Craig Hospital Inventory of Environmental Factors

Community Dwelling Elderly Adults With and Without Stoke: (Han et al, 2005; n = 400; mean age = 71.5 (5.03); mean Barthel Index score for participants with stroke = 19.9 (0.099) points; Barthel Index score for participants without stroke = 16.5 (3.93) South Korean Sample) 

• Mean total scores (Korean language sample) = 13.0 (14.77) 

Chronic and Acute SCI: (Kennedy et al, 2009; n = 80, 10% complete tetraplegia, 29% incomplete tetraplegia; 21% complete paraplegia, 29% incomplete paraplegia; mean age = 50.37 (range = 18 to 81) years)  

Results suggested that environmental barriers did not seem to have a large impact on activities (for this sample)

Mean scores (SD) by domain:

• Attitudes and Support = 0.51 (1.14)
• Services and Assistance = 1.44 (1.85)
• Physical and Structural = 2.24 (2.27)
• Policies = 0.86 (1.76)
• Work and School = 0.18 (0.56)

Children and Youth with Physical Disabilities: (Law et al, 2007; n = 427; aged 6 to 14 years; 50.8% with CP or related disorder)

• 3 age cohorts: 6-8; 9-11; 12-14 yo
  • Children aged 12 to 14 experienced significantly more barriers than children in other cohorts

CHIEF Norms for Children with Disabilities:

Domain

Total

6 to 8 years

9 to 11 years

12 to 14 years

Services and assistance*

1.02 (1.20)

0.86 (1.14)

0.97 (1.14)

1.25 (1.32)

Attitudes*

0.88 (1.18)

0.65 (1.04)

0.83 (1.14)

1.16 (1.30)

School and work*

1.55 (1.88)

1.31 (1.67)

1.47 (1.66)

1.90 (2.30)

Natural and built environment†

1.31 (1.35)

1.11 (1.30)

1.25 (1.28)

1.59 (1.46)

Policies*

1.24 (1.71)

1.08 (1.64)

1.18 (1.60)

1.48 (1.90)

Values = Mean (SD)

*Significant means for the 12 to 14 group in comparison with all groups (p<.05).
†Significant means for the 12 to 14 group in comparison with 6 to 8 year olds (p<.001).

SCI and TBI : (Quoted from Whiteneck, Meade, et al, 2004; n = 103; 2 weeks between assessments)

• Excellent CHIEF total score test-retest reliability (ICC > 0.90)
• Excellent sub-scale test-retest reliability (ICC's ranged from 0.77 to 0.89)

Multiple Diagnosis (Spinal Cord Injury, Traumatic Brain Injury, Multiple Sclerosis, Amputee, Cerebral Palsy, Auditory/Visual impairments, Developmental Disabilities): (Whiteneck, Harrison-Felix, et al, 2004; n=125 (SCI=46; TBI=54; Others=25); 2 weeks between assessments; CHIEF long form was used in this study) 

• Subject-Proxy Agreement (family members/friends of the 125 participants: Adequate total score test retest reliability (ICC=.62)

SCI, TBI, MS, Amputation, or "other" impairment: (Whiteneck, Harrison-Felix et al, 2004; 2 samples n = 97 (50 with disabilities and 40 without disabilities), n= 409 with disabilities; mean age = 44)

Internal Consistency (Cronbach's alpha)

Scale:

Strength

alpha

Total scale

Excellent

0.93

Physical and structural barriers subscale

Adequate

0.77

Policy barriers subscale

Adequate

0.77

Work and school barriers subscale

Excellent

0.81

Attitude and support barriers subscale

Adequate

0.79

Services and assistance barriers subscale

Adequate

0.76

Discriminant Validity 

Multiple Diagnosis: (Whiteneck, Harrison-Felix, et al, 2004; n=409 (SCI=124; TBI=120; Multiple Sclerosis=55; Amputees=35; Auditory/Visual Impairments, developmental disabilities, cerebral palsy, multiple impairments=75 ) 

• All CHIEF items, all subscales, and the total score produced statistically significant differences across the impairment groups
• People with disabilities consistently reported an overall higher level of environmental barriers on all subscales and the total CHIEF score
• People with severe disabilities in the disability sample (eg, those with SCI, TBI) generally scored higher on subscales and the total score than the full range of people reporting any disability in the BRFSS sample
• People with TBI scored lower on physical barriers than those in the other 2 major disability groups (SCI, other diagnoses)
• People with SCI reported more barriers related to personal equipment, but attitudes in the home were more problematic for people with TBI 

Multiple Diagnosis and population-based sample: (Whiteneck, Harrison-Felix, et al, 2004; n=409 (SCI=124; TBI=120; Multiple Sclerosis=55; Amputees=35; Auditory/Visual Impairments, developmental disabilities, cerebral palsy, multiple impairments=75; BRFSS sample=2269; development of the CHIEF-SF ) 

• Correlations between CHIEF subscales and total score from the long form and short form ranged from .794 to .960
• Mean score findings are consistent with the CHIEF long form findings

Spinal Cord Injury, Traumatic Brain Injury, MS, amputation or “other” impairment : (Whiteneck, Harrison-Felix, et al, 2004; n = 97 (50 with disabilities and 40 without disabilities), 409 = with disabilities; mean age = 44) 

• All CHIEF items, all subscales, and the total score produced statistically significant differences across the impairment groups
• People with disabilities consistently reported an overall higher level of environmental barriers on all subscales and total CHIEF score than those without disabilities
• People with severe disabilities generally scored higher on subsclaes and the total score than the full range of people reporting any disability. 

Content validity was demonstrated through the consensus of 4 Subject Matter Experts (SME's) charged. The SME panel created 4 instruments that largely overlapped with each other. These instruments were then synthesized into a single measure (see Whiteneck et al, 2004 for more information).

SCI and TBI : (Quoted from Whiteneck, Meade, et al, 2004; n = 103; 2 weeks between assessments) 

• Excellent CHIEF total score test-retest reliability (ICC > 0.90)
• Excellent sub-scale test-retest reliability (ICC's ranged from 0.77 to 0.89)

Chronic TBI: (Whiteneck et al, 2004; n = 73; Discharge FIM Physical sub-scale = 83.5 (11.0), Cognitive Sub-scale = 27.9 (4.32) points)

CHIEF Total and sub-scale scores with other 1-year outcomes

1-year outcomes

Total CHIEF

Physical barriers

Attitudes and barriers

Services and assistance

Policies

Work / School

Life satisfaction (SWLS)

−0.39*

−0.40*

−0.30*

−0.23

−0.27*

−0.16

total CHART

−0.38*

−0.18

−0.33*

−0.29*

−0.20

−0.29

Cognitive independence

−0.26*

−0.10

−0.29*

−0.30*

−0.17

−0.12

Physical independence

−0.11

−0.04

−0.25*

−0.13

−0.07

--

Mobility

−0.33*

−0.33*

−0.28*

−0.28*

−0.28*

−0.18

Social integration

−0.16

−0.16

−0.26*

−0.13

−0.20

−0.16

Occupation/productive

−0.37*

−0.29*

−0.30*

−0.35*

−0.23*

−0.33*

Economic self-sufficiency

−0.16

−0.02

−0.18

−0.09

−0.12

−0.10

*p < .05 using the Spearman’s rho correlation.

r < = Poor
r .31 to .59 = Adequate
r > .6 = Excellent

SWLS = Satisfaction with Life Scale
CHART = Craig Handicap Assessment and Reporting Technique

Chronic TBI: (Whiteneck, Gerhart, et al, 2004; n = 73; mean age at injury: 16-30 years old= 44, 31-45 years old=19, 46-60 years old=10; gender=55, male; CHIEF long form was used in this study) 

Discharge FIM Physical sub-scale = 83.5 (11.0), Cognitive Sub-scale = 27.9 (4.32) points)

CHIEF Total and sub-scale scores with other 1-year outcomes

1-year outcomes

Total CHIEF

Physical barriers

Attitudes and barriers

Services and assistance

Policies

Work / School

Life satisfaction (SWLS)

−0.39*

−0.40*

−0.30*

−0.23

−0.27*

−0.16

total CHART

−0.38*

−0.18

−0.33*

−0.29*

−0.20

−0.29

Cognitive independence

−0.26*

−0.10

−0.29*

−0.30*

−0.17

−0.12

Physical independence

−0.11

−0.04

−0.25*

−0.13

−0.07

--

Mobility

−0.33*

−0.33*

−0.28*

−0.28*

−0.28*

−0.18

Social integration

−0.16

−0.16

−0.26*

−0.13

−0.20

−0.16

Occupation/productive

−0.37*

−0.29*

−0.30*

−0.35*

−0.23*

−0.33*

Economic self-sufficiency

−0.16

−0.02

−0.18

−0.09

−0.12

−0.10

*p < .05 using the Spearman’s rho correlation.

r < = Poor 
r .31 to .59 = Adequate 
r > .6 = Excellent

SWLS = Satisfaction with Life Scale 
CHART = Craig Handicap Assessment and Reporting Technique

Chronic TBI : (Whiteneck, Gerhart, et al, 2004; n=73; mean age at injury: 16-30 years old= 44, 31-45 years old=19, 46-60 years old=10; gender=55, male; CHIEF long form was used in this study)

Mean product scores for CHIEF and FIM

FIM Sub-scale

Total Score Strength

Total CHIEF

Physical Barriers

Attitudes and Support

Services and Assistance

Politics

Work / School

Physical independence items ≥ 6*

Adequate

0.44

0.51

0.40

0.43

0.44

0.26**

Physical independence items not ≥ 6

Excellent

0.76

0.93

0.72

0.69

0.82

0.55**

Cognitive independence items ≥ 6*

Poor

0.28**

0.41

0.23

0.31

0.27**

0.13

Cognitive independence items not ≥ 6

Excellent

0.69**

0.80

0.54

0.58

0.61**

0.37

**p < .05 Mann-Whitney Test for 2 groups; Kruskal-Wallis Test for more than 2 groups

*indicating independence without assistance from others

Pearson Correlations of CHIEF and other 1 year outcomes

1-year outcomes

Total CHIEF

Physical barriers

Attitudes and barriers

Services and assistance

Policies

Work-School

Life Satisfaction (SWLS total score)

-0.39†

-0.40†

-0.30†

-0.23

-0.27†

-0.16

Handicap/lack of social participation (total CHART)

-0.38†

-0.18

-0.33†

-0.29†

-0.20

-0.29

Cognitive Independence (CHART subscale)

-0.26†

-0.10

-0.29†

-0.30†

-0.17

-0.12

Physical Independence (CHART subscale)

-0.11

-0.04

-0.25†

-0.13

-0.07

‡

Mobility (CHART subscale)

-0.33†

-0.33†

-0.28†

-0.28†

-0.28†

-0.18

Social Integration (CHART subscale)

-0.16

-0.16

-0.26†

-0.13

-0.20

-0.16

Occupation/productive capacity (CHART subscale)

-0.37

-0.29†

-0.30†

-0.35†

-0.23†

-0.33†

Economic self-sufficiency (CHART subscale)

-0.16†

-0.02

-0.18

-0.09

-0.12

-0.10

†P < .05 using the Spearma n’s rho correlation; ‡‡Correlation not calculated

Chronic and Acute SCI: (Kennedy et al, 2009; n = 80, 10% complete tetraplegia, 29% incomplete tetraplegia; 21% complete paraplegia, 29% incomplete paraplegia; mean age = 50.37 (range = 18 to 81) years)  

Results suggested that environmental barriers did not seem to have a large impact on activities (for this sample)

Mean scores (SD) by domain:

• Attitudes and Support = 0.51 (1.14)
• Services and Assistance = 1.44 (1.85)
• Physical and Structural = 2.24 (2.27)
• Policies = 0.86 (1.76)
• Work and School = 0.18 (0.56)

Chronic SCI: (Whitemeck, Meade et al, 2004; n = 2762 participants enrolled in the Model Spinal Cord Injury Systems (MSCIS) program; CHIEF 12 item Short Form used)

Mean CHIEF-SF Score by AIS Grade:

Group

n % (n = 2686) 

CHIEF Total

Physical & Structural

Services & Assistance

Work & School*

Attitudinal & Support

Policy

C1-4 ABC

13%

.90

1.22

0.95

.43

.64

.86

C5-8 ABC

25%

.78

1.16

0.80

.25

.58

.71

Para ABC

41%

.76

1.07

0.80

.26

.56

.67

AIS D

20%

.63

1.09

0.65

.21

.39

.50

Spinal Cord Injury : (Whiteneck, Harrison-Felix, et al, 2004 n=409 with 103 of the total 409 receiving 2ndCHIEF 2 weeks after initial assessment; n=125 participants family/friends completed CHIEF as proxy ) 

• Excellent test-retest reliability total CHIEF (ICC = 0.93)
• Excellent sub-scale test reliability ( ICC range = 0.77-.89) 

SCI and TBI : (Quoted from Whiteneck, Meade, et al, 2004; n = 103; 2 weeks between assessments) 

• Excellent CHIEF total score test-retest reliability (ICC > 0.90)
• Excellent sub-scale test-retest reliability (ICC's ranged from 0.77 to 0.89)

Participant/Proxy Agreement:

Spinal Cord Injury : (Whiteneck, Harrison-Felix, et al, 2004 n=409 with 103 of the total 409 receiving 2ndCHIEF 2 weeks after initial assessment; n=125 participants family/friends completed CHIEF as proxy ) 

• Adequate participant proxy agreement (ICC= 0.62)

Population based sample (in Colorado): ( Whiteneck, Harrison-Felix et al., 2004 (n=2269; (mean age=44; gender=57% male; with and without disabilities)

• Initial principle components factor analysis of the CHIEF’s 25 item product scores: 6 factors with eigenvalues over 1.0.
• After varimax rotation, the 5-factor solution (accounting for 48% of the cumulative variance) was far more interpretable.
• The 5 factors formed logical constructs, which were labeled “attitude and support barriers,” “services and assistance barriers,” “physical and structural barriers,” “policy barriers,” and “work and school barriers.”