Predictors of participation enfranchisement of wheelchair users with spinal cord injury in the United States

Context/objective: To investigate predictors of participation enfranchisement of individuals living with spinal cord injury (SCI) who use a wheelchair full-time. Design: Secondary data analysis of a cross-sectional study. Setting: Community, United States. Participants: Participants were 59 wheelchair users (median age of 52.5 years, IQR = 21) with chronic SCI (>1 year after injury). Interventions: No intervention. Main outcome measures: Participation enfranchisement was measured using the enfranchisement scale of the Community Participation Indicators (CPI). Dependent variables included importance of participation (CPI-Importance) and control over participation (CPI-Control) subscales of the CPI. Independent variables included demographics and clinical characteristics (age, sex, time since injury, level of injury), wheelchair skills, mobility level, symptoms of depression, and environmental barriers. Backward multivariable linear regression analyses were carried-out to identify predictors of CPI-Importance and CPI-Control. Results: Five predictors including mobility level, wheelchair skills, sex, level of injury, and symptoms of depression explained 57% (F = 14; P < 0.01) of the variance in CPI-Importance. Three predictors including mobility level, symptoms of depression, and environmental barriers explained 60% (F = 27; P < 0.01) of the variance in CPI-Control. Conclusion: This study provides evidence of potential modifiable factors such as mobility, wheelchair skills, environmental barriers, and symptoms of depression that can influence importance of participation and control over participation of wheelchair users with SCI. The models presented in this study can serve as a conceptual framework to design effective interventions to improve participation enfranchisement of wheelchair users with SCI.