Andrea Bökel, Marie-Luise Dierks, Christoph Gutenbrunner, Norbert Weidner, Veronika Geng, Yorck-Bernhard Kalke, Thomas Liebscher, Frank-Rainer Abel, Christian Sturm
Department of Rehabilitation Medicine, Hannover Medical School, 30625 Hannover, Germany. E-mail: boekel.andrea@mh-hannover.de
DOI: 10.2340/16501977-2717

Objective: The German Spinal Cord Injury Survey is part of the International Spinal Cord Injury Survey, which aims to collect data about the life experience of persons with spinal cord injury worldwide. This paper reports on the perceived environmental barriers of the German study population and their associations with quality of life.
Design: Cross-sectional explorative observational study using survey data.
Participants: A total of 1,479 persons with spinal cord injury aged 18 years and older.
Methods: After descriptive analyses, exploratory factor analysis was used to build groups of environmental barriers. Logistic regressions were performed to assess correlates of perceived environmental barriers. Spearman’s correlations were used to analyse the association between perceived barriers and quality of life.
Results: Barriers regarding infrastructure had a relatively large impact. Barriers in relation to people’s attitudes towards spinal cord injury and the equipment of people with spinal cord injury had a relatively small impact on the lives of people with spinal cord injury. Several subpopulations showed a higher risk in experiencing barriers. Quality of life decreased with increasing experience of barriers.
Conclusion: The most life-hardening barriers were identified related to infrastructure, a category in which most barriers are modifiable, for example, buildings or transportation.

Environmental barriers influence the lives of people with spinal cord injury. This study measured the perception of environmental barriers like inadequate accessibility, insufficient transportation, lack of technical aids or other services, as well as attitudes of other people towards spinal cord injury. All these may hinder people with spinal cord injury to do whatever they want or to get where ever they want to. The participants perceived a large number of barriers, which made their lives a lot harder. The most life hardening barriers were inaccessibility of public and private buildings, weather conditions and long-distance transportation. Furthermore participants perceived problems with disability insurance, a lack of equality promotion or financial problems which made their lives a lot harder. Since most of these barriers are man-made, target political interventions should be developed to reduce these barriers.