Association of environmental factors with levels of home and community participation in an adult rehabilitation cohort

Objective: To examine whether home and community environmental barriers and facilitators are predictors of social and home participation and community participation at 1 and 6 months after discharge from an acute care or inpatient rehabilitation hospital. Design: Cohort study. Setting: Postacute care. Participants: Adults (N=342) age 18 years or older with a diagnosis of complex medical, orthopedic, or neurologic condition recruited from acute care and inpatient rehabilitation facilities. The mean age +/- standard deviation of participants was 68 +/- 14 years; 49% were women and 92% were white. Interventions: Not applicable. Main Outcome Measures: Participation in social, home and community affairs as assessed with the Participation Measure for Post-Acute Care. Results: Adjusting for covariates, 1 month after discharge a greater presence of home mobility barriers (P<.01) was associated with less social and home participation; whereas greater community mobility barriers (P<.01) and more social support (P<.001) were associated with greater participation. At 6 months, social support was the only environmental factor associated with participation after adjusting for covariates. Conclusions: This study provides new empirical evidence that environmental barriers and facilitators do influence participation in a general rehabilitation cohort, at least in the short term.