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en Perceived Autonomy as a Mediators between Environmental Accessibility and Activities of Daily Living among Paraplegic Patients Background: Environmental access is&ensp;an important determinant of functional independence for individuals with mobility disabilities. Nonetheless,&ensp;only little is known of the role that paraplegic patients' self-ascribed autonomy plays in this context. Thus, we aimed to test whether perceived autonomy mediates the association between daily-living activities and accessibility of and&ensp;environmental elements in the urban context. Methods: This cross-sectional, descriptive correlational study was conducted on 423 paraplegic individuals in Nasiriyah&ensp;city of Iraq from September to October 2025. Validated tools were utilized as&ensp;follow; the Barthel Index was used for measuring extent of ADL performance, the Perceived Autonomy Support Scale for People with Physical Disabilities (PASS-PD) was used measuring autonomous motivation, while questions 11-18 from the CHIEF-SF (Craig Hospital Inventory of Environmental Factors - Short Form) (CIESH(S)). Data were analyzed using SPSS v28 and the PROCESS macro (Model4) for&ensp;mediation analysis and Pearson’s correlation. Results: The association of ‘perceived autonomy’ with ADLs (r = 0.623 p < 0.001) was positive, while&ensp;that of ‘environmental accessibility’ had negative correlations for ADLs as well as perceived autonomy (–0.512 and –0.474, p < 0.001). Mediation analysis confirmed a significant indirect effect&ensp;of environmental accessibility on ADLs through perceived autonomy (B=-0.224, 95% CI [-0.296, -0.159]). Combined model explained 45.1%&ensp;variability in ADL performance. Conclusion: Perceived autonomy is a mediating factor of the relationship between environmental accessibility and&ensp;functional independence. Rehabilitation&ensp;programmes should include adaptation of the environment and ways to further independence that paraplegic patients can function better in their daily lives. ,Perceived Autonomy,Activities of Daily Living,Paraplegia,Functional Independence,and Environmental Accessibility 0 0 http://ijwph.daneshafarand.org/browse.php?a_code=A-10-2412-1&slc_lang=en&sid=3 A.A. Kadhim alaa-kadhim@utq.edu.iq 1003194753284600380095 1003194753284600380095 Yes A.A. Abed 1003194753284600380129 1003194753284600380129 No S.A. Laftah 1003194753284600380130 1003194753284600380130 No N.N. Abadi 1003194753284600380131 1003194753284600380131 No