*Minimal updates were made to the original blog post in regards to the CHIEF. No updated or current research utilizing the CHIEF in pediatric PT was found as well.

Source: http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=979

(Accessed 20 February 2017)

Critical Review – CHIEF

By: Mariah Cole

Descriptive Information:

  • Title: Craig Hospital Inventory of Environmental Factors (CHIEF)
    1. Version 3.0 April 2001
    2. Published in 1999
    3. Updated and revised in 2012
  • Source:

Craig Hospital Research Department

3425 S. Clarkson Street, Englewood Colorado 80110

  • Costs: Free and easily accessible – manual and assessment available on Craig Hospital Website
  • Purpose: “To assess the degree of which elements of the physical, social, and political environments act as barriers or facilitators to full participation for people with disabilities.” Five domains assessed to evaluate environmental factors – accessibility, accommodations, resource availability, social support, equality.
  • Type of Test: Patient Reported Outcomes
  • Target Population and Ages:
    • Stroke, CP, SCI, TBI, MS, and Amputee
    • Adolescent (13-17), Adult (18-64), Elderly (+65)
  • Time Requirements – Administration and Scoring: 6 to 30 min
    • CHIEF – 10 min
    • CHIEF (short form) – 5 min
    • Add 5 min if administered by interview
    • Normally completed by individual

Test Administration:

  • Administration:Paper/pencil completion of 25 items by the individual (12 items for CHIEF–SF)
  • Scoring:
    • Frequency score (0=never, 1=less than monthly, 2=monthly, 3=weekly, and 4=daily) indicating frequency of encountering environmental barriers.
    • Magnitude scores (0=no problem, 1=little problem, and 2=big problem) indicating size of the problem barrier presented.
    • Frequency-magnitude product score (0-8) indicating overall impact of environmental barrier on individual’s life.
    • Scores are calculated by multiplying 25 items by the frequency, magnitude, and overall impact scores.
  • Type of Information, resulting form testing: Overall impact of environmental barriers on individuals’ ADLs, participation, and QOL
  • Environment for Testing: No specific requirements
  • Equipment and Materials Needed: None
  • Examiner Qualifications: None – no training required
  • Standardized/Normative data:
    • Community Dwelling Elderly Adults with and without Stroke
    • Chronic and Acute SCI
    • Children and Youth with Physical Disabilities
  • Evidence of Reliability:
    • Test-retest
      • SCI – excellent reliability total CHIEF (ICC=0.93)
      • SCI and TBI – excellent CHIEF total score (ICC > 0.90) and excellent sub-scale reliability (0.77 to 0.89)
      • Multiple Diagnosis (SCI, TBI, MS, Amputees, CP, Auditory/Visual impairments, Developmental Disabilities) – adequate reliability (ICC=0.62)
    • Interrater/Intrarater
      • SCI – adequate (ICC=0.62)
  • Evidence of Validity:
    • Content – SCI, TBI, amputee, MS, etc.
      • 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 (Whiteneck et al, 2004)
      • All CHIEF items, all subscales, and the total score produced statistically significant differences across the impairment groups (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)
      • People with severe disabilities generally scored higher on subscales and the total score than the full range of people reporting any disability (Whiteneck et al, 2004)
  • MCID: Not established

Summary Comments:

  1. Strengths:
    • The CHIEF is short, free, and easily administered with no requirements or equipment. A shorter version provided as well – CHIEF-SF.
    • Assesses factors that limit patients’ participation beyond physical impairments with hopes of removing the barriers to improve patient rehabilitation, recovery, and reintegration back into their lives.
    • Assesses domains such as physical accessibility, accommodations and modifications, resource availability, social support, and equality of opportunity and how elements of the environment can limit/impede or facilitate a patient’s participation, satisfaction, and QOL.
  2. Weaknesses:
    • No MCID or MDC
    • No standard error of measurement
  3. Clinical applications: As a physical therapist, it is important to identify, acknowledge, and understand the possible factors or elements that impede or assist in a patient’s rehabilitative process. It is our responsibility to advocate for our patients and educate them to provide the best potential for a successful outcome and improved quality of life.