Quality of Life Concepts

Secondary Health Conditions

Impediments to Community Integration (ICI)

Description: This is a condition-specific tool that assesses how bowel dysfunction impedes on community participation (community integration) following spinal cord injury (SCI).

Format: 16 statements reflecting 3 identified general areas of life: 1. Leisure activities, 2. Socializing with friends and family, and 3. Feeling bad about oneself.

Scoring: Respondents are asked to rate how much a specific activity was affected by their current bowel dysfunction on a scale from 1 (not at all) to 10 (very much).

Administration and Burden: Approximately 10 minutes.

Psychometrics for SCI: Reliability scores for each sub-scale were found to be acceptable (primary relationships, α = .89; feelings about self, α = .88; home environment, α = .71).  

Languages: English

QoL Concept: The ICI measures the impact of bowel dysfunction on Participation in relation to three areas. This corresponds to Boxes C (achievements) and E (subjective evaluations and reactions) on Dijker’s Model.

Permissions/Where to Obtain: Public Domain; The ICI can be obtained in this journal article:

Roach MJ, Frost FS, Creasey G. Social and personal consequences of acquired bowel dysfunction for persons with spinal cord injury. J Spinal Cord Med 2000; 23: 263-269.


Bowel Dysfunction SCI Studies: One cross-sectional study.

  1. Roach MJ, Frost FS, Creasey G. Social and personal consequences of acquired bowel dysfunction for persons with spinal cord injury. J Spinal Cord Med 2000; 23:263-9.

Sensitivity to Impact: Roach et al. (2000) administered the Impediments to Community Integration (ICI) measure along with four domains (free time, friendships, family life, and life in general) of Andrews and Withey’s [1] Satisfaction with Life Survey to community-dwelling persons with SCI (N = 103). There was a significant negative relationship between subjective severity and the 3 ICI measures, in which the greater the perceived severity of bowel dysfunction, the poorer the outcome in terms of personal relationships, feelings about oneself, and home environment. The significance of the association varied with objective measures of bowel dysfunction. There was no association between bowel dysfunction and subjective well-being, even when impediments were controlled for.

In general, non-parametric correlation analysis showed that the more people felt that their bowel dysfunction affected their personal relationships as measured by the ICI, the lower their satisfaction with free time and family life. This study supports the idea that the ICI is sensitive to bowel dysfunction impact.

Suggestions for Use: Although the ICI was developed in a theory-guided manner and designed specifically for persons with SCI, further work establishing the psychometric properties of the ICI is recommended, which should be done using it along with more established measures of community participation.

Additional References:

  1. Andrews FM, Withey SB. Social indicators of well-being: America's perceptions of life quality. New York; Plenum Press; 1976.
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