An ICF Perspective on Impact of Environmental Barriers on Community Participation in Stroke Patients: A Qualitative Approach

Objective: To explore the environmental factors acting as barriers to community participation from the perspective of ICF in individuals with stroke.

Design: Observational.

Setting: Physiotherapy department of a tertiary care center.

Participants: 50 stroke patients with hemiplegia, ambulatory (with/without assistive devices) and community-dwelling voluntarily participated. Patients with severe cognitive, visual, perceptual and communication deficits were excluded. Convenience sampling was used.

Main outcome measure: A questionnaire was designed based on the domains of International Classification of Functioning and Disability; and included elements of physical and social environments. This was administered through a semi-structured interview.

Result: Among the various factors identified, mobility barriers community (e.g., uneven sidewalks, unavailability of lifts) and at home (e.g., stairs or doors) have been implicated to limit community participation by majority of subjects (97% & 87%) followed by lack of accessibility of roads (95%), lack of accessibility of restrooms (55%) and lack of accessibility of transport (45%). Lack of services, systems and policies was perceived as a barrier and inappropriate attitude and lack of support of family and friends by 25% and 20% subjects respectively.

Conclusion: Environmental factors are crucial determinants of community participation in stroke patients. Along with physical environmental factors, social and attitudinal aspects of environment also have an impact on community participation by stroke patients.

Clinical Implications: Knowledge of these findings will assist rehabilitation of stroke patients by overcoming barriers and enhancing facilitators through environmental modification in community for easy accessibility, training in community/in a simulated environment and policy changes e.g. changes in regulations, insurance, etc.

Keywords:Environmental barriers, Community participation; Stroke