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Purpose: Earthquake survivors whose physical injuries result in disability may be at increased risk for prolonged and severe post-traumatic stress disorder. We estimated the prevalence of post-traumatic stress disorder, functional limitations, and environmental barriers in 289 survivors with disabilities induced by the 2008 Wenchuan earthquake eight years after the disaster. We also investigated the relationship of post-traumatic stress disorder symptom severity with function, considering a mediating role of environmental barriers.Methods: Post-traumatic stress disorder was measured with post-traumatic stress disorder checklist-civilian version. Physical and mental functioning was assessed with Medical Outcomes Short Form-36 and perceived environmental barriers were evaluated with Nottwil Environmental Factors Inventory-Short Form. Path analysis was employed to examine the relationship of exposures, post-traumatic stress disorder symptom severity, environmental barriers, and physical and mental function.Results: Prevalence of probable post-traumatic stress disorder was 18.68% (95% CI: 14.19-23.18%). Earthquake survivors with lower physical and mental functioning perceived more environmental barriers, and those who perceived more barriers demonstrated more severe post-traumatic stress disorder symptoms, confirming a mediating role of environmental barriers.Conclusions: Long-term community-based health services for earthquake survivors with disabilities should combine both mental and physical rehabilitation and focus on creating disability-inclusive environments.Implications for rehabilitationEarthquake survivors whose physical injuries result in permanent disability may experience two different types of psychological trauma. The first originates from the initial psychological impact of the disaster and their injuries and the second arises from the added difficulty of coping with environmental barriers given the limitations imposed by their impairments.Even years after the disaster, prevalence of post-traumatic stress disorder is likely high in earthquake survivors with acquired musculoskeletal or neurological impairments and needs to be considered in the rehabilitation process.Physical and mental functioning, as well as environmental barriers, are important intervention targets to reduce post-traumatic stress disorder symptoms.Long-term community-based health services for earthquake survivors with disabilities are needed that combine both mental health and physical rehabilitation components with advocating for disability-inclusive environments.

The portrayal of disabled people in the media can influence the public's perception of disability in both positive and negative ways. In this article, an experimental before and after design is used to determine the effects of a short film on the attitudes of non-disabled and disabled persons concerning employment and productivity of persons with disabilities.Three questions were posed to 480 study participants prior to and following a short film featuring a police officer with paraplegia. Linear mixed models were used to assess the effects of time point and disability status on the responses.The non-disabled participants' ratings of eligibility for employment of a paraplegic man and estimates of the employment rate of disabled people were significantly enhanced following the film. Nevertheless, the film had no significant effects on the ratings given by participants with disabilities in terms of eligibility, employment rate or productivity.This investigation highlights the potentially important influence of media portrayal and coverage of people with disabilities on attitudes of the public concerning disability.Restrictions in participation may result from an interaction of persons with impairments with an environment that is dominated by negative attitudes towards disability The portrayal of disabled people in the media can influence the public's attitudes towards disability in both positive and negative ways In this experimental study, attitudes of the general public were significantly improved following viewing a short film featuring a positive media portrayal of a police officer with paraplegia.

Visual cues from persons with impairments may trigger stereotypical generalisations that lead to prejudice and discrimination. The main objective of this pilot study is to examine whether visual stimuli of impairment activate latent prejudice against disability and whether this connection can be counteracted with priming strategies.In a field experiment, participants were asked to rate photographs showing models with mental impairments, wheelchair users with paraplegia, and persons without any visible impairment. Participants should appraise the models with regard to several features (e.g. communicativeness, intelligence). One hundred participants rated 12 photo models yielding a total of 1183 observations. One group of participants was primed with a cover story introducing visual perception of impairment as the study's gist, while controls received neutral information.Photo models with mental impairments were rated lowest and models without visible impairment highest. In participants who did not have prior contacts with persons with impairments, priming led to a levelling of scores of models with and without impairment. Prior contacts with persons with impairments created similar effects as the priming. Unexpectedly, a pattern of converse double discrimination to the disadvantage of men with mental impairments was revealed.Signs of stereotypical processing of visual cues of impairment have been found in participants of the Swiss general population. Personal contact with persons with impairments as well as priming participants seems to reduce stereotyping.

Purpose. To illustrate the conceptualization and development of a research institution from the comprehensive perspective based on the integrative model of functioning provided by the World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF). The newly founded research institution Swiss Paraplegic Research which focuses on the comprehensive study of spinal cord injury (SCI) serves as an example. Method. Description of organizational development and structure. Results. The creation of specialized research institutions which develop their core competence from the comprehensive perspective poses unique challenges. It is depicted how these challenges can be met through several approaches. These encompass the identification and specification of a common mission and research goals, the organization of research along distinct scientific fields, the set-up of a respective core competence, and the design of research structures suited to conduct studies of high methodological and organizational complexity. Finally, they comprise the development of a transdisciplinary workforce and the integration into a research landscape which is organized along scientific disciplines and not along interdisciplinary themes. Conclusion. The ideas and approaches described in this paper may serve as an example for creating integrative research institutions dedicated to human functioning and rehabilitation research from the comprehensive perspective.

The paper by Lennart Nordenfelt (this issue) provides an interesting contribution to the theoretical background of the International Classification of Functioning, Disability and Health (ICF) and t...

The objective of this paper is to present a framework for systematically describing different approaches to measure environmental factors (EF) and to discuss some strengths and weaknesses of these approaches.Identification of suitable criteria for ordering measurements of EF was based on an analysis of existing reviews, a qualitative literature review and feedback from experts. Items of selected EF measures were linked to the International Classification of Functioning, Disability and Health.Experimental and observational designs for the study of EF are distinguished and illustrated with examples. Approaches to study EF are differentiated into those directly measuring an environmental interaction with function and those relying on an independent assessment of environmental features. By applying these criteria, a three-dimensional matrix framework for measurement of EF in observational studies is developed.The acknowledgement of different measurement approaches to the scientific study of EF is one pathway towards an increased understanding of the connection between environments and functioning. Many different measures may be used to approximate the realities of disabling or enabling environments. This review provides an initial framework for improving our fundamental comprehension of the complexity of the measurement of EF in the context of human health and disability.

The complexity of rehabilitation outcomes in terms of functioning and disability leads to the need for dimension reduction in relation to specific research or clinical problems. Several statistical procedures are at hand. This article examines whether and to what extent principal component analysis (PCA) and graphical models differ in the dimension reduction of data based on the International Classification of Functioning, Disability and Health (ICF).Using a data set of 1048 persons with spinal cord injury from 14 different countries as a case in point, this article compares the solutions in dimension reduction generated with a graphical model based on least average shrinkage selection operator (LASSO) regression on one hand and with a PCA on the other.Some factors extracted with the PCA properly match the clusters found with the graphical model, while in others less commonality can be found. In general, overlap ranges from 9 to 100% with 75% on average. Many of the discovered clusters or factors, i.e. dimensions, are compatible with the ICF structure, particularly in activity and participation.Functioning is a multidimensional, complex and dynamic outcome. We recommend being careful with dimension reduction based on statistical procedures alone. Theoretical considerations and clinical significance should always guide statistics. Stability of emergent dimensions that are compatible with theoretical or clinical considerations is a most important point. At least two different statistical procedures for dimension reduction, for instance PCA and LASSO regression, should be applied to conservatively select those dimensions that stay stable with both procedures.