Perceived environmental barriers for people with spinal cord injury and their influence on quality of life.

Environmental barriers are a broad category of factors that often limit people with disabilities from fully participating in their daily lives—especially for those with spinal cord injuries (SCI), which can overwhelmingly affect mobility. While high-income countries have greater access to medical care and see higher survival rates, SCI is still understood to be an individual challenge against societal hurdles that impede a person’s independence. The most typically cited obstacles are inaccessibility to both public and private spaces, limitations due to lack of supportive assistance, restricted and limited transportation options, and attitudes of surrounding people (e.g., prejudice), all of which negatively impact quality of life.

Research into these factors is important, as many of them can be addressed and improved with direct government intervention and social policies. To determine priority issues, a research team administered questionnaires to 1,479 people with SCI between March and December of 2017. Hoping to ascertain the influence of environmental barriers on quality of life, the survey had participants rank the frequency of perceived environmental barriers, split into four categories: infrastructure, attitudes, equipment, and climate. Respondents reported that:

• Infrastructure was the most common barrier. Inaccessibility to homes of family and friends and inadequate access to public spaces were ranked first and third most frequent, respectively.
• The second most common barrier was climate, such as unfavorable weather conditions that impacted travel or negatively affected SCI symptoms.
• Other barriers included lack of both long- and short-term transportation aids (such as stair lifts, walkers, or wheelchairs), financial situations (such as lack of money or government support), lack of equipment (such as lack of writing devices and computers), and social attitudes towards people with SCI (such as negative perceptions from family and friends).
• Those with greater care (such as living with a partner or family, or being in follow-up programs) perceived more barriers, as they were more socially integrated and had more opportunities to come in contact with restrictions.
• Quality of life was directly impacted by the perception of barriers.

Because most of these barriers are man-made and largely the result of a disability-exclusive social landscape, targeted political action and campaigns towards wider accessibility can help dismantle obstacles that may be invisible to people without disabilities. Such efforts would widen the scope of independence not only for SCI patients, but all people with disabilities, directly improving their quality of life. Critically, disabled voices must remain at the forefront of these efforts to ensure that policies reflect actual needs and priorities within the disabled community.

Bökel A, Dierks M, Gutenbrunner C, et al. Perceived environmental barriers for people with spinal cord injury in Germany and their influence on quality of life. Journal of Rehabilitation Medicine. (July 2020).