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The Effect of Environmental Barriers on Community Integration for Individuals With Moderate to Severe Traumatic Brain Injury

Fleming, Jennifer PhD; Nalder, Emily PhD; Alves-Stein, Serena BOccThy(Hons); Cornwell, Petrea PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

The Journal of Head Trauma Rehabilitation: March/April 2014 - Volume 29 - Issue 2 - p 125–135
doi: 10.1097/HTR.0b013e318286545d
Original Articles

Objective: To describe environmental barriers endorsed by individuals with traumatic brain injury during the first 6 months after discharge and determine their effect on community integration.

Design: Prospective longitudinal study with data collected at predischarge and at 1, 3, and 6 months postdischarge.

Participants: One hundred thirty-five individuals with a diagnosis of traumatic brain injury discharged from a large metropolitan hospital to a home/community environment.

Measures: Sydney Psychosocial Reintegration Scale; Craig Hospital Inventory of Environmental Factors; and Mayo-Portland Adaptability Inventory-4.

Results: Multiple regression analyses indicated that environmental barriers arising during the transition from hospital to home had a negative association with community integration outcomes. Physical barriers were most commonly endorsed, but attitudinal barriers were significantly correlated with relationship changes.

Conclusion: Environmental barriers should be addressed in rehabilitation and considered in policy development for people with traumatic brain injury. Future research on the measurement of environmental barriers is recommended.

School of Health and Rehabilitation Sciences, The University of Queensland (Drs Fleming and Nalder and Ms Alves-Stein); Centre for Functioning and Health Research, Queensland Health (Dr Fleming); Occupational Therapy Department, Princess Alexandra Hospital (Dr Fleming); Metro North Hospital and Health Service (Dr Cornwell); and Behavioural Basis of Health program, Griffith Health Institute, Griffith University (Dr Cornwell), Brisbane, Queensland, Australia.

Corresponding Author: Jennifer Fleming, PhD, Centre for Functioning and Health Research, Queensland Health, PO Box 6053, Buranda, Brisbane 4102, Queensland, Australia (

This project is supported by an Australian Research Council Linkage grant (LP0776294) and partner organizations, Department of Communities (Disability Services) and Acquired Brain Injury Outreach Service.

The authors thank Drs Michele Foster, Tamara Ownsworth, and Terry Haines, Prof Linda Worrall, and Drs Melissa Kendall and Lesley Chenoweth for their input into the research design and in obtaining grant funding. The authors also thank Mrs Cassandra Shields for assistance with data collection and all participants for the time they invested in this study.

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins