Environmental barriers and participation restrictions in community-dwelling individuals with spinal cord injury in Jiangsu and Sichuan Provinces of China: Results from a cross-sectional survey

Figures & data

Figure 1 Model illustrating research hypotheses.

Note: “+” represents positive association.

Table 1 Characteristics of participants (N = 1355).

Categorical variables		Frequency	Percentage
Sex	Male	963	71.07
	Female	392	28.93
Ethnic group	Majority (Han)	1317	97.20
	Minority	38	2.80
Marital status	Married	1138	83.99
	Else	217	16.01
Education level	Primary or below	392	28.93
	Lower secondary	473	34.91
	Higher secondary	282	20.81
	Post-secondary	109	8.04
	Bachelor or above	99	7.31
Living alone	Yes	79	5.83
	No	1276	94.17
Type of injury	Paraplegia	907	66.94
	Tetraplegia	448	33.06
Degree of injury	Complete	345	25.46
	Incomplete	1010	74.54
Continuous variables	Min	P25	Median	P75	Max
Age-(>16^&)	17	41	50	59	91
Household income (1–10^&)	1	2	4	5	10
Subjective social status (1–10^&)	1	2	4	5	10
Time since injury in years (>3 months^&) -	0	2	4	5	54
Participation restrictions (0–12^&)	0	0	5	9	12
Environmental barriers (0–14^&)	0	1	5	9	14

Note: ^&Range of possible values. Frequency and percentage are reported for categorical variables, while minimum, maximum, median, upper quartile(P25), and lower quartile(P75) values are reported for continuous variables.

Figure 2 Prevalence of perceiving environmental barriers (N = 1355).

Note: Blue and red bars indicate percentages, numbers inside bars indicate frequencies.

Figure 3 Prevalence of experiencing participation restrictions (N = 1355).

Note: Blue and red bars indicate percentages, numbers inside bars indicate frequencies.

Table 2 Four Steps Mediation Test based on ZIP Regressions (N = 1355).

Predictors	Step 1			Step 2			Step 3 and 4
	Participation restrictions by SCI characteristics			Environmental barriers by SCI characteristics			Participation restrictions by SCI characteristics and environmental barriers
Count portion	Model 1 (IRR with 95% CI)	Model 2 (IRR with 95% CI)	Model 3^‡ (IRR with 95% CI)	Model 4 (IRR with 95% CI)	Model 5 (IRR with 95% CI)	Model 6^‡ (IRR with 95% CI)	Model 7 (IRR with 95% CI)	Model 8^‡ (IRR with 95% CI)
Type of injury: Tetraplegia (Paraplegia as reference)	1.10*** [1.05,1.16]		1.15*** [1.10,1.21]	0.92** [0.88,0.97]		0.97 [0.92,1.02]	1.17*** [1.12,1.23]	1.15*** [1.10,1.21]
Degree of injury: Complete (Incomplete as reference)		1.47*** [1.40,1.54]	1.42*** [1.35,1.50]		1.38*** [1.32,1.45]	1.31*** [1.24,1.38]	1.25*** [1.19,1.31]	1.25*** [1.18,1.31]
Environmental barriers							1.08*** [1.08,1.09]	1.07*** [1.06,1.08]
Intercept	6.14*** [5.97,6.32]	5.59*** [5.43,5.76]	7.05*** [6.14,8.11]	6.84*** [6.65,7.03]	5.97*** [5.80,6.15]	10.24*** [8.92,11.76]	3.25*** [3.09,3.42]	3.74*** [3.22,4.35]
Inflated portion^&	Model 1 (OR with 95% CI)	Model 2 (OR with 95% CI)	Model 3^‡ (OR with 95% CI)	Model 4 (OR with 95% CI)	Model 5 (OR with 95% CI)	Model 6^‡ (OR with 95% CI)	Model 7 (OR with 95% CI)	Model 8^‡ (OR with 95% CI)
Type of injury: Tetraplegia (Paraplegia as reference)	1.36 [0.99,1.86]		1.05 [0.75,1.48]	1.09 [0.81,1.45]		0.82 [0.59,1.14]	1.13 [0.79,1.62]	1.06 [0.72,1.54]
Degree of injury: Complete (Incomplete as reference)		0.13*** [0.07,0.25]	0.19*** [0.09,0.39]		0.14*** [0.08,0.24]	0.22*** [0.12,0.41]	0.32** [0.16,0.66]	0.36* [0.16,0.79]
Environmental barriers							0.74*** [0.69,0.79]	0.71*** [0.66,0.77]
Intercept	0.15*** [0.12,0.18]	0.22*** [0.19,0.26]	0.03*** [0.01,0.09]	0.22*** [0.19,0.26]	0.30*** [0.26,0.35]	0.05*** [0.02,0.15]	0.51*** [0.39,0.67]	0.17* [0.04,0.66]

Note: CI, Confidence Interval, IRR Incidence Rate Ratio, OR Odds Ratio, ^&Predicted is the probability of reporting zero restrictions/barriers. ^‡Models 3, 6 and 8, were adjusted for the following co-variates: sex, age, ethnic group, being married, living alone, education, household income, subjective social status, years since SCI, and province; Incidence-rate ratios and odds ratios are reported for the count portion and the inflated portion, respectively; 95% confidence intervals are given in brackets; * p < 0.05, ** p < 0.01, *** p < 0.001.

Table 3 ZIP regression of Number of Participation Restrictions on Lesion Characteristics and Specific Environmental Barriers (N = 1348).

Predictors	Participation restrictions
	Unadjusted		Adjusted^ǂ
	Count portion (IRR with 95% CI)	Inflated portion^& (OR with 95% CI)	Count portion (IRR with 95% CI)	Inflated portion^& (OR with 95% CI)
Type of injury (Paraplegia as reference)	1.20*** [1.14,1.26]	1.05 [0.71,1.54]	1.17*** [1.12,1.24]	0.94 [0.62,1.43]
Degree of injury (Incomplete as reference)	1.19*** [1.13,1.26]	0.33** [0.15,0.72]	1.20*** [1.14,1.26]	0.38* [0.15,0.92]
Environmental barriers
Access public	1.53*** [1.38,1.68]	0.30** [0.12,0.74]	1.47*** [1.33,1.62]	0.25** [0.09,0.67]
Access homes	1.28*** [1.17,1.40]	0.92 [0.36,2.37]	1.32*** [1.21,1.44]	0.91 [0.32,2.62]
Climate	0.96 [0.91,1.02]	1.23 [0.81,1.86]	0.93* [0.88,0.99]	1.26 [0.77,2.06]
Attitudes of society	1.03 [0.96,1.10]	0.43 [0.18,1.01]	1.06 [0.99,1.13]	0.39 [0.14,1.10]
Attitudes of family members	1.07 [0.99,1.16]	0.75 [0.19,2.95]	1.06 [0.98,1.15]	0.72 [0.13,3.83]
Attitudes of friends	1.06 [0.95,1.18]	0.50 [0.10,2.44]	1.03 [0.92,1.14]	0.30 [0.04,2.12]
Attitudes of colleagues, neighbors or acquaintances	1.04 [0.94,1.14]	4.29* [1.18,15.50]	1.03 [0.94,1.14]	6.11* [1.44,25.91]
Short transportation	1.01 [0.94,1.08]	1.38 [0.60,3.17]	0.98 [0.92,1.05]	1.68 [0.66,4.27]
Long transportation	1.08* [1.01,1.17]	0.43* [0.19,0.95]	1.11** [1.04,1.20]	0.41* [0.17,0.96]
Nursing and assistance services	1.07 [1.00,1.15]	1.05 [0.44,2.51]	1.04 [0.97,1.12]	1.05 [0.40,2.77]
Medical supplies	0.98 [0.91,1.05]	0.41 [0.14,1.14]	1.00 [0.93,1.08]	0.32 [0.10,1.02]
Finances	0.99 [0.91,1.08]	0.83 [0.47,1.44]	0.96 [0.88,1.05]	0.90 [0.46,1.74]
Communication devices	1.12*** [1.05,1.19]	1.11 [0.43,2.88]	1.07* [1.01,1.15]	0.70 [0.21,2.31]
State services	1.13** [1.04,1.22]	0.63 [0.33,1.22]	1.10* [1.02,1.19]	0.59 [0.28,1.27]
Intercept	2.83*** [2.64,3.03]	0.45*** [0.33,0.62]	3.44*** [2.91,4.07]	0.07** [0.01,0.46]

Note: CI, Confidence Interval; IRR Incidence Rate Ratio; OR Odds Ratio. ^ǂThe model was adjusted for the following control variables sex, age, ethnic group, being married, living alone, education, household income, subjective social status, years since SCI, and province. ^&Predicted is the probability of reporting zero restrictions/barriers. Incidence-rate ratios and odds ratios are reported for the count portion and the inflated portion, respectively; 95% confidence intervals are given in brackets; * p < 0.05, ** p < 0.01, *** p < 0.001.