The relationship between the objective measures and subjective reports of the environmental experience for individuals with mobility impairments Jacqueline Webel June 30, 2005

Problem Statement A lack of measures exist to assess the interaction of individuals with mobility impairments and the environment Current measures do not describe how users of different technologies and varying abilities use the environment A gap exists between the objective measures of the built environment and the subjective reports of the individual Current measures assess the capacity of the individual – what he or she “can do” and not what the individual actually does in context

Theoretical Basis ICIDH-2 influence of the social and built environment on participation attempt to distinguish what people could do from what they actually do ICF clarify the concepts and coding and better integrate environmental factors into the classification system the physical, social and attitudinal features of the environment either hinder or facilitate participation “management of the problem requires social action, and it is the collective responsibility of society at large to make the environmental modifications necessary for the full participation of people with disabilities in all areas of social life.”

Disability Model created the concept that disability is synonymous with functional status falls short of considering the context in which function is measured Glass – Tenses of Function “Enacted function, whether physical, cognitive, emotional or social, refers to the end result of the confluence of situational and ecological factors which shape the moment to moment performance of functional tasks in the real world” Current assessments do not support the concepts set forth through theory Theoretical Basis

Approaches to Assessment Current assessments do not lend to values that correspond to functioning and participation as they are conceptualized according to the ICF framework Many assessments are unable to measure participation due to a design that does not incorporate context

“Tenses of Functioning” Three “tenses” of functioning: hypothetical (capacity), experimental (capability), and enacted (performance). The lack of distinction between the three tenses has led to the development of measures that inaccurately assess function, and do not consider the importance of the outcome of participation of individuals in various contexts

Review of Measures Perenboom and Chorus (2003) Studied nine assessments to determine fit with the domains of the ICF Perceived Handicap Questionnaire and London Handicap Scale found to have best fit, but both of these assessments measure the “can do” and not the “do do”

Review of Measures Whiteneck (2004) Craig Hospital Inventory of Environmental Factors (CHIEF) Measures barriers and not facilitators Need to understand and capitalize on supportive features in the environment to minimize the expression of disability

Review of Measures Noreau et al (2004) Assessment of Life Habits (LIFE-H) Quality of social participation  Degree of accomplishment, assistance needed, satisfaction with the accomplishment Claimed to be valuable for assessments measuring participation according to the ICF, but no study to support claim

Review of Measures Gray et al, (in review) PARTS/M to assess psychometric properties of participation among individuals with mobility impairments Movement from the “can do” to the “do do” tense of measuring participation

Specific Aims Administration of the CHEC to understand the objective features of the built environment Administration of the CPPRS to assess perceived experience of environmental interaction Development of a new measure to describe the relationship between the environment and the perceived experience.