment (EMA) measure of participation that provides a more dynamic picture of causal factors. Using EMA methods, participants complete multiple data points about pain, barriers, and participation as they occur, across time and situations. Our hope is that EMA methods will better assist researchers and practitioners in evaluating the dynamic interplay of personal and environmental factors, leading to improved participation interventions, including medical rehabilitation, vocational rehabilitation, and independent living.