Individuals with disability experience more participation restrictions throughout their lives than their counterparts in the general population.1 This implies limitations in their active involvement in various aspects of daily life and their integration into society, making participation, for some authors, the “ultimate target for rehabilitation”.2 Although it is well known that the participation of people with disability decreases with increasing severity of impairment, altered health status may not explain all participation restrictions in this population. As defined by the International Classification of Functioning, Disability and Health (ICF), restrictions in participation result from an imbalance between “body function and structures”, “personal factors” and “environmental factors” (EFs).3 EFs are external elements that influence an individual's life and functioning. They include the proximal environment, such as the physical environment, social relationships, and attitudes, as well as the more distant environment, such as societal systems, services, and laws.3 The ICF model suggests that an inadequate environment could be detrimental to participation.3 Some studies have even highlighted that an insufficiently adapted environment may play a mediating role in the link between disabilities and participation restrictions in childhood.4,5 Previous studies in children and adolescents has shown that severe limitations in functioning increase the need for environmental adaptation and an insufficiently adapted environment would not compensate for disabilities and could explain part of the restrictions on participation linked to disability for children and adolescents.4,5 However, the mediating role of environmental inadequacy in the participation of young adults with disability is still poorly explored by international research, while the environment is notably adaptable, making it an essential subject of study for improving participation.

Among disabilities, cerebral palsy (CP) is of particular scientific interest because of its prevalence (it is the most common early-onset physical disability),6 the nature and severity of impairments and comorbidities (impaired motor function often accompanied by “disturbances of sensation, perception, cognition, communication, and behavior; by epilepsy, and by secondary musculoskeletal problems”).7 In addition, people with CP experience a range of participation restrictions, whose description, origins and implications for daily life are well documented in childhood and adolescence.8,9 However, these findings cannot be generalized to adulthood, as needs and expectations change considerably after the transition to adulthood.10 In studies that directly question them, adults with CP consider their participation as central to their daily lives, sometimes even as central as their health condition.11 They also identify key areas that should be addressed, such as employment, accessibility and mobility, independent living in the community and autonomy (including financial autonomy), communication, access to media and assistive technologies, leisure activities, democratic participation and self-determination.10, 11, 12 One participative study had defined an ICF-Core-Set for adults with CP, which includes an environmental classification, structuring the EFs relevant to this population into four chapters, named “products and technology”, “support and relationships”, “attitudes” and “services, systems and policies”. This disability- and age-specific classification aims to reflect adults with CP actual experience of the environment.13 Understanding the extent to which inadequacy of these environments is associated with participation restrictions among these young adults will help to identify potential levers for improving their participation.

This study aimed to quantify, using the European Adults Environment Questionnaire (EAEQ), the mediating role of the four environmental chapters of the ICF-Core-Set in the effect of the functional limitations on participation restrictions in young adults with CP.