Measuring Environmental Factors: Unique and Overlapping International Classification of Functioning, Disability and Health Coverage of 5 Instruments

Allen W. Heinemann*, Ana Miskovic, Patrick Semik, Alex Wong, Jessica Dashner, Carolyn Baum, Susan Magasi, Joy Hammel, David S. Tulsky, Sofia F. Garcia, Sara Jerousek, Jin Shei Lai, Noelle E. Carlozzi, David B. Gray

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objectives To describe the unique and overlapping content of the newly developed Environmental Factors Item Banks (EFIB) and 7 legacy environmental factor instruments, and to evaluate the EFIB's construct validity by examining associations with legacy instruments. Design Cross-sectional, observational cohort. Setting Community. Participants A sample of community-dwelling adults with stroke, spinal cord injury, and traumatic brain injury (N=568). Interventions None. Main Outcome Measures EFIB covering domains of the built and natural environment; systems, services, and policies; social environment; and access to information and technology; the Craig Hospital Inventory of Environmental Factors (CHIEF) short form; the Facilitators and Barriers Survey/Mobility (FABS/M) short form; the Home and Community Environment Instrument (HACE); the Measure of the Quality of the Environment (MQE) short form; and 3 of the Patient Reported Outcomes Measurement Information System's (PROMIS) Quality of Social Support measures. Results The EFIB and legacy instruments assess most of the International Classification of Functioning, Disability and Health (ICF) environmental factors chapters, including chapter 1 (products and technology; 75 items corresponding to 11 codes), chapter 2 (natural environment and human-made changes; 31 items corresponding to 7 codes), chapter 3 (support and relationships; 74 items corresponding to 7 codes), chapter 4 (attitudes; 83 items corresponding to 8 codes), and chapter 5 (services, systems, and policies; 72 items corresponding to 16 codes). Construct validity is provided by moderate correlations between EFIB measures and the CHIEF, MQE barriers, HACE technology mobility, FABS/M community built features, and PROMIS item banks and by small correlations with other legacy instruments. Only 5 of the 66 legacy instrument correlation coefficients are moderate, suggesting they measure unique aspects of the environment, whereas all intra-EFIB correlations were at least moderate. Conclusions The EFIB measures provide a brief and focused assessment of ICF environmental factor chapters. The pattern of correlations with legacy instruments provides initial evidence of construct validity.

Original languageEnglish (US)
Pages (from-to)2113-2122
Number of pages10
JournalArchives of physical medicine and rehabilitation
Issue number12
StatePublished - Dec 1 2016


  • Attitude
  • Environment
  • Rehabilitation

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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