Using the ICF framework to evaluate the effects of environmental factors on physical disability among people with diabetes mellitus.

This study aimed to analyze the influence of environmental factors on the ICF activity-participation outcome, controlling for body function and personal factor dimensions of 75 diabetes patients. Outcome measures included questionnaires on musculoskeletal pain (Nordic Questionnaire), physical and environment domains of World Health Organization Quality of Life version BRIEF (WHOQOL-brief) and clinical and personal data. Multiple linear regression with hierarchical entry of variables was used. An assessment of WHOQOL-brief revealed a score of 66.6 (SD = 17.3) to physical domain and 58.8 (DP = 12.1) to environment domain. The factors associated with physical domain were lower limb pain, number of comorbidities, and environment barriers. The highest environmental barriers were financial constraints, availability of health services, deficiency of self-management, and inadequate family and social support. The final model explained 44.0% ([12.02],  < 0.001) of variability of the physical domain. We confirmed the functional consequences of diabetes mellitus to be complex and multifactorial. An approach that considers the interaction between individual and environmental attributes is necessary due to the disabling nature of this health condition.