Built environment predictors of participation for physically disabled adults

This study investigates the influence of the built environment on participation among adults aged 17 and older chronically physically disabled from spinal cord injury (SCI). Data are from participants from the New Jersey site (N=504) of the Spinal Cord Injury Model Systems (SCIMS) database, a longitudinal study of persons with traumatic SCI living in the community, surveyed between 2000 and 2012. Participation is measured across four domains—physical independence, mobility, occupational, and social integration—by the Craig Handicap Assessment and Reporting Technique (CHART). Covariates include impairment-related, health status, and background (i.e., socioeconomic and demographic) characteristics as well as assistive technology use and vehicle access. Geographic information systems (GIS) data was used to construct a measure of the land use mix for a 5-mile buffer of the individual's residential location to assess the built environment. Logistic regression models were analyzed for each functional domain. Contrary to expectations, preliminary analysis indicated that persons living in single use (i.e. predominantly residential) communities reported increased odds of physical independence, mobility, and social participation due in part to contingencies between land use type and individual functional differences. Conversely, persons living in communities characterized by mixed land use reported increased odds of occupational participation. Importantly, all analyses indicate that the built environment predicts participation controlling for a range of individual predictors. Overall, these findings provide support for the role of environment in the disabling process and may be used to help target interventions intended to improve social integration for persons with disabilities.