Craig Hospital Inventory of Environmental Factors

Posted on: March 15, 2015 | By: mchiuminatto | Filed under: Craig Hospital Inventory of Environmental Factors (CHIEF)

Source: http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=979. Accessed March 15, 2015.

 

Critical Review

 

Reviewer: Michael Chiuminatto SPT, on 03/15/2014

 I. Descriptive Information

A. Title: Craig Hospital Inventory of Environmental Factors

  1. Originally Published in 1999
  2. Version 3.0 April 2001

B. Source: Craig Hospital Research Department 3425 S. Clarkson Street, Englewood Colorado 80110

C. Availability and Costs: Free, Accessible Here- http://craighospital.org/uploads/CraigHospital.ChiefManual.pdf

D. Purpose: The purpose of this assessment is; “To assess the degree to which elements of the physical, social, and political environments act as barriers or facilitators to full participation for people with disabilities.”

E. Target Population and Ages: Target Populations include Stroke; Cerebral Palsy; Spinal Cord Injury; Traumatic Brain Injury; Multiple Sclerosis; Amputee Population; ages 6-12, 13-17, 18-64, 65+

F. Type of Test: Short Patient Reported Outcomes, assessing the individuals ADLs, Patient Satisfaction, QOL, ICF Domain: Environmental

G. Time Requirements, Administration, and Scoring: 6-30 mins; 25 items across 5 domains using Paper and Pencil, completed by the individual or an individuals proxy.

II. Test Administration

A.  Administration: Paper and pencil completion of the 25 items by the individual or individuals proxy.

B.  Scoring: Scores are calculated by multiplying each of the 25 items with the frequency score (range:0 to 4 ) by magnitude (range: 1 to 2) to yield a an overall “impact” score (range: 0-8)

C. Type of information, resulting from testing: Results lead to an overall “impact score”

D. Equipment and Materials Needed: CHIEF Form, and Pencil

E. Examiner Qualifications: None; Read Manual

F. Standardization/normative data: Community Dwelling Elderly Adults with and without Stroke; Chronic and Acute SCI; Children and Youth with Physical Disabilities

G. Evidence of Reliability:

  1. Test retest Reliability
    • Excellent Test retest reliability (ICC-.93) and sub-scale test reliability (ICC.77-.89) for SCI.
    • Excellent CHIEF total score test retest reliability (ICC>.90) and sub-scale test retest reliability (ICC .77-.89); SCI and TBI.
    • Adequate Subject-Proxy Agreement ICC=.62)
  2. Interrater/Intrarater Reliability
    • Adequate Participant Proxy agreement ICC=.62

 H. Evidence of Validity:

  1. Content Validity Chronic TBI
    • Content validity was demonstrated through the consensus of 4 Subject Matter Experts (SME’s) charged. The SME panel created 4 instruments that largely overlapped with each other. These instruments were then synthesized into a single measure (see Whiteneck et al, 2004
    • People with disabilities consistently reported an overall higher level of environmental barriers on all subscales and total CHIEF score than those without disabilities Whiteneck et al, 2004

 

  1. Discriminative Validity Chronic TBI
    • All CHIEF items, all subscales, and the total score produced statistically significant differences across the impairment groups
    • People with disabilities consistently reported an overall higher level of environmental barriers on all subscales and the total CHIEF score (Whiteneck, et al 2004)

 

 III. Summary

A. Strengths: The CHIEF is short, easily administered, and requires no training to deliver. It assesses environmental factors that can limit rehabilitation success outside of the clinic

B. Weaknesses: No floor/ceiling effect, or MCID has been determined for the CHIEF assessment.

C. Clinical Applications: The CHIEF assessment can be utilized in numerous clinical environments to provide a larger picture of patient’s environmental conditions outside of rehabilitation. Identifying environmental factors that could limit an individual with disabilities, can aid Physical Therapists in educating and referring patients to get the assistance they need to be successful not only with rehabilitation but in other environmental participation domains.

 

The following Article utilized the CHIEF Assessment

 

Source: Law M, Petrenchik T, King G, Hurley P. Perceived environmental barriers to recreational, community, and school participation for children and youth with physical disabilities. Arch Phys Med Rehabil. 2007;88(12):1636-42.

The purpose of the study was to comprehensively describe parent perceptions to environmental barriers for their children with physical disabilities. The analysis utilized cross-sectional data gathered in the first wave of a longitudinal study. Questionnaires were mailed to the families before a home visit was made. The questionnaires were completed by the parent that included, “reports of parent and child health; family cohesion and activity preferences, social supports, demographic information, and assessments of the child’s behavioral health status; social development and social support; and parent-reported perceptions of environmental barriers to their child’s participation.” The study included 427 parent child pairs in three age cohorts ranging from 6-14. Barriers to participation were measured utilizing the CHIEF assessment.

 

Data Analyses utilized descriptive statistics, “because the linkage between family income and barriers to childhood participation is well established, 37 we tested and controlled for the effect of family income by including it as a covariate in the analysis.” The results demonstrated that environmental barriers to their children’s participation occurred across multiple “environmental contexts.” The highest barriers were associated with school and work. The study concludes that due to the multiple environmental barriers, this allows for multiple points of entry to “facilitate change.”  “Although we cannot always change a child’s functional abilities, in most circumstances, we can enhance participation by minimizing disabling gaps between a child’s capabilities and the social and physical demands of the environments in which children live, learn, play, and develop.”

 

4 responses to “Craig Hospital Inventory of Environmental Factors”

  1. jmoore44 says:

    I find it very interesting that this measure can be used in such a variety of patient populations and ages! It appears as this would be a versatile measure to have in the clinic. This is especially true when considering the fact that it can be used on both adults and children, and there are many different domains assessed with the same tool. The only downside is the time to complete. I wouldn’t want to spend 25 min of my initial evaluation on this measure. If it could be given to the patient before the appointment (while in waiting room) then that would be ideal. Learning the environmental factors that could be heavily influencing the patient’s rehabilitation can be very important as so this would be a valuable tool when educating and working with the family to develop the best possible treatment plan for all parties involved in the process.

  2. abeker says:

    I think one of the most important aspects of your outcome measurement is cost. So many of the outcome measurements used in today’s healthcare system have a high cost which limits their use. By being free, the Craig Inventory allows it to be used without cost. In addition, the reliability for the test remains high and it is widely known so the results of the test can be interpreted correctly by a wide variety of health care professionals. I agree with Jmoore44 that the inventory can take a fairly long time to complete, but this time (25 minutes) is fairly short compared to other inventories which can take upwards of an hour. I also feel the Craig Inventory is useful because it is specific to certain conditions, which you specified in your blog. Overall, I think the Craig Inventory is an excellent tool for health care professionals to have on hand. Great review of the test.

  3. Paula A. DiBiasio says:

    Great comments! I believe this one can be given to the patient or caregiver to complete at home. A real time saver!

  4. kchildress says:

    No additional updates to the CHIEF outcome measure at this time.

    Source: Furtado SRC, Sampaio RF, Kirkwood RN, Vaz DV, Mancini MC. Moderating effect of the environment in the relationship between mobility and school participation in children and adolescents with cerebral palsy. Braz J Phys Ther. 2015 July-Aug; 19(4):311-319.

    The purpose of this study was to discover the relationship between environmental factors in regards to children and adolescents diagnosed with Cerebral Palsy (CP) and the relationship between mobility and school participation. There were a total of 99 children ranging in age from 6-18 years old, with their parents/caregivers assistance throughout the study. The participants varied in mobility, some participants ambulated with orthoses while others did not, the study also included children who used a wheel chair for longer distances. The participants were recruited from a children’s rehabilitation center in Brazil. The study used three different instruments to determine the relationship of mobility and school participation, they included, Gross Motor Function Classification System (GMFCS), School Function Assessment (SFA) and the Craig Hospital Inventory of Environmental Factors (CHIEF). The CHIEF outcome measure was completed by the child’s parent/caregiver.

    It should be noted that the results of this study may present different outcomes in mobility and participation due to environmental factors in the US as compared to Brazil due to the programs and public transportation available to those residing in the US. According to the CHIEF sub-scale, transportation was the biggest barrier for participation; attitudes/assistance were the least restrictive barrier to participation. Due to the classification of mobility defined in this study by GMFCS, the variation of participation was congruent with the mobility classification. In conclusion, “the hypothesis advocated by the ICF conceptual model that environmental factors significantly affect the relationship between functioning components was not supported by the present study.”

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