Environmental factors: a systematic review of instruments and content analysis using the International Classification of Functioning, Disability and Health

Abstract

Purpose: This study aims to describe and compare the content of instruments that assess environmental factors (EF) using the International Classification of Functioning, Disability and Health (ICF). Relevance: Assessing the impact of EF on patients' functioning is an important part of the rehabilitation process. Physiotherapists need to know which instruments assess EF, which EF these instruments assess and which methodology of assessment they use, in order to choose the appropriate instrument. The ICF provides a universal framework that can be used to describe and compare the health of patients and that serves as a reference for the documentation in physiotherapy. Therefore it can be used to characterise existing instruments. Participants: Not applicable. Methods: A systematic search of 3 databases (PubMed, CINAHL and PEDro) was conducted to identify all instruments that assess EF. Combinations of the following key words were used without language restriction: environment, factors, components, barriers to participation, facilitators to participation, International Classification of Functioning, Disability and Health, social participation. Two investigators independently screened all instruments identified, which were included if developed for adults, addressed more than one 2nd level category of any of the 5 Chapters on EF and not specific to a health condition. Analysis: Included instruments had their content examined independently by 2 investigators that identified all meaningful concepts and linked them to the most precise ICF category according to published rules. Percentage agreement between the 2 investigators varied between 84% and 95%. Results: 8 instruments met the inclusion criteria containing 558 meaningful concepts linked to 2nd or 3rd level ICF categories from one of the 5 EF chapters (1. Products and technology, 2. Natural Environment, 3. Support and relationships, 4. Attitudes, 5. Services, systems and policies). 5/8 instruments cover all the 5 chapters; 1/8 instrument covers 4/5 chapters (1, 3-5); 1/8 instrument covers chapters 1 and 2 and 1/8 instrument covers chapter 1 only. 5/8 instruments had between 61% and 100% of their items linked to categories in Chapter 1. In contrast, the highest percentage of items from one instrument linked to categories in Chapter 2 was11%, Chapter 3 was 30%, Chapter 4 was 20% and Chapter 5 was 49%. 3/8 instruments assessed whether EF were present or absent in a specific context, 3/8 assessed the intensity of EF' impact and 2/8 assessed the intensity and frequency of the EF' impact. Conclusions: Instruments assessing EF differ in their content and type of assessment and have several items linked to the same ICF category. Most instruments are designed to assess primarily products and technology (Chapter 1) and only a minority assesses the intensity and frequency of EF' impact, which is of great relevance to rehabilitation. Different instruments are needed that assess the intensity and frequency of EF' impact and that use ICF categories as the items for assessment. Implications: The results of this study can guide physiotherapists in clinical practice and research in selecting an appropriate EF instrument for a specific purpose.