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Received: 2026/02/11 | Accepted: 2026/02/27
Received: 2026/02/11 | Accepted: 2026/02/27
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Abstract (30 Views)
Background: Environmental access is an important determinant of functional independence for individuals with mobility disabilities. Nonetheless, only little is known of the role that paraplegic patients' self-ascribed autonomy plays in this context. Thus, we aimed to test whether perceived autonomy mediates the association between daily-living activities and accessibility of and environmental elements in the urban context.
Methods: This cross-sectional, descriptive correlational study was conducted on 423 paraplegic individuals in Nasiriyah city of Iraq from September to October 2025. Validated tools were utilized as follow; the Barthel Index was used for measuring extent of ADL performance, the Perceived Autonomy Support Scale for People with Physical Disabilities (PASS-PD) was used measuring autonomous motivation, while questions 11-18 from the CHIEF-SF (Craig Hospital Inventory of Environmental Factors - Short Form) (CIESH(S)). Data were analyzed using SPSS v28 and the PROCESS macro (Model4) for mediation analysis and Pearson’s correlation.
Results: The association of ‘perceived autonomy’ with ADLs (r = 0.623 p < 0.001) was positive, while that of ‘environmental accessibility’ had negative correlations for ADLs as well as perceived autonomy (–0.512 and –0.474, p < 0.001). Mediation analysis confirmed a significant indirect effect of environmental accessibility on ADLs through perceived autonomy (B=-0.224, 95% CI [-0.296, -0.159]). Combined model explained 45.1% variability in ADL performance.
Conclusion: Perceived autonomy is a mediating factor of the relationship between environmental accessibility and functional independence. Rehabilitation programmes should include adaptation of the environment and ways to further independence that paraplegic patients can function better in their daily lives.
Methods: This cross-sectional, descriptive correlational study was conducted on 423 paraplegic individuals in Nasiriyah city of Iraq from September to October 2025. Validated tools were utilized as follow; the Barthel Index was used for measuring extent of ADL performance, the Perceived Autonomy Support Scale for People with Physical Disabilities (PASS-PD) was used measuring autonomous motivation, while questions 11-18 from the CHIEF-SF (Craig Hospital Inventory of Environmental Factors - Short Form) (CIESH(S)). Data were analyzed using SPSS v28 and the PROCESS macro (Model4) for mediation analysis and Pearson’s correlation.
Results: The association of ‘perceived autonomy’ with ADLs (r = 0.623 p < 0.001) was positive, while that of ‘environmental accessibility’ had negative correlations for ADLs as well as perceived autonomy (–0.512 and –0.474, p < 0.001). Mediation analysis confirmed a significant indirect effect of environmental accessibility on ADLs through perceived autonomy (B=-0.224, 95% CI [-0.296, -0.159]). Combined model explained 45.1% variability in ADL performance.
Conclusion: Perceived autonomy is a mediating factor of the relationship between environmental accessibility and functional independence. Rehabilitation programmes should include adaptation of the environment and ways to further independence that paraplegic patients can function better in their daily lives.
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