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Kendrick D, Lindley R, Blackburn L, Roadevin C, Thompson E, Andrews I, Anwar F, Brooks A, Carlton E, Crouch R, Day F, Fallon S, Farrin A, Graham L, Hoffman K, Howell R, Holmes J, James M, Jones T, Kellezi B, Kettlewell J, Morriss R, das Nair R, Richardson D, Smith M, Timmons S, Wright-Hughes A, Radford K. Early vocational rehabilitation and psychological support for trauma patients to improve return to work (the ROWTATE trial): study protocol for an individually randomised controlled multicentre pragmatic trial. Trials 2024; 25:439. [PMID: 38956682 PMCID: PMC11221047 DOI: 10.1186/s13063-024-08183-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 05/17/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Moderately severe or major trauma (injury severity score (ISS) > 8) is common, often resulting in physical and psychological problems and leading to difficulties in returning to work. Vocational rehabilitation (VR) can improve return to work/education in some injuries (e.g. traumatic brain and spinal cord injury), but evidence is lacking for other moderately severe or major trauma. METHODS ROWTATE is an individually randomised controlled multicentre pragmatic trial of early VR and psychological support in trauma patients. It includes an internal pilot, economic evaluation, a process evaluation and an implementation study. Participants will be screened for eligibility and recruited within 12 weeks of admission to eight major trauma centres in England. A total of 722 participants with ISS > 8 will be randomised 1:1 to VR and psychological support (where needed, following psychological screening) plus usual care or to usual care alone. The ROWTATE VR intervention will be provided within 2 weeks of study recruitment by occupational therapists and where needed, by clinical psychologists. It will be individually tailored and provided for ≤ 12 months, dependent on participant need. Baseline assessment will collect data on demographics, injury details, work/education status, cognitive impairment, anxiety, depression, post-traumatic distress, disability, recovery expectations, financial stress and health-related quality of life. Participants will be followed up by postal/telephone/online questionnaires at 3, 6 and 12 months post-randomisation. The primary objective is to establish whether the ROWTATE VR intervention plus usual care is more effective than usual care alone for improving participants' self-reported return to work/education for at least 80% of pre-injury hours at 12 months post-randomisation. Secondary outcomes include other work outcomes (e.g. hours of work/education, time to return to work/education, sickness absence), depression, anxiety, post-traumatic distress, work self-efficacy, financial stress, purpose in life, health-related quality of life and healthcare/personal resource use. The process evaluation and implementation study will be described elsewhere. DISCUSSION This trial will provide robust evidence regarding a VR intervention for a major trauma population. Evidence of a clinically and cost-effective VR intervention will be important for commissioners and providers to enable adoption of VR services for this large and important group of patients within the NHS. TRIAL REGISTRATION ISRCTN: 43115471. Registered 27/07/2021.
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Affiliation(s)
- Denise Kendrick
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK.
| | - Rebecca Lindley
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK
| | - Lauren Blackburn
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Cristina Roadevin
- Nottingham Clinical Trials Unit, University Park, Nottingham, NG7 2RD, UK
| | - Ellen Thompson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Isabel Andrews
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK
| | - Fahim Anwar
- Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Adam Brooks
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Edd Carlton
- North Bristol NHS Trust Southmead Hospital, Southmead Road, Westbury-On-Trym, Bristol, BS10 5NB, UK
| | - Robert Crouch
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, S016 6YD, UK
| | - Florence Day
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Steve Fallon
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK
| | - Amanda Farrin
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Laura Graham
- Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, UK
| | - Karen Hoffman
- Centre for Trauma Sciences, Barts Health NHS Trust and Queen Mary University London, Blizard Institute, 4 Newark St, London, E1 2AT, UK
| | - Rebekah Howell
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Jain Holmes
- Centre for Rehabilitation & Ageing Research (CRAR), Injury, Recovery Sciences and Inflammation (IRIS), School of Medicine, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Marilyn James
- Nottingham Clinical Trials Unit, University Park, Nottingham, NG7 2RD, UK
| | - Trevor Jones
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK
| | - Blerina Kellezi
- Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK
| | - Jade Kettlewell
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University Park, Nottingham, NG7 2RD, UK
| | - Richard Morriss
- Institute of Mental Health, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | | | - Davina Richardson
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, London, W2 1NY, UK
| | - Matthew Smith
- Academic Department of Rehabilitation Medicine, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Stephen Timmons
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, NG8 1BB, UK
| | | | - Kathryn Radford
- Centre for Rehabilitation & Ageing Research (CRAR), Injury, Recovery Sciences and Inflammation (IRIS), School of Medicine, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
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Oude Geerdink E, Huysmans MA, van Kempen H, van Weeghel J, Motazedi E, Anema JR. Individual Placement and Support and Participatory Workplace Intervention on the Work Participation of People with Disabilities: A Randomised Controlled Trial. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10219-6. [PMID: 38954248 DOI: 10.1007/s10926-024-10219-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE This study assessed the effectiveness of Individual Placement and Support (IPS), Participatory Workplace Intervention (PWI), and IPS + PWI on work participation and health of people with work disabilities. METHODS A randomised controlled 2 × 2 factorial trial with 120 clients and an 18-month follow-up was performed. Differences between IPS and no-IPS and between PWI and no-PWI were assessed using log-rank tests and Cox proportional hazards models. RESULTS In the IPS group, restricted mean survival time (RMST) for sustainable paid employment was 352 days, compared to 394 in the no-IPS group (HR = 1.47, 95% CI = 0.81-2.63). In the PWI group the RMST was 378 days, compared to 367 in the no-PWI group (HR = 0.89, 95% CI = 0.48-1.64). For the secondary outcome 'starting any paid employment, a trial placement, or education' RMST was significantly lower for the IPS group (222 days) than for the no-IPS group (335 days; HR = 1.85, 95% CI = 1.01-3.42). Mental health was significantly lower (worse) in the PWI group (difference -4.07, 95% CI = -7.93 to -0.22) than in the no-PWI group. For all other secondary outcomes, no statistically significant differences were found. CONCLUSION No statistically significant differences were observed in the duration until starting sustainable employment between IPS and no-IPS, and between PWI and no-PWI. The duration until starting any paid employment, a trial placement, or education was shorter in the IPS group than in the no-IPS group, but further research should explore whether this also increases sustainable employment in the longer term.
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Affiliation(s)
- E Oude Geerdink
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU Medical Center, Vrije Universiteit Amsterdam, Van der Boechorstraat 7, Postbus 7057, 1081 BT, Amsterdam, The Netherlands.
| | - M A Huysmans
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU Medical Center, Vrije Universiteit Amsterdam, Van der Boechorstraat 7, Postbus 7057, 1081 BT, Amsterdam, The Netherlands
| | - H van Kempen
- Research and Statistics, City of Amsterdam, Amsterdam, The Netherlands
| | - J van Weeghel
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - E Motazedi
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU Medical Center, Vrije Universiteit Amsterdam, Van der Boechorstraat 7, Postbus 7057, 1081 BT, Amsterdam, The Netherlands
| | - J R Anema
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU Medical Center, Vrije Universiteit Amsterdam, Van der Boechorstraat 7, Postbus 7057, 1081 BT, Amsterdam, The Netherlands
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Whitworth A, Baxter S, Cullingworth J, Clowes M. Individual Placement and Support (IPS) beyond severe mental health: An overview review and meta-analysis of evidence around vocational outcomes. Prev Med Rep 2024; 43:102786. [PMID: 38975284 PMCID: PMC11225006 DOI: 10.1016/j.pmedr.2024.102786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 07/09/2024] Open
Abstract
Objective To provide an overview review of international evidence of vocational outcomes in Individual Placement and Support (IPS) interventions for populations other than severe mental health. Methods An overview of reviews published in English since 2000 reporting vocational outcomes (job entry, work sustainment, earnings, work hours, time to job entry) against counterfactuals of IPS interventions for population groups other than severe mental health. The overview review maximises data from individual studies and includes additional recent primary studies. DerSimonian-Laird random effects meta-analysis was performed. Results Thirteen eligible studies were identified from five reviews and five more recent individual studies were also identified. IPS studies covered a range of groups with a concentration towards mental health. For the primary vocational outcome of job entry all IPS studies showed superior job entry rates compared to control groups with an overall weighted odds ratio of 1.78 [1.42,2.22]. Substantial heterogeneity was identified by study size and the overall weighted odds ratio of 1.32 [1.2,1.46] estimated from the large and medium sized studies seems a more plausible estimate of the likely effects of scaled-up IPS interventions in groups beyond severe mental health. Secondary vocational outcomes including job sustainment, total earnings, average weekly hours worked and time to job entry were typically superior in IPS services than control groups. Conclusions IPS services are consistently more effective in supporting diverse population groups into sustained employment compared to business-as-usual employment services. The evidence is limited by unclear terminology, small sample sizes, incomplete intervention fidelity, intervention contamination and inconsistent measurement.
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Affiliation(s)
- Adam Whitworth
- Strathclyde Business School, University of Strathclyde, 199 Cathedral St, Glasgow G40QU, UK
| | - Susan Baxter
- University of Sheffield, School for Health and Related Research, Regent Court, Regent Street, Sheffield S14DA, UK
| | - Jane Cullingworth
- School of Social and Political Sciences, Adam Smith Building, University of Glasgow, G128RT, UK
| | - Mark Clowes
- University of Sheffield, School for Health and Related Research, Regent Court, Regent Street, Sheffield S14DA, UK
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Raha SS, Yip S, Ho C, Olayinka O, Peláez-Ballestas I, Rame-Montiel AK, MacIsaac R, Henderson R, Kovacs Burns K, Bakal J, Charbonneau R, Kamran R, Loyola-Sanchez A. Novel Application of the World Health Organization Community-Based Rehabilitation Matrix to Understand Services' Contributions to Community Participation for Persons With Traumatic Spinal Cord Injury: A Mixed-Methods Study. Am J Phys Med Rehabil 2023; 102:815-822. [PMID: 36917031 DOI: 10.1097/phm.0000000000002220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
PURPOSE The aim of the study is to use the World Health Organization community-based rehabilitation matrix for understanding services' contributions to foster community participation for people with traumatic spinal cord injury. METHODS This study used a convergent mixed-methods design with a quantitative arm describing the frequency with which services contributed to 22 of the community-based rehabilitation-matrix elements and a qualitative arm involving document reviews and stakeholder interviews. Results were integrated following Onwuegbuzie and Teddlie's method (i.e., quan + QUAL). RESULTS Twenty of the 22 (91%) of the World Health Organization community-based rehabilitation elements were addressed by traumatic spinal cord injury services. Five types of services were identified. Integrated results showed that the strengths of traumatic spinal cord injury services were as follows: (1) comprehensiveness; (2) essential medical services publicly funded; (3) numerous social protections available; and (4) highly active community-based organizations. Identified opportunities to improve these services were as follows: (1) increase specificity for traumatic spinal cord injury and (2) increase communication and integration among services. CONCLUSIONS Services available for people with traumatic spinal cord injury in the province studied address most of the elements of the World Health Organization community-based rehabilitation matrix. However, lack of cohesion between services could create gaps that hinder community participation. Addressing these gaps could improve the quality of life and outcomes of people with traumatic spinal cord injury.
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Affiliation(s)
- Srijan S Raha
- From the Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (SSR, SY, CH, OO, AL-S); Cumming School of Medicine, University of Calgary, Calgary, Canada (SSR); Faculty of Science, University of British Columbia, Vancouver, Canada (SY); Alberta Health Services, Edmonton, Canada (CH, KKB, AL-S); Hospital General de México "Dr. Eduardo Liceaga," México City, Mexico (IP-B); Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada (AKR-M); Spinal Cord Injury Alberta, Edmonton, Canada (RM); Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada (RH, RC); Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada (RH); School of Public Health, University of Alberta, Edmonton, Canada (KKB); Provincial Research Data Services, Alberta Health Services, Edmonton, Canada (JB); Alberta Health Services, Calgary, Canada (RC); Department of Clinical Neurosciences, University of Calgary, Calgary, Canada (RC); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada (RK)
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Vigna E, Beyer S, Meek A. A demographic and qualitative analysis of the determinants of success in a National Supported Employment project. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023. [PMID: 36919902 DOI: 10.1111/jar.13094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/08/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND People with an intellectual disability and/or autism experience low employment rates compared to the general population. This study shows what the determinants of success are in getting this group of young people into paid employment. METHOD The research is based on data collected on 1008 young people, aged 16-25, participating in the Engage to Change project across Wales, to support young people to achieve employment. A real-time data collection system was used from their engagement and throughout their journey to employment. RESULTS This research indicates an overall employment rate of 23% for the project to date, based on total referral. Young people who engaged in 'significant work experience', such as paid placement or supported internship, had a greater employment rate of 37%. CONCLUSION Previous and current real work experiences increased the chances of young people of becoming employed, above the effect of supported employment and job coach support.
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Affiliation(s)
- Elisa Vigna
- National Centre for Mental Health - School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Stephen Beyer
- National Centre for Mental Health - School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Andrea Meek
- National Centre for Mental Health - School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Ottomanelli L, Cotner BA, Swanson SJ, Dirk L, Arriola NB, Carlomagno J, Toscano R. Individual Placement and Support Helps People With Spinal Cord Injury Find and Keep Jobs They Want. Arch Phys Med Rehabil 2023:S0003-9993(23)00054-0. [PMID: 36736601 DOI: 10.1016/j.apmr.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/04/2022] [Accepted: 11/13/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Lisa Ottomanelli
- Research Service of the James A. Haley Veterans' Hospital (JAHVH), and the Rehabilitation and Mental Health Counseling Program, Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida (USF), Tampa, FL.
| | - Bridget A Cotner
- Research Service of the JAHVH; Department of Anthropology, USF, is Secretary of the ACRM Military and Veterans Affairs Networking Group
| | | | - Lynn Dirk
- Tampa VA Research and Education Foundation
| | | | - Joe Carlomagno
- Vocational Rehabilitation Services, Veterans Health Administration, Washington, DC
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Poutanen J, Joensuu M, Unkila K, Juvonen-Posti P. Sustainable employability in Supported Employment and IPS interventions in the context of the characteristics of work and perspectives of the employers: a scoping review protocol. BMJ Open 2022; 12:e058413. [PMID: 35715178 PMCID: PMC9207909 DOI: 10.1136/bmjopen-2021-058413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The sustainable employment outcomes and cost-effectiveness of Supported Employment (SE) and Individual Placement and Support (IPS) have been well reported. Research has also focused on various target groups, compliance with the quality criteria for the implementation of the SE/IPS method in diverse work life and social security contexts. However, the impact of employers' interests and the quality and opportunities of jobs or the work itself for sustainable working careers have not been studied extensively. The objective of the proposed scoping review is to systematically explore what is known about sustainable employability in SE and IPS interventions in the context of the characteristics of work and perspectives of the employers. METHODS AND ANALYSES The scoping review methodological framework by Arksey and O'Malley and its recently enhanced versions are used as guidelines in this study. The literature search, which was conducted in Medline, Scopus, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and Social Science Premium Collection (ProQuest), identified a total of 2706 articles after the removal of duplicates. Key findings of selected studies will be charted, analysed and reported. ETHICS AND DISSEMINATION The study does not require ethics approval, as the data are collected from secondary sources. The final version of the scoping review will be published in a peer-reviewed academic journal. Findings of the review will be used in the upcoming ethnographic observation at work study, which is part of the Finnish Work Ability Programme Evaluation Study (2020-2023).
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Affiliation(s)
- Joonas Poutanen
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Matti Joensuu
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Kirsi Unkila
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Tampere, Finland
| | - Pirjo Juvonen-Posti
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
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Ottomanelli L, Goetz LL, Barnett SD, Njoh E, Fishalow J. Factors associated with past and current employment of veterans with spinal cord injury. J Spinal Cord Med 2022; 45:137-147. [PMID: 32634338 PMCID: PMC8890580 DOI: 10.1080/10790268.2020.1769950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objective: The purpose of this study was to examine variables predictive of post-SCI return to employment and current employment among a large cohort of veterans with Spinal Cord Injury (SCI) treated within the Veterans Health Administration (VHA) SCI System of Care.Design: Cross sectional analysis of data obtained during in-person baseline interviews and follow-up phone interviews.Setting: Seven SCI Centers within Veteran Affairs Medical Centers.Participants: 1047 veterans with SCI receiving inpatient or outpatient care in VHA.Results: Only 29.8% were employed post-SCI, 27.9% reported employment within the immediate 5 years before the baseline interview, but only 9.2% reported current employment at the time of the baseline interview. Significant predictors of current employment among these veterans with SCI included recent employment experience, history of legal problems, duration of SCI, education, and life satisfaction.Conclusions: The baseline employment rate following SCI of a large, representative sample, was 29.8%. Greater duration of SCI predicted unemployment, likely due to the older age of this population. Additional years of education promoted current and post-SCI employment, while a history of legal problems was a barrier to employment.
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Affiliation(s)
- Lisa Ottomanelli
- James A. Haley Veterans’ Hospital and Clinics, Tampa, Florida, USA,Department of Mental Health and Rehabilitation Counseling, University of South Florida, Tampa, Florida, USA,Correspondence to: Lisa Ottomanelli, James A. Haley Veterans’ Hospital and Clinics, 8900 Grand Oaks Circle, Tampa, FL33637, USA.
| | - Lance L. Goetz
- Hunter Holmes McGuire VA Medical Center and Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Scott D. Barnett
- James A. Haley Veterans’ Hospital and Clinics, Tampa, Florida, USA
| | - Eni Njoh
- James A. Haley Veterans’ Hospital and Clinics, Tampa, Florida, USA
| | - Jaclyn Fishalow
- James A. Haley Veterans’ Hospital and Clinics, Tampa, Florida, USA
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Probyn K, Engedahl MS, Rajendran D, Pincus T, Naeem K, Mistry D, Underwood M, Froud R. The effects of supported employment interventions in populations of people with conditions other than severe mental health: a systematic review. Prim Health Care Res Dev 2021; 22:e79. [PMID: 34879882 PMCID: PMC8724223 DOI: 10.1017/s1463423621000827] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/20/2021] [Accepted: 11/15/2021] [Indexed: 11/07/2022] Open
Abstract
AIM To assess the effectiveness of supported employment interventions for improving competitive employment in populations of people with conditions other than only severe mental illness. BACKGROUND Supported employment interventions have been extensively tested in severe mental illness populations. These approaches may be beneficial outside of these populations. METHODS We searched PubMed, Embase, CINAHL, PsycInfo, Web of Science, Scopus, JSTOR, PEDro, OTSeeker, and NIOSHTIC for trials including unemployed people with any condition and including severe mental illness if combined with other co-morbidities or other specific circumstances (e.g., homelessness). We excluded trials where inclusion was based on severe mental illness alone. Two reviewers independently assessed risk of bias (RoB v2.0) and four reviewers extracted data. We assessed rates of competitive employment as compared to traditional vocational rehabilitation or waiting list/services as usual. FINDINGS Ten randomised controlled trials (913 participants) were included. Supported employment was more effective than control interventions for improving competitive employment in seven trials: in people with affective disorders [risk ratio (RR) 10.61 (1.49, 75.38)]; mental disorders and justice involvement [RR 4.44 (1.36,14.46)]; veterans with posttraumatic stress disorder (PTSD) [RR 2.73 (1.64, 4.54)]; formerly incarcerated veterans [RR 2.17 (1.09, 4.33)]; people receiving methadone treatment [RR 11.5 (1.62, 81.8)]; veterans with spinal cord injury at 12 months [RR 2.46 (1.16, 5.22)] and at 24 months [RR 2.81 (1.98, 7.37)]; and young people not in employment, education, or training [RR 5.90 (1.91-18.19)]. Three trials did not show significant benefits from supported employment: populations of workers with musculoskeletal injuries [RR 1.38 (1.00, 1.89)]; substance abuse [RR 1.85 (0.65, 5.41)]; and formerly homeless people with mental illness [RR 1.55 (0.76, 3.15)]. Supported employment interventions may be beneficial to people from more diverse populations than those with severe mental illness alone. Defining competitive employment and increasing (and standardising) measurement of non-vocational outcomes may help to improve research in this area.
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Affiliation(s)
- Katrin Probyn
- Department of Psychology, Royal Holloway, University of London, Egham Hill, Egham, Surrey, UK
| | | | | | - Tamar Pincus
- Department of Psychology, Royal Holloway, University of London, Egham Hill, Egham, Surrey, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Khadija Naeem
- Department of Psychology, Royal Holloway, University of London, Egham Hill, Egham, Surrey, UK
| | - Dipesh Mistry
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- University Hospitals Coventry & Warwickshire, University of Warwick, Coventry, UK
| | - Robert Froud
- Department of Health Sciences, Kristiana University College, Oslo, Norway
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Metcalfe JD, Drake RE. Participation in Individual Placement and Support in the Supported Employment Demonstration. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:521-529. [PMID: 34855098 DOI: 10.1007/s10488-021-01180-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
Individual placement and support (IPS) was the primary intervention in the United States Social Security Administration's supported employment demonstration (SED), a large randomized trial that sought to increase employment and reduce disability among those whose first application for disability benefits was denied. Researchers developed a measure of participation in IPS services to quantify participation among enrollees assigned to receive IPS. The IPS participation measure, which IPS teams completed monthly for individual clients, recorded clients assigned to IPS as being either out of contact with their IPS treatment teams or, if in contact, according to their employment status (employed or not employed) and receipt of IPS job search services (participating or not participating). The measure also recorded types of IPS activities and reasons for non-participation. IPS teams completed the IPS participation measure at a rate of approximately 95% each month. Between 27 and 35% of enrollees assigned to a treatment condition participated in IPS services each month during the first 24 months of measurement. The most common activities were applying for jobs and attending job interviews. Most of those out of contact were not responding to outreach efforts (58-72%). Those in contact but not participating despite being unemployed were typically either uninterested in employment (20-44%) or difficult to reach (10-16%). As IPS expands to serve new populations, it will be important to document and understand the links between individual characteristics, variance in participation patterns, and employment outcomes. Subsequent analyses of SED data will investigate these relationships among enrollees.
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Affiliation(s)
- Justin D Metcalfe
- Westat Inc, 85 Mechanic Street, Suite C3-1, Box4A, Lebanon, NH, 03766, USA.
| | - Robert E Drake
- Westat Inc, 85 Mechanic Street, Suite C3-1, Box4A, Lebanon, NH, 03766, USA
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Ahonle ZJ, Kreider CM, Hale-Gallardo J, Castaneda G, Findley K, Ottomanelli L, Romero S. Implementation and use of video tele-technologies in delivery of individualized community-based vocational rehabilitation services to rural veterans. JOURNAL OF VOCATIONAL REHABILITATION 2021. [DOI: 10.3233/jvr-211159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Telerehabilitation is an effective health delivery method for patients with a variety of health conditions. There is insufficient knowledge about use of telerehabilitation to support patients with disabilities and chronic illness in obtaining or sustaining competitive employment. Employment rates of Veterans are lower than civilian rates, and the employment gap is higher for Veterans living in rural areas. OBJECTIVE: To investigate factors that enabled and constrained routine use of video tele-technologies in delivering individualized community-based vocational rehabilitation (referred to as Tele-VR) services and to identify impacts and promising practices in implementation. METHODS: Semi-structured interviews with providers from two Veterans Health Administration Medical Sites that use telerehabilitation to supplement their existing face-to-face individualized community-based VR services. Interviews were analyzed using thematic analysis. RESULTS: Five themes in the implementation of Tele-VR were identified (1) Enhancing Workflow for Providers, (2) Improving Quality of Therapeutic Care, (3) Practicalities in Implementing Tele-VR, (4) Embedding Vocational Rehabilitation into Interdisciplinary Care as a Facilitator to Implementation, and (5) Impact of Tele-VR. CONCLUSIONS: The telerehabilitation delivery of employment service to Veterans with disabilities is a viable means for remotely providing or enhancing face-to-face individualized and community-based VR services that support Veterans’ competitive employment and job stability within their communities.
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Affiliation(s)
- Zaccheus J. Ahonle
- Veterans Rural Health Resource Center –Gainesville, Department of Veterans Affairs, Gainesville, FL, USA
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - Consuelo M. Kreider
- Veterans Rural Health Resource Center –Gainesville, Department of Veterans Affairs, Gainesville, FL, USA
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - Jennifer Hale-Gallardo
- North Florida/South Georgia Veterans Health System, Department of Veterans Affairs, Gainesville, FL, USA
| | - Gail Castaneda
- Veterans Rural Health Resource Center –Gainesville, Department of Veterans Affairs, Gainesville, FL, USA
| | - Kimberly Findley
- Veterans Rural Health Resource Center –Gainesville, Department of Veterans Affairs, Gainesville, FL, USA
| | - Lisa Ottomanelli
- VA - James A Haley Veterans’ Hospital and Clinics, Tampa, FL, USA
| | - Sergio Romero
- Veterans Rural Health Resource Center –Gainesville, Department of Veterans Affairs, Gainesville, FL, USA
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
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12
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Nowrouzi-Kia B, Nadesar N, Sun Y, Ott M, Sithamparanathan G, Thakkar P. Prevalence and predictors of return to work following a spinal cord injury using a work disability prevention approach: A systematic review and meta-analysis. TRAUMA-ENGLAND 2021. [DOI: 10.1177/14604086211033083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Worldwide, spinal cord injuries are associated with diminished participation in the labor market. Inconclusive reporting and differences between workplace settings for individuals with spinal cord injury (SCI) make conceptualizing return to work rates among this population inherently challenging. The objectives of this study are to explore factors associated with return to work (RTW) following an SCI. Moreover, the factors were classified according to the work disability prevention framework. Finally, we conducted a meta-analysis of the prevalence of RTW following an SCI. Methods Original articles were identified through a literature search in four health databases. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the mapping and identification of records. Included studies contained primary studies that included the nature of the injury, antecedent factors associated with the injury, and study characteristics and RTW outcomes. Exclusion criteria for the studies included if there was no discussion of RTW outcomes, systematic reviews, and meta-analyses. Results A total of 461 full-text articles were assessed for eligibility, and eight studies were included and assessed using the Critical Appraisal Skills Programme checklist, Risk of Bias, and Newcastle–Ottawa Scale. Four studies identified personal system factors, four identified healthcare system factors, two identified compensation system factors, and one identified workplace system factors. Conclusions Attempts to optimize RTW among persons with SCI are inherently difficult due to the diversity of this client population. Findings from the studies included in this systematic review support the utility of interventions for facilitating RTW, such as vocational rehabilitation and workplace accommodations, while simultaneously acknowledging the limitations in identifying specific interventions as facilitatory or inhibitory throughout the process.
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Affiliation(s)
- Behdin Nowrouzi-Kia
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Research in Occupational Safety and Health, School of Rural and Northern Health, Laurentian University, Sudbury, ON, Canada
| | - Nirusa Nadesar
- Centre for Research in Occupational Safety and Health, School of Rural and Northern Health, Laurentian University, Sudbury, ON, Canada
| | - Yingji Sun
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Markus Ott
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gobika Sithamparanathan
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Priya Thakkar
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Dunn J, Martin RA, Hackney JJ, Nunnerley JL, Snell D, Bourke JA, Hall A, Derrett S. Early vocational rehabilitation for people with spinal cord injury: a research protocol using realist synthesis and interviews to understand how and why it works. BMJ Open 2021; 11:e048753. [PMID: 33941637 PMCID: PMC8098913 DOI: 10.1136/bmjopen-2021-048753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Return to work after spinal cord injury (SCI) is linked to well-being and better physical and mental health outcomes. In New Zealand, work rates after SCI are lower than the general population. Vocational rehabilitation is one method of supporting return to work. Although the best model has not been determined, there is evidence supporting early intervention. However, most vocational rehabilitation research focuses on return to work outcomes without considering why vocational rehabilitation works, for whom and under what circumstances. Given this knowledge gap, we detail a realist synthesis protocol aiming to explain how contextual factors trigger relevant mechanisms to facilitate return to work after SCI. METHODS AND ANALYSIS This study will use a realist synthesis approach, following Realist And MEta-narrative Evidence Synthesis: Evolving Standards (RAMESES) guidelines. First, we will undertake a realist review of existing published and grey literature. Second, to assist with theoretical conceptualisation, we will interview people with SCI who have received vocational rehabilitation. Finally, we will survey people with SCI who received early vocational rehabilitation for theoretical testing and refinement. ETHICS AND DISSEMINATION University of Otago Ethics Committee (Reference H19/170) has been obtained. A knowledge translation event will address issues relevant to wider implementation of the intervention and study findings. Findings will be also be disseminated through peer reviewed journals, conference presentations and formal reports.
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Affiliation(s)
- Jennifer Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Rachelle A Martin
- Department of Medicine, University of Otago, Wellington, New Zealand
- Burwood Academy of Independent Living, Christchurch, New Zealand
| | | | - Joanne L Nunnerley
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
- Burwood Academy of Independent Living, Christchurch, New Zealand
| | - Deborah Snell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - John A Bourke
- Burwood Academy of Independent Living, Christchurch, New Zealand
- Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
| | - Andrew Hall
- New Zealand Spinal Trust, Christchurch, New Zealand
| | - Sarah Derrett
- Preventative and Social Medicine, University of Otago, Dunedin, New Zealand
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14
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Wehman P, Schall C, McDonough J, Sima A, Brooke A, Ham W, Whittenburg H, Brooke V, Avellone L, Riehle E. Competitive Employment for Transition-Aged Youth with Significant Impact from Autism: A Multi-site Randomized Clinical Trial. J Autism Dev Disord 2020; 50:1882-1897. [PMID: 30825082 DOI: 10.1007/s10803-019-03940-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study reports the results of a multi-site, parallel block randomized clinical trial to expand the previous findings regarding the implementation of Project SEARCH plus ASD Supports (PS + ASD) on employment outcomes upon graduation from high school. Participants were 156 individuals with significant impact from ASD between the ages of 18-21. There was a significant difference between treatment and control groups with 73.4% of the treatment group acquiring competitive employment at or above minimum wage by 1-year after graduation compared to 17% of the control group for whom data was provided. At 1-year, employed treatment group participants worked an average of 21.2 h per week (SD = 9) for a mean hourly wage of $9.61 per hour (SD = $1.55).Clinical Trial Registration: clinicaltrials.gov Identifier: NCT03560453.
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Affiliation(s)
- Paul Wehman
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA.,Rehabilitation Research and Training Center, Virginia Commonwealth University, Richmond, VA, USA.,School of Education, VCU Autism Center for Excellence, Virginia Commonwealth University, Box 842011, Richmond, VA, 23284-2011, USA
| | - Carol Schall
- Rehabilitation Research and Training Center, Virginia Commonwealth University, Richmond, VA, USA. .,School of Education, Virginia Commonwealth University, Richmond, VA, USA. .,School of Education, VCU Autism Center for Excellence, Virginia Commonwealth University, Box 842011, Richmond, VA, 23284-2011, USA.
| | - Jennifer McDonough
- Rehabilitation Research and Training Center, Virginia Commonwealth University, Richmond, VA, USA.,School of Education, Virginia Commonwealth University, Richmond, VA, USA
| | - Adam Sima
- Department of Biostatistics, Virginia Commonwealth University, Richmond, USA
| | - Alissa Brooke
- Rehabilitation Research and Training Center, Virginia Commonwealth University, Richmond, VA, USA.,School of Education, Virginia Commonwealth University, Richmond, VA, USA.,School of Education, VCU Autism Center for Excellence, Virginia Commonwealth University, Box 842011, Richmond, VA, 23284-2011, USA
| | - Whitney Ham
- Rehabilitation Research and Training Center, Virginia Commonwealth University, Richmond, VA, USA.,School of Education, Virginia Commonwealth University, Richmond, VA, USA.,School of Education, VCU Autism Center for Excellence, Virginia Commonwealth University, Box 842011, Richmond, VA, 23284-2011, USA
| | - Holly Whittenburg
- Rehabilitation Research and Training Center, Virginia Commonwealth University, Richmond, VA, USA.,School of Education, Virginia Commonwealth University, Richmond, VA, USA
| | - Valerie Brooke
- Rehabilitation Research and Training Center, Virginia Commonwealth University, Richmond, VA, USA.,School of Education, Virginia Commonwealth University, Richmond, VA, USA.,School of Education, VCU Autism Center for Excellence, Virginia Commonwealth University, Box 842011, Richmond, VA, 23284-2011, USA
| | - Lauren Avellone
- Rehabilitation Research and Training Center, Virginia Commonwealth University, Richmond, VA, USA.,School of Education, Virginia Commonwealth University, Richmond, VA, USA.,School of Education, VCU Autism Center for Excellence, Virginia Commonwealth University, Box 842011, Richmond, VA, 23284-2011, USA
| | - Erin Riehle
- Division of Disability Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Holmlund L, Guidetti S, Hultling C, Seiger Å, Eriksson G, Asaba E. Evaluating the feasibility of ReWork-SCI: a person-centred intervention for return-to-work after spinal cord injury. BMJ Open 2020; 10:e036000. [PMID: 32819984 PMCID: PMC7443280 DOI: 10.1136/bmjopen-2019-036000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility of: (1) ReWork-SCI with regard to adherence and acceptability and (2) a study design for evaluating ReWork-SCI with regard to recruitment, retention and outcome measures. DESIGN Pre-test and post-test, single group, feasibility study. SETTING Spinal cord injury (SCI) unit at a regional rehabilitation centre in Sweden. PARTICIPANTS Two women and five men (n=7). Eligible criteria: (1) sustained traumatic or non-traumatic SCI; (2) completed the first acute care episode in a hospital; (3) between 18 to 65 years of age; (4) assessed by a physician as approachable for participation in the intervention; (5) history of permanent or temporary employment; (6) self-reported desire to return to work; and (7) ability to communicate in English or Swedish. INTERVENTION ReWork-SCI is a person-centred intervention for return-to-work (RTW), developed and evaluated using the Medical Research Council's guidelines. ReWork-SCI follows a person-centred, structured and coordinated intervention process led by a coordinator within a SCI rehabilitation team. OUTCOME MEASURES The feasibility of ReWork-SCI and a study design was evaluated using a set of outcome measurement tools, vocational data, logbooks and semi-structured interviews. RESULTS All eligible participants accepted enrolment and follow-up. All participants had a plan for RTW after 3 months and four participants had initiated part-time work or work trial 6 months after commencement of intervention. Adherence and acceptability were overall good. Challenges of the intervention related to the person-centred follow-up, staff shortage and rootedness in the SCI team. CONCLUSIONS ReWork-SCI was feasible and can contribute to a systematic design of an individualised plan, facilitate decision-making and build trust in the RTW process after SCI. Core features of the intervention was the systematic structure, use of a person-centred approach and dialogue with the employer. For the effectiveness of ReWork-SCI, modifications and considerations of study design are needed.
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Affiliation(s)
- Lisa Holmlund
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Rehab Station Stockholm/Spinalis, R&D Unit, Rehab Station Stockholm, Stockholm, Sweden
| | - Susanne Guidetti
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Claes Hultling
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Neurology, Karolinska Universitetssjukhuset, Solna, Sweden
| | - Åke Seiger
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Rehab Station Stockholm/Spinalis, R&D Unit, Rehab Station Stockholm, Stockholm, Sweden
| | - Gunilla Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
| | - Eric Asaba
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Research, Education, and Development Unit, Stockholms Sjukhem Foundation, Stockholm, Sweden
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16
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Holmlund L, Guidetti S, Eriksson G, Asaba E. Return-to-work: Exploring professionals' experiences of support for persons with spinal cord injury. Scand J Occup Ther 2020; 28:571-581. [PMID: 32755475 DOI: 10.1080/11038128.2020.1795245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To generate knowledge about how professional stakeholders organise and experience the support of the return-to-work (RTW) process for persons with spinal cord injury (SCI). METHODS Constructivist grounded theory approach. Professional stakeholders (n = 34) involved in the RTW process and representing three Swedish Regions were recruited into seven focus groups. Analysis followed initial, focussed, and theoretical coding. FINDINGS The core category - mediating intentions to support work and possibilities of working through social, labour market, and societal context - illustrates complexities of when and how to support a person with SCI in the RTW process, and a risk of delayed, unequal, or absent RTW processes. Analysis outlines: (1) Assessment of ability to work - uncertainty of how and when; (2) Planning RTW - divide between dynamic and rule-based perspectives; (3) Work re-entry - unequal paths towards viable solutions. CONCLUSIONS In RTW after SCI, it is critical to acknowledge how the RTW process is situated in relation to the person and context. A possible direction - grounded in an occupational perspective - through early identification of needs and resources and coordination derived from the SCI rehabilitation setting within healthcare is suggested. This can facilitate a time-sensitive and equal RTW process.
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Affiliation(s)
- Lisa Holmlund
- Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.,Spinalis SCI Unit, Rehab Station Stockholm, Stockholm, Sweden
| | - Susanne Guidetti
- Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Gunilla Eriksson
- Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.,Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
| | - Eric Asaba
- Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.,Research, Education, and Development Unit, Stockholms Sjukhem Foundation, Stockholm, Sweden.,Department of Occupational Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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17
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Verhoef JAC, Bal MI, Roelofs PDDM, Borghouts JAJ, Roebroeck ME, Miedema HS. Effectiveness and characteristics of interventions to improve work participation in adults with chronic physical conditions: a systematic review. Disabil Rehabil 2020; 44:1007-1022. [PMID: 32686963 DOI: 10.1080/09638288.2020.1788180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Chronic physical conditions often negatively affect work participation. The objective of this systematic review is to investigate the effectiveness and characteristics of vocational rehabilitation interventions for people with a chronic physical condition. METHODS Searches in five databases up to April 2020 identified 30 studies meeting our inclusion criteria. Two reviewers independently assessed and extracted data. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) framework was used to evaluate quality of evidence for three outcome measures related to work participation. RESULTS All vocational rehabilitation interventions consisted of multiple components, but their characteristics varied widely. Analysis of 22 trials yielded a moderate positive effect with moderate certainty of interventions on work status; analysis of five trials with low risk of bias showed a large positive effect with moderate certainty (risk ratio 1.33 and 1.57, respectively). In addition, in eight studies we found a moderate to small positive effect with low certainty on work attitude (standardized mean difference = 0.59 or 0.38, respectively). We found no effect on work productivity in nine studies. CONCLUSION The systematic review of the literature showed positive effects of vocational rehabilitation interventions on work status and on work attitude; we found no effect on work productivity.Implications for rehabilitationIn rehabilitation, addressing work participation of persons with a chronic physical condition using targeted interventions is beneficial to improve or sustain work participation, irrespective of the intervention characteristics and diagnosis.Interventions that include multiple components and offer individual support, whether or not combined with group sessions, are likely to be more effective in improving work participation in persons with a chronic physical condition.The overview of vocational interventions in this systematic review may assist healthcare professionals in making informed decisions as to which intervention to provide.Vocational rehabilitation, as well as studies on work participation in chronic disease, should include a long follow-up period to explore if work participation is sustainable and contributes to health and wellbeing.
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Affiliation(s)
- Joan A C Verhoef
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marjolijn I Bal
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pepijn D D M Roelofs
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Jeroen A J Borghouts
- Research Centre Caring Society, Avans University of Applied Sciences, Breda, The Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,Rijndam Rehabilitation Institute, Rotterdam, The Netherlands
| | - Harald S Miedema
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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18
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Ottomanelli L, Goetz LL, O'Neill J, Lauer E, Dyson-Hudson T. 30 Years After the Americans with Disabilities Act: Perspectives on Employment for Persons with Spinal Cord Injury. Phys Med Rehabil Clin N Am 2020; 31:499-513. [PMID: 32624107 DOI: 10.1016/j.pmr.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The Americans with Disabilities Act, passed in 1990, represented landmark legislation and led to significant improvements in accessibility, such as prohibiting discrimination based on disability in public life, including employment. Now 30 years later, however, employment rates for persons with disabilities, including spinal cord injury, remain low. This article discusses why employment is so important for persons with spinal cord injury and challenges that remain. Presented are previously unpublished employment data from a nationally representative US sample. Finally, the state of the art of vocational rehabilitation, including models proven to facilitate this critical rehabilitation outcome, is discussed.
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Affiliation(s)
- Lisa Ottomanelli
- Research Service (151R), James A. Haley Veterans' Hospital and Clinics, 8900 Grand Oak Circle, Tampa, FL 33637, USA; Rehabilitation and Mental Health Counseling Program, Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, 4202 E. Fowler Ave, Tampa, FL 33620, USA.
| | - Lance L Goetz
- Spinal Cord Injury and Disorders (128), Department of Veterans Affairs, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - John O'Neill
- Center for Employment and Disability Research, Kessler Foundation, 120 Eagle Rock Avenue, East Hanover, NJ 07936, USA
| | - Eric Lauer
- Institute on Disability/University Centers for Excellence in Disabilities Education, Research, and Service, College of Health and Human Services, University of New Hampshire, 10 West Edge Drive, Suite 101, Durham, NH 03824, USA
| | - Trevor Dyson-Hudson
- Center for Spinal Cord Injury Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
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20
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Lervik LV, Knapstad M, Smith ORF. Process evaluation of Prompt Mental Health Care (PMHC): the Norwegian version of Improving Access to Psychological Therapies. BMC Health Serv Res 2020; 20:437. [PMID: 32430000 PMCID: PMC7236093 DOI: 10.1186/s12913-020-05311-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 05/08/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Prompt Mental Health Care (PMHC) is the Norwegian adaptation of Improving Access to Psychological Therapies (IAPT). Thus far, evaluations of PMHC have mostly focused on the effectiveness, rather than on contextual and implementation processes. Therefore, the objective of this study was to do a process evaluation and examine: 1) To what extent do the services follow guidelines provided by the Norwegian Directorate of Health (NDH), 2) what the therapists experienced as important barriers and facilitators in implementing the service, and 3) client treatment satisfaction and its associations with baseline variables. METHOD The present study uses data from 526 clients who received PMHC treatment in the municipalities of Sandnes and Kristiansand. The therapists completed questionnaires about each client's course of treatment. We conducted semi-structured interviews with the therapists and analysed them using thematic analysis. Data from client questionnaires were used to report descriptive sample statistics including symptom severity and treatment satisfaction. Linear regression was adopted to examine the associations between client treatment satisfaction and baseline characteristics. RESULTS Several aspects of PMHC were implemented in line with the guidelines provided by NDH. Importantly, both services reached out to the intended target group, and could further be characterized as low-threshold with relatively short waiting times (median waiting time between initial contact and treatment start was 27 days, IQR 18-39), no waiting lists, and frequent use of self-referral (33.3%). From the client perspective, results indicated a high degree of treatment satisfaction (Mean = 3.93 (SD = .71, range 1-5)), and this was true across demographic characteristics and symptom severity at baseline (all p > .05). Most notable challenges that came forward were; the low provision of guided self-help (received by only 1.0% of clients), the lack of focus on work participation (low to some degree of focus in 70.8% among sick-listed clients), the collaboration with other services (no collaboration in 85.3% of the clients), and some aspects regarding future development of the service. CONCLUSION Both sites managed to implement key aspects of PMHC in line with the guidelines, but further development of the program is warranted. Discussion of challenges and future recommendations are presented.
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Affiliation(s)
- Linn Vathne Lervik
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5015, Bergen, Norway.
| | - Marit Knapstad
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5015, Bergen, Norway.,Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Otto Robert Frans Smith
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5015, Bergen, Norway
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21
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Examining implicit procedural learning in tetraplegia using an oculomotor serial reaction time task. PLoS One 2020; 15:e0232124. [PMID: 32324808 PMCID: PMC7179886 DOI: 10.1371/journal.pone.0232124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/07/2020] [Indexed: 11/19/2022] Open
Abstract
Background and objective Clinical observations indicate that implicit procedural learning, a central component of physical and psychosocial rehabilitation, is impeded following spinal cord injury. In accordance, previous research has revealed a specific deficit in implicit sequence learning among individuals with paraplegia using a standard, manual version of the serial reaction time task. To extend these findings and shed light on the underlying sources of potential spinal cord injury-related deficits in sequence learning, we used an ocular activated serial reaction time task to compare sequence learning performance between individuals with tetraplegia and healthy controls. Participants and measures Twelve participants with spinal cord injury in C5-T1 were compared to 12 matched control participants on measures derived from an ocular activated serial reaction time task. Depression and additional cognitive measures were assessed to explore the source and specificity of potential sequence learning deficits. Results Like controls, and in contrast with previous findings in paraplegia, the spinal cord injury group showed intact implicit sequence learning, evidenced by declining reaction times and improved anticipation over the first six blocks of the serial reaction time task, and an advantage for the initial learning sequence over a novel interference sequence. Conclusions The ocular activated serial reaction time task elicited a performance pattern similar to standard motor versions, such that participants with tetraplegia demonstrated unimpaired sequence learning. This suggests that previously reported implicit sequence learning deficits in spinal cord injury directly involved motor functioning rather than cognitive aspects of the task, and that the ocular activated sequence learning task could be a valid alternative for assessing implicit sequence learning in populations that cannot perform spinal-cord dependent motor tasks. Implications for post-spinal cord injury rehabilitation and adjustment are discussed.
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22
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Merritt CH, Taylor MA, Yelton CJ, Ray SK. Economic impact of traumatic spinal cord injuries in the United States. ACTA ACUST UNITED AC 2019; 6. [PMID: 33869674 PMCID: PMC8052100 DOI: 10.20517/2347-8659.2019.15] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Individuals having sustained traumatic spinal cord injury (TSCI) in the United States are living longer as compared to historical trends, thanks to an ever-evolving understanding of the nature of this injury. Despite this, multiple barriers to care for TSCI patients remain including variations in government-issued veteran insurance, privatized insurance, and among uninsured individuals. The United States alone experiences 12,000 new TSCI cases every year, many of these are found to occur in a growing proportion of elderly individuals. It is crucial to understand both the short-term direct costs as wells as the long-term rehabilitation costs required by these TSCI patients. The lifetime financial burden for those having sustained a TSCI can be immense for patients, insurance companies, and hospital systems alike. Among those with TSCI, re-hospitalization rates are high, leading to increased healthcare resource utilization within this specific patient population. Costs can quickly balloon into hundreds of thousands of dollars and cause a profound financial burden for these patients. This review article seeks to communicate an understanding of the current financial landscape surrounding TSCI patients. The authors will also examine the costs of acute emergency room surgical care such as American spinal injury association grade, hospital length of stay, as well as the timing delay between injury and surgical decompression. Long-term costs associated with TSCI such as rehabilitation, care of secondary comorbidities, and post-injury employment prospects will be examined as well. These costs will be framed from the patient’s perspective as well as from both the hospital and insurance company’s perspectives. It is hoped a complete understanding as to what makes TSCI such a medically and financially burdensome injury will allow for improved healthcare resource utilization in this population.
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Affiliation(s)
- Christopher H Merritt
- Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - Matthew A Taylor
- Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - Caleb J Yelton
- Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - Swapan K Ray
- Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA
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Bond GR, Drake RE, Pogue JA. Expanding Individual Placement and Support to Populations With Conditions and Disorders Other Than Serious Mental Illness. Psychiatr Serv 2019; 70:488-498. [PMID: 30813865 DOI: 10.1176/appi.ps.201800464] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A systematic review of studies of individual placement and support (IPS) for populations other than those with serious mental illness was conducted. METHODS The authors searched three electronic databases (PubMed, Web of Science, and Scopus) for studies of IPS and modified IPS. Eligibility criteria for the systematic review included randomized controlled trials with prospective data collection on competitive employment rate and at least 10 study participants from a well-defined population other than people with serious mental illness. Results were compiled for competitive employment rates, IPS fidelity, and other outcomes. RESULTS Three clinical groups other than people with serious mental illness have been studied: people with psychiatric disorders other than serious mental illness, people with substance use disorders, and people with musculoskeletal or neurological disorders. Nine controlled trials with a total of 2,902 participants included six trials with people who had psychiatric disorders other than serious mental illness, two with people who had substance use disorders, and one with people who had spinal cord injuries. In eight studies, results for competitive employment rates significantly favored IPS. Meta-analysis yielded an overall weighted odds ratio of 2.23 (95% confidence interval=1.53-3.24, p<.001). Findings for other employment outcomes also favored IPS, but findings on symptom reduction and quality of life were inconsistent. The strongest (and only replicated) findings were for veterans with posttraumatic stress disorder (PTSD). Methodological limitations included small samples, major modifications to IPS fidelity, and short follow-up periods. CONCLUSIONS IPS, often with modifications, is a promising employment intervention for several populations in addition to people with serious mental illnesses. The strongest evidence pertains to veterans with PTSD. IPS should be offered to these veterans. Research on other populations, including people with anxiety, depression, substance use disorder, musculoskeletal or neurological conditions, or pain syndromes, needs development, amplification, and replication.
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Sutton BS, Ottomanelli L, Njoh E, Barnett S, Goetz L. Economic evaluation of a supported employment program for veterans with spinal cord injury. Disabil Rehabil 2019; 42:1423-1429. [PMID: 31099272 DOI: 10.1080/09638288.2018.1527955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To estimate the net monetary benefit of an individual placement and support-based supported employment program for Veterans with spinal cord injuries.Design: Economic evaluation comparing a supported employment program to treatment as usual, using cost and quality-of-life data from a longitudinal study of Veterans with spinal cord injuries.Setting: Spinal cord injury centers in the Veterans Health Administration.Participants: Subjects (N = 213) who participated in a 24-month supported employment program at seven spinal cord injury centers. Supported employment participants were compared with a group of spinal cord injury Veterans who received treatment as usual in a prior study.Main outcome measures: Costs and quality-adjusted life years using the Veterans Rand-6 Dimension, estimated from the Veterans Rand 36-Item Health Survey.Results: The supported employment program was more effective at both 1- and 2-year periods compared with treatment as usual. Outpatient costs were significantly higher for supported employment, but inpatient costs were not significantly different from treatment as usual. When cost and effectiveness were compared jointly using net monetary benefit, a supported employment program following the core principles of Individual Placement and Supported employment was more effective but not cost-effective at standard willingness to pay thresholds. When we considered a sub-group of the supported employment participants who more closely resemble the treatment as usual group from a randomized trial, there was no significant difference in the cost-effectiveness of supported employment when compared to treatment as usual.Conclusions: With higher effectiveness and similar costs, supported employment for spinal cord injury Veterans has the potential to be cost-effective. Future studies need to randomize participants or carefully match participants based on observable patient characteristics to improve cost-effectiveness evaluations of this population.Implications for RehabilitationSupported employment as part of ongoing rehabilitation care helps individuals with spinal cord injury return to work and improve their quality of life.Many studies show that supported employment programs are cost effective for persons with mental disabilities, but there is only limited economic evaluation data on use of supported employment with persons with spinal cord injury.This study shows that supported employment integrated with ongoing rehabilitation care is more effective in restoring employment and health-related quality of life.
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Affiliation(s)
- Bryce S Sutton
- Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL, USA
| | - Lisa Ottomanelli
- Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL, USA.,Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa, FL, USA
| | - Eni Njoh
- Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL, USA
| | - Scott Barnett
- Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL, USA
| | - Lance Goetz
- Hunter Holmes McGuire VA Medical Center, Richmond, VI, USA.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VI, USA
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25
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Dorsett P, McLennan V. Exploring the ‘status quo’ in vocational rehabilitation and employment outcomes following spinal cord injury. JOURNAL OF VOCATIONAL REHABILITATION 2019. [DOI: 10.3233/jvr-180995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Pat Dorsett
- School of Human Services and Social Work, Griffith University, Queensland, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Vanette McLennan
- School of Allied Health Sciences, Griffith University, Queensland, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
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26
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Morin JP, King AB, Goetz LL, Wolfe LG, Klausner AP. Racial disparities in bladder management in veterans with spinal cord injury and disorders. Neurourol Urodyn 2019; 38:968-974. [PMID: 30801793 DOI: 10.1002/nau.23942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/06/2018] [Accepted: 01/21/2019] [Indexed: 11/08/2022]
Abstract
AIMS Neurogenic lower urinary tract dysfunction is common in individuals with spinal cord injury and disorders (SCI/D). The purpose of this study was to identify specific demographic, neurologic, and urologic factors associated with different bladder management methods (BMMs) in individuals with SCI/D. METHODS A retrospective review of BMMs at a large Veterans Affairs SCI/D center was performed to identify associated risk factors including demographics, neurologic factors, and urologic factors. Bivariate analysis was performed to identify factors associated with specific BMMs. Then, a propensity-matched racial group analysis was performed to identify independent factors associated with differences in BMM. RESULTS Data from 833 patients with SCI/D were reviewed and included 52.1% Caucasians and 39.6% African Americans. On bivariate analysis, current age, years since the injury, the severity of functional impairment, nonmedical mechanism of injury, and Caucasian race were associated with increased rates of indwelling catheter use. In an analysis of propensity-matched racial groups, African-American race was found to be an independent risk factor for not using indwelling catheters on multivariate analysis (odds ratio = 0.55). This finding was not related to access to care, as the rate of urodynamic testing was similar between races ( P = 0.174). CONCLUSIONS Caucasians were more likely to use indwelling catheters and less likely to use conservative BMMs despite proper urodynamic evaluation. The racial discrepancy suggests a need for future research aimed at identifying unknown psychosocial factors associated with the use of indwelling catheters in individuals with SCI/D.
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Affiliation(s)
- Jacqueline P Morin
- Division of Urology/Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Ashley B King
- Division of Urology/Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Lance L Goetz
- Spinal Cord Injury & Disorders Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Luke G Wolfe
- Division of Urology/Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Adam P Klausner
- Division of Urology/Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
- Division of Urology/Department of Surgery, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
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Frederick DE, VanderWeele TJ. Supported employment: Meta-analysis and review of randomized controlled trials of individual placement and support. PLoS One 2019; 14:e0212208. [PMID: 30785954 PMCID: PMC6382127 DOI: 10.1371/journal.pone.0212208] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 01/29/2019] [Indexed: 11/17/2022] Open
Abstract
Supported employment is a treatment whereby those with severe mental illness (or other disabilities) receive aid searching for competitive employment and mental health (or other) treatments concurrently. The most popular implementation of supported employment is individual placement and support (IPS). We conducted meta-analytic analyses of the randomized controlled trials of IPS. We found that subjects in IPS, compared to usual treatment conditions, had better vocational outcomes (obtained any competitive employment: RR = 1.63, 95%CI = [1.46, 1.82]; job tenure: d = 0.55, 95%CI = [0.33, 0.79]; job length: d = 0.46, 95%CI = [0.35, 0.57]; income: d = 0.48, 95%CI = [0.36, 0.59]) Non-vocational outcomes estimates, while favoring IPS, included the null (quality of life: d = 0.30, 95%CI = [-0.07, 0.67]; global functioning: d = 0.09, 95%CI = [-0.09, 0.27]; mental health: d = 0.03, 95%CI = [-0.15, 0.21]). Analysis of the expected proportion of studies with a true effect on non-vocational outcomes with d>0.2 showed some reason to expect a possible improvement for quality of life for at least some settings (Prop = 0.57, 95%CI = [0.30, 0.84]).
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Affiliation(s)
- Donald E. Frederick
- Human Flourishing Program, The Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States of America
| | - Tyler J. VanderWeele
- Human Flourishing Program, The Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
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28
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Abstract
Spinal cord injury results in multiple secondary comorbidities, which vary based on injury severity and other characteristics. Persons with spinal cord injury are at lifelong risk for many complications, most of which are at least partially preventable with proper medical care. The Veterans Health Administration Spinal Cord Injury and Disorders (SCI&D) System of Care offers these evaluations to all persons in their registries. Annual evaluations are performed at any of the 24 SCI&D Veterans Administration Centers nationwide. This allows veterans to receive the care from an interdisciplinary team that specializes in the care of veterans with spinal cord injury.
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29
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Wehman P, Avellone L, Pecharka F, Sorboro K, Webster JB, Young C, Barton S, Robbins WA, Clanton ST. Reintegrating Veterans with Polytrauma into the Community and Workplace. Phys Med Rehabil Clin N Am 2018; 30:275-288. [PMID: 30470425 DOI: 10.1016/j.pmr.2018.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This article addresses employment as a critical part of community reintegration for polytrauma patients. Interdisciplinary polytrauma teams can work to effectively identify and eliminate known barriers to employment for veterans and offer continued support and guidance. This article discusses key themes pertinent to vocational reentry for service members/veterans, identifies evidenced-based employment models, highlights the essential role of everyday technology in meeting support needs, and describes 2 exemplar polytrauma models: the Louis Stokes Cleveland Veteran Affairs Medical Center in Cleveland, Ohio, and the Service member Transitional Advanced Rehabilitation (STAR) program at the Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, Virginia.
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Affiliation(s)
- Paul Wehman
- Division of Rehabilitation Research, Virginia Commonwealth University School of Medicine, 1314 West Main Street, PO Box 842011, Richmond, VA 23284, USA.
| | - Lauren Avellone
- Rehabilitation Research and Training Center, Virginia Commonwealth University, 1314 West Main Street, PO Box 842011, Richmond, VA 23284, USA
| | - Frederick Pecharka
- Louis Stokes Cleveland VA Medical Center, 1620 East 105th Street, Cleveland, OH 44106, USA
| | - Katti Sorboro
- Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Joseph B Webster
- Department of Physical Medicine and Rehabilitation, School of Medicine at Virginia Commonwealth University, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA
| | - Cynthia Young
- Service Member Transitional Advanced Rehabilitation (STAR) Program, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Boulevard, Building 514, Richmond, VA 23249, USA
| | - Sharon Barton
- Service Member Transitional Advanced Rehabilitation (STAR) Program, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Boulevard, Building 514, Richmond, VA 23249, USA
| | - William A Robbins
- Polytrauma Transitional Rehabilitation Program (PTRP), Servicemember Transitional Advanced Rehabilitation (STAR) Program, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Boulevard, Building 514, Richmond, VA 23249, USA
| | - Samuel T Clanton
- Traumatic Brain Injury/Polytrauma Fellow, Hunter Holmes McGuire VA Medical Center, Virginia Commonwealth University, 1223 East Marshall Street, PO Box 980677, Richmond, VA 23284-0667, USA
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30
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Holmlund L, Hultling C, Asaba E. Mapping Out One's Own Paths Toward Work: Focus on Experiences of Return to Work After Spinal Cord Injury. QUALITATIVE HEALTH RESEARCH 2018; 28:2020-2032. [PMID: 29911499 DOI: 10.1177/1049732318782706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Involving persons with spinal cord injury (SCI) as experts in their lives is important for research to design relevant health care interventions. The purpose of this study was to use photovoice methods to explore experiences of barriers and possibilities in return to work among working adults with SCI. The photovoice group consisted of six persons living with SCI that met weekly over 2 months to share and discuss photos related to return to work. Five themes were identified: (a) there is only one way, (b) welcome back-or not, (c) to be like anyone else-or to be perceived as someone else, (d) friction in the absence of clarity, and (e) finding integrated strategies for everyday life with work. Work was experienced as rewarding and viable, but due to lack of societal and workplace support, a need to map out one's own paths toward work was identified.
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Affiliation(s)
- Lisa Holmlund
- 1 Karolinska Institutet, NVS, Huddinge, Sweden
- 2 Rehab Station Stockholm, Sweden
| | - Claes Hultling
- 1 Karolinska Institutet, NVS, Huddinge, Sweden
- 2 Rehab Station Stockholm, Sweden
- 3 Karolinska University Hospital, Solna, Sweden
| | - Eric Asaba
- 1 Karolinska Institutet, NVS, Huddinge, Sweden
- 4 Stockholms Sjukhem Foundation, Stockholm, Sweden
- 5 Tokyo Metropolitan University, Tokyo, Japan
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31
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Ottomanelli L, Goetz LL, Barnett SD, Njoh E. Predictors of employment outcomes among supported employment program participants with spinal cord injury. JOURNAL OF VOCATIONAL REHABILITATION 2018. [DOI: 10.3233/jvr-180960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lisa Ottomanelli
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans’ Hospital, Tampa, FL, USA
- Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa, FL, USA
| | - Lance L. Goetz
- Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Scott D. Barnett
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans’ Hospital, Tampa, FL, USA
| | - Eni Njoh
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans’ Hospital, Tampa, FL, USA
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32
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Pinto AD, Hassen N, Craig-Neil A. Employment Interventions in Health Settings: A Systematic Review and Synthesis. Ann Fam Med 2018; 16:447-460. [PMID: 30201643 PMCID: PMC6130994 DOI: 10.1370/afm.2286] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/30/2018] [Accepted: 05/10/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Employment is a key social determinant of health. People who are unemployed typically have worse health than those employed. Illness and disability can result in unemployment and be a barrier to regaining employment. We combined a systematic review and knowledge synthesis to identify both studies of employment interventions in health care settings and common characteristics of successful interventions. METHODS We searched the peer-reviewed literature (1995-2017), and titles and abstracts were screened for inclusion and exclusion criteria by 2 independent reviewers. We extracted data on the study setting, participants, intervention, methods, and findings. We also conducted a narrative synthesis and iteratively developed a conceptual model to inform future primary care interventions. RESULTS Of 6,729 unique citations, 88 articles met our criteria. Most articles (89%) focused on people with mental illness. The majority of articles (74%) tested interventions that succeeded in helping participants gain employment. We identified 5 key features of successful interventions: (1) a multidisciplinary team that communicates regularly and collaborates, (2) a comprehensive package of services, (3) one-on-one and tailored components, (4) a holistic view of health and social needs, and (5) prospective engagement with employers. CONCLUSIONS Our findings can inform new interventions that focus on employment as a social determinant of health. Although hiring a dedicated employment specialist may not be feasible for most primary care organizations, pathways using existing resources with links to external agencies can be created. As precarious work becomes more common, helping patients engage in safe and productive employment could improve health, access to health care, and well-being.
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Affiliation(s)
- Andrew D Pinto
- The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada .,Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nadha Hassen
- The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Amy Craig-Neil
- The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
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Cotner BA, Ottomanelli L, O'Connor DR, Njoh EN, Barnett SD, Miech EJ. Quality of Life Outcomes for Veterans With Spinal Cord Injury Receiving Individual Placement and Support (IPS). Top Spinal Cord Inj Rehabil 2018; 24:325-335. [PMID: 30459495 DOI: 10.1310/sci17-00046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Individual Placement and Support (IPS) is an evidence-based practice that helps persons with mental and/or physical disabilities, including spinal cord injury, find meaningful employment in the community. While employment is associated with positive rehabilitation outcomes, more research is needed on the impact of IPS participation on non-vocational outcomes, particularly quality of life (QOL). Objective: To identity QOL outcomes experienced with (1) IPS participation and (2) IPS participation leading to employment. Methods: Using a mixed method design, data on quality of life outcomes were collected from 151 interviews and 213 surveys completed by veterans with SCI participating in IPS. Results: At 12 months, participants who obtained competitive employment (CE) and those who did not (no-CE) showed improvement on most measures. In months 12-24, the CE group showed improvements on all study measures while the no-CE group declined on many indices. Statistically significant changes were observed between participants who obtained CE versus no-CE on several measures. Themes were identified from interview data related to productivity and well-being. Productivity themes were (1) contributing to society, (2) earning an income, and (3) maintaining employment. Themes for well-being were (1) mental health/self-confidence, (2) physical health, and (3) goal setting. Themes were associated with IPS participation irrespective of employment outcomes. Conclusion: IPS participants who were competitively employed report consistent improvement in handicap, health-related QOL, and life satisfaction measures across time. Qualitative findings revealed improved QOL outcomes in productivity and well-being for veterans participating in IPS overall, regardless of employment outcomes.
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Affiliation(s)
- Bridget A Cotner
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, Tampa, Florida.,Department of Anthropology, University of South Florida, Tampa, Florida
| | - Lisa Ottomanelli
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, Tampa, Florida.,Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa, Florida
| | - Danielle R O'Connor
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, Tampa, Florida
| | - Eni N Njoh
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, Tampa, Florida
| | - Scott D Barnett
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, Tampa, Florida
| | - Edward J Miech
- VA HSR&D Center for Health Information & Communication, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana.,VA Health Services Research and Development (HSR&D) PRISM QUERI, Indianapolis, Indiana.,Regenstrief Institute, Indianapolis, Indiana.,Department of Emergency Medicine & Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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34
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Cotner BA, Ottomanelli L, Keleher V, Dirk L. Scoping review of resources for integrating evidence-based supported employment into spinal cord injury rehabilitation. Disabil Rehabil 2018; 41:1719-1726. [PMID: 29485303 DOI: 10.1080/09638288.2018.1443161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE Individual placement and support (IPS), an evidence-based supported employment (SE) program, has helped Veterans with spinal cord injury (SCI) receiving care in the Veterans Health Administration to obtain work. To facilitate integration of IPS into SCI rehabilitation, resources are needed. A scoping review was conducted to identify tools and resources suitable for providers of SCI care. METHODS Applying a modified version of Arksey and O'Malley's framework, a scoping review of literature on SE tools or resources was conducted. The original review focused on resources published between 2002 and 2015 and available in English. Prior to publication an updated review through 2017 was conducted. RESULTS From 1822 tools and resources identified in the initial review, 24 met criteria for inclusion and were evaluated by an advisory panel of experts, who selected 16 tools that addressed five topics: IPS in SCI (n = 2) orientation to SCI (n = 3); IPS SE (n = 7), job accommodations (n = 2), and benefits planning (n = 2). The updated review yielded no tools or resources that met inclusion criteria. CONCLUSION Despite few resources to guide implementation of IPS in SCI, 16 essential resources were identified that, combined into a toolkit, may facilitate translation of IPS in SCI from research to clinical care. Implications for rehabilitation The toolkit consists of 16 essential resources and is currently available online to all persons involved in spinal cord injury rehabilitation to educate them about this effective means of assisting persons with spinal cord injury to find employment and to facilitate translation of individual placement and support in spinal cord injury from research to clinical care. While expert-informed, the toolkit is being field tested with both clinical and vocational providers to facilitate the adoption of individual placement and support by spinal cord injury rehabilitation programs. The revised version will be made available online.
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Affiliation(s)
- Bridget A Cotner
- a VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR) , James A. Haley Veterans' Hospital , Tampa , FL , USA.,b Department of Anthropology , University of South Florida , Tampa , FL , USA
| | - Lisa Ottomanelli
- a VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR) , James A. Haley Veterans' Hospital , Tampa , FL , USA.,c Department of Rehabilitation and Mental Health Counseling , University of South Florida , Tampa , FL , USA
| | - Virginia Keleher
- a VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR) , James A. Haley Veterans' Hospital , Tampa , FL , USA
| | - Lynn Dirk
- a VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR) , James A. Haley Veterans' Hospital , Tampa , FL , USA
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Supported Employment for Veterans With Traumatic Brain Injury: Patient Perspectives. Arch Phys Med Rehabil 2018; 99:S4-S13.e1. [DOI: 10.1016/j.apmr.2017.06.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/16/2017] [Accepted: 06/29/2017] [Indexed: 11/20/2022]
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36
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Supported Employment for Veterans With Traumatic Brain Injury: Provider Perspectives. Arch Phys Med Rehabil 2018; 99:S14-S22. [DOI: 10.1016/j.apmr.2017.06.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/22/2017] [Accepted: 06/29/2017] [Indexed: 11/19/2022]
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37
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Rødevand L, Ljosaa TM, Granan LP, Knutzen T, Jacobsen HB, Reme SE. A pilot study of the individual placement and support model for patients with chronic pain. BMC Musculoskelet Disord 2017; 18:550. [PMID: 29282028 PMCID: PMC5746000 DOI: 10.1186/s12891-017-1908-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
Background Individual Placement and Support (IPS) is an evidence-based work rehabilitation model with well-documented effects for people with mental illness. The model has, however, never been tested out for people with chronic pain. This pilot study aimed to investigate chronic pain patients’ experiences with the IPS job support model. Methods We recruited eight consecutive patients referred for various chronic pain conditions at a hospital outpatient pain clinic. They were offered IPS job support as an integrated part of their interdisciplinary pain rehabilitation. The patients’ experiences were investigated through semi-structured interviews 3 months after inclusion in the study. Results The participants reported mostly positive experiences with IPS. One participant dropped out of the study after deterioration of symptoms, while the remaining participants were satisfied with the intervention. Particular helpful aspects of the IPS intervention were the follow-up from the employment specialist, focus on competitive employment, focus on work despite pain complaints, reframing work into something positive, administrative support, and practice in writing applications. No participants reported adverse experiences from the IPS intervention. Within a 12-months time frame, 3 of the 8 participants gained competitive employment. Conclusions This is the first report of the IPS model of supported employment applied in an outpatient setting for chronic pain patients. The results suggest that IPS can be successfully integrated with interdisciplinary pain rehabilitation, and warrants large-scale testing in a randomized controlled trial.
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Affiliation(s)
- L Rødevand
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - T M Ljosaa
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - L P Granan
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - T Knutzen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - H B Jacobsen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - S E Reme
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway. .,Department of Psychology, Faculty of Social Sciences, University of Oslo, Postboks 1094 Blindern, 0317, Oslo, Norway.
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Pogoda TK, Levy CE, Helmick K, Pugh MJ. Health services and rehabilitation for active duty service members and veterans with mild TBI. Brain Inj 2017; 31:1220-1234. [DOI: 10.1080/02699052.2016.1274777] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Terri K. Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Charles E. Levy
- Physical Medicine and Rehabilitation Service, Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Center for Arts in Medicine, College of the Arts, University of Florida, Gainesville, Florida, USA
| | - Katherine Helmick
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
| | - Mary Jo Pugh
- South Texas Veterans Healthcare System, San Antonio, Texas, USA
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
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Goetz LL, Ottomanelli L, Barnett SD, Sutton B, Njoh E. Relationship Between Comorbidities and Employment Among Veterans with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2017; 24:44-53. [PMID: 29434460 DOI: 10.1310/sci16-00047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To determine the relationship between medical and mental health comorbidities in a large cohort of veterans with spinal cord injury (SCI). Methods: Data were collected from interviews and electronic medical records of veterans with SCI (N = 1,047) who received care at 7 geographically diverse SCI centers within the Department of Veterans Affairs across the country (https://clinicaltrials.gov/ct2/show/NCT01141647). Employment, medical, functional, and psychosocial data underwent cross-sectional analysis. Results: Lack of any documented mental health diagnosis correlated strongly with being employed at the time of enrollment. No single comorbidity was associated with employment at enrollment, but an increased number of medical and/or mental health comorbidities ("health burden") were associated with a decreased likelihood of employment at the time of enrollment. Conclusion: Further investigation is needed to clarify whether comorbidity severity or combinations of specific comorbidities predict rehabilitation outcome, including employment.
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Affiliation(s)
- Lance L Goetz
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Lisa Ottomanelli
- VA HSR&D/RR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital, Tampa, Florida.,Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa, Florida
| | - Scott D Barnett
- VA HSR&D/RR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Bryce Sutton
- VA HSR&D/RR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Eni Njoh
- VA HSR&D/RR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital, Tampa, Florida
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Holmlund L, Guidetti S, Eriksson G, Asaba E. Return to work in the context of everyday life 7-11 years after spinal cord injury - a follow-up study. Disabil Rehabil 2017; 40:2875-2883. [PMID: 28793801 DOI: 10.1080/09638288.2017.1362597] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this follow-up study was to explore experiences of return to work in the context of everyday life among adults 7-11 years after spinal cord injury (SCI). METHODS This study used in-depth interviews and observations in a qualitative design with eight persons who had previously been interviewed in 2008. A narrative approach was used during data gathering and analysis. RESULTS Return to work was experienced as something constantly needing to be negotiated in the context of everyday life. Several years after SCI expectations for work and perceptions of possibilities for meaningful work had changed. Five main themes were identified through the analysis, (1) negotiating the possibilities of working, (2) hope for future work tempered with concern, (3) education as a possible path to employment, (4) paths toward return to work in light of unmet support, and (5) unpaid occupations grounded in interest and competence. CONCLUSIONS Persons who have no higher education or lack viable employment to return to after SCI seem to be vulnerable in return to work. Early and timely interventions tailored to the person's interests and competencies, in which the rehabilitation team has a distinct coordinating role, are thus critical in return to work. Implications for Rehabilitation Tensions between hope and expectations for work and unmet needs of support can lead to barriers in return to work, particularly for those who have no higher education or lack employment to return to after spinal cord injury. Rehabilitation after spinal cord injury can benefit from focus on how the balance of work fits into routines in the context of everyday life. Early and timely interventions integrating the person's interests and competencies in return to work after spinal cord injury in combination with having a health care provider who has a distinct coordinating role are critical.
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Affiliation(s)
- Lisa Holmlund
- a Department of Neurobiology, Care Science and Society, Division of Occupational Therapy , Karolinska Institutet , Huddinge , Sweden.,b Spinalis SCI Unit , Rehab Station Stockholm , Stockholm , Sweden
| | - Susanne Guidetti
- a Department of Neurobiology, Care Science and Society, Division of Occupational Therapy , Karolinska Institutet , Huddinge , Sweden
| | - Gunilla Eriksson
- a Department of Neurobiology, Care Science and Society, Division of Occupational Therapy , Karolinska Institutet , Huddinge , Sweden.,c Department of Neuroscience, Rehabilitation Medicine , Uppsala University , Uppsala , Sweden
| | - Eric Asaba
- a Department of Neurobiology, Care Science and Society, Division of Occupational Therapy , Karolinska Institutet , Huddinge , Sweden.,d Research, Education, and Development Unit , Stockholms Sjukhem Foundation , Stockholm , Sweden.,e Department of Occupational Therapy, Graduate School of Human Health Sciences , Tokyo Metropolitan University , Tokyo , Japan
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Nützi M, Trezzini B, Ronca E, Schwegler U. Key demands and characteristics of occupations performed by individuals with spinal cord injury living in Switzerland. Spinal Cord 2017; 55:1051-1060. [DOI: 10.1038/sc.2017.84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/12/2017] [Accepted: 06/13/2017] [Indexed: 11/09/2022]
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Bloom J, Dorsett P, McLennan V. Integrated services and early intervention in the vocational rehabilitation of people with spinal cord injuries. Spinal Cord Ser Cases 2017; 3:16042. [PMID: 28382213 DOI: 10.1038/scsandc.2016.42] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/27/2016] [Accepted: 12/12/2016] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The design was a narrative review. The objective of the study was to investigate the potential for early vocational rehabilitation (VR) interventions for people with spinal cord injury (SCI) in overcoming barriers in returning to work, and to pinpoint factors contributing to effectiveness in early VR intervention for this population. The setting was at Queensland, Australia. MATERIALS AND METHODS Synthesis of the findings of a literature search of online databases ProQuest and CINAHL, using keywords relating to the employment situation and VR of people with SCI. Themes were identified and analysed in accordance with the research objectives. RESULTS Despite increasing government commitment to the workforce and social participation of people with disabilities, Australians living with SCI have significantly diminished employment outcomes compared with the general population. Current VR approaches usually do not commence until some months post discharge, potentially missing a window of opportunity to preserve pre-existing employment or assist in vocational decision making. The review found that there are opportunities for enhancing VR service provision following SCI, namely integrating the VR programme within the primary rehabilitation team thus facilitating early VR intervention. DISCUSSION Emerging evidence shows promising results for early intervention in VR; however, questions remain regarding ideal intervention approaches, and it is clear that further empirical investigation is required to support the use of early intervention models post SCI. The study was sponsored by Motor Accident Insurance Commission (MAIC).
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Affiliation(s)
- Julia Bloom
- School of Allied Health, Griffith University , Meadowbrook, Queensland, Australia
| | - Pat Dorsett
- School of Human Services and Social Work, Griffith University, Meadowbrook, Queensland, Australia; Menzies Health Institute, Queensland, Australia
| | - Vanette McLennan
- School of Allied Health, Griffith University, Meadowbrook, Queensland, Australia; Menzies Health Institute, Queensland, Australia
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Cotner BA, Ottomanelli L, O’Connor DR, Trainor JK. Provider-identified barriers and facilitators to implementing a supported employment program in spinal cord injury. Disabil Rehabil 2017; 40:1273-1279. [DOI: 10.1080/09638288.2017.1294209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Bridget A. Cotner
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans’ Hospital, Tampa, FL, USA
- Department of Anthropology, University of South Florida, Tampa, FL, USA
| | - Lisa Ottomanelli
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans’ Hospital, Tampa, FL, USA
- Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa, FL, USA
| | - Danielle R. O’Connor
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans’ Hospital, Tampa, FL, USA
| | - John K. Trainor
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans’ Hospital, Tampa, FL, USA
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Ottomanelli L, Goetz LL, Barnett SD, Njoh E, Dixon TM, Holmes SA, LePage JP, Ota D, Sabharwal S, White KT. Individual Placement and Support in Spinal Cord Injury: A Longitudinal Observational Study of Employment Outcomes. Arch Phys Med Rehabil 2017; 98:1567-1575.e1. [PMID: 28115071 DOI: 10.1016/j.apmr.2016.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 12/07/2016] [Accepted: 12/10/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the effects of a 24-month program of Individual Placement and Support (IPS) supported employment (SE) on employment outcomes for veterans with spinal cord injury (SCI). DESIGN Longitudinal, observational multisite study of a single-arm, nonrandomized cohort. SETTING SCI centers in the Veterans Health Administration (n=7). PARTICIPANTS Veterans with SCI (N=213) enrolled during an episode of either inpatient hospital care (24.4%) or outpatient care (75.6%). More than half the sample (59.2%) had a history of traumatic brain injury (TBI). INTERVENTION IPS SE for 24 months. MAIN OUTCOME MEASURE Competitive employment. RESULTS Over the 24-month period, 92 of 213 IPS participants obtained competitive jobs for an overall employment rate of 43.2%. For the subsample of participants without TBI enrolled as outpatients (n=69), 36 obtained competitive jobs for an overall employment rate of 52.2%. Overall, employed participants averaged 38.2±29.7 weeks of employment, with an average time to first employment of 348.3±220.0 days. Nearly 25% of first jobs occurred within 4 to 6 months of beginning the program. Similar employment characteristics were observed in the subsample without TBI history enrolled as outpatients. CONCLUSIONS Almost half of the veterans with SCI participating in the 24-month IPS program as part of their ongoing SCI care achieved competitive employment, consistent with their expressed preferences at the start of the study. Among a subsample of veterans without TBI history enrolled as outpatients, employment rates were >50%. Time to first employment was highly variable, but quite long in many instances. These findings support offering continued IPS services as part of ongoing SCI care to achieve positive employment outcomes.
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Affiliation(s)
- Lisa Ottomanelli
- Veterans Affairs Health Services Research & Development Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital, Tampa, FL; Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa, FL.
| | - Lance L Goetz
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA
| | - Scott D Barnett
- Veterans Affairs Health Services Research & Development Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital, Tampa, FL
| | - Eni Njoh
- Veterans Affairs Health Services Research & Development Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital, Tampa, FL
| | - Thomas M Dixon
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
| | | | - James P LePage
- Veterans Affairs North Texas Healthcare System, Dallas, TX; Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX
| | - Doug Ota
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA
| | - Sunil Sabharwal
- Veterans Affairs Boston Health Care System, Boston, MA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
| | - Kevin T White
- Veterans Affairs Health Services Research & Development Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital, Tampa, FL
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Bloch A, Tamir D, Vakil E, Zeilig G. Specific Deficit in Implicit Motor Sequence Learning following Spinal Cord Injury. PLoS One 2016; 11:e0158396. [PMID: 27355834 PMCID: PMC4927174 DOI: 10.1371/journal.pone.0158396] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 06/15/2016] [Indexed: 12/04/2022] Open
Abstract
Background Physical and psychosocial rehabilitation following spinal cord injury (SCI) leans heavily on learning and practicing new skills. However, despite research relating motor sequence learning to spinal cord activity and clinical observations of impeded skill-learning after SCI, implicit procedural learning following spinal cord damage has not been examined. Objective To test the hypothesis that spinal cord injury (SCI) in the absence of concomitant brain injury is associated with a specific implicit motor sequence learning deficit that cannot be explained by depression or impairments in other cognitive measures. Methods Ten participants with SCI in T1-T11, unharmed upper limb motor and sensory functioning, and no concomitant brain injury were compared to ten matched control participants on measures derived from the serial reaction time (SRT) task, which was used to assess implicit motor sequence learning. Explicit generation of the SRT sequence, depression, and additional measures of learning, memory, and intelligence were included to explore the source and specificity of potential learning deficits. Results There was no between-group difference in baseline reaction time, indicating that potential differences between the learning curves of the two groups could not be attributed to an overall reduction in response speed in the SCI group. Unlike controls, the SCI group showed no decline in reaction time over the first six blocks of the SRT task and no advantage for the initially presented sequence over the novel interference sequence. Meanwhile, no group differences were found in explicit learning, depression, or any additional cognitive measures. Conclusions The dissociation between impaired implicit learning and intact declarative memory represents novel empirical evidence of a specific implicit procedural learning deficit following SCI, with broad implications for rehabilitation and adjustment.
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Affiliation(s)
- Ayala Bloch
- The National Institute for the Rehabilitation of the Brain Injured, Tel Aviv, Israel
- * E-mail:
| | - Dror Tamir
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eli Vakil
- Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Cotner BA, Njoh EN, Trainor JK, O'Connor DR, Barnett SD, Ottomanelli L. Facilitators and barriers to employment among veterans with spinal cord injury receiving 12 months of evidence-based supported employment services. Top Spinal Cord Inj Rehabil 2016; 21:20-30. [PMID: 25762857 DOI: 10.1310/sci2101-20] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Return to work is associated with positive rehabilitation outcomes for persons with spinal cord injury (SCI); however, more research is needed on vocational support for persons with disabilities seeking employment. OBJECTIVE The association between facilitators and barriers of employment and employment outcome was examined among Veterans with SCI who participated in an evidence-based supported employment (EBSE) program. METHODS Using a mixed-methods, nested case-control design, data on facilitators and barriers to employment were extracted from qualitative interviews and quantitative measures administered in person to 34 Veterans with SCI who completed 12 months of an EBSE program. Participants who did (case) and did not (control) obtain competitive employment were matched on time since SCI. Facilitators and barriers to employment were compared between the groups. RESULTS Self-report measures administered at baseline were examined; there were no statistically significant factors that predicted employment outcomes after 12 months of EBSE program participation. Qualitative interview data revealed program-specific facilitators and Veteran characteristics that were associated with employment outcomes. CONCLUSIONS Qualitative data illustrate how the integration of the vocational rehabilitation specialist on the medical team is helpful for addressing identified disability-specific barriers, including practical matters such as transportation and caregiving schedules, to facilitate employment outcomes.
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Affiliation(s)
- Bridget A Cotner
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital , Tampa, Florida
| | - Eni N Njoh
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital , Tampa, Florida
| | - John K Trainor
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital , Tampa, Florida
| | - Danielle R O'Connor
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital , Tampa, Florida
| | - Scott D Barnett
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital , Tampa, Florida ; Institute for Credentialing Research, American Nurses Credentialing Center , Washington, DC
| | - Lisa Ottomanelli
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital , Tampa, Florida ; Department of Rehabilitation and Mental Health Counseling, University of South Florida , Tampa, Florida
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Ottomanelli L, Barnett SD, Goetz LL, Toscano R. Vocational rehabilitation in spinal cord injury: what vocational service activities are associated with employment program outcome? Top Spinal Cord Inj Rehabil 2016; 21:31-9. [PMID: 25762858 DOI: 10.1310/sci2101-31] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Designing effective vocational programs for persons with spinal cord injury (SCI) is essential for improving return to work outcome following injury. The relationship between specific vocational services and positive employment outcome has not been empirically studied. OBJECTIVE To examine the association of specific vocational service activities as predictors of employment. METHOD Secondary analysis of a randomized, controlled trial of evidence-based supported employment (EBSE) with 12-month follow-up data among 81 Veteran participants with SCI. RESULTS Primary activities recorded were vocational counseling (23.9%) and vocational case management (23.8%). As expected, job development and employment supports were the most time-consuming activities per appointment. Though the amount of time spent in weekly appointments did not differ by employment outcome, participants obtaining competitive employment averaged significantly more individual activities per appointment. Further, for these participants, job development or placement and employment follow-along or supports were more likely to occur and vocational counseling was less likely to occur. Community-based employment services, including job development or placement and employment follow-along or supports as part of a supported employment model, were associated with competitive employment outcomes. Office-based vocational counseling services, which are common to general models of vocational rehabilitation, were associated with a lack of employment. CONCLUSIONS Vocational services that actively engage Veterans with SCI in job seeking and acquisition and that provide on-the-job support are more likely to lead to employment than general vocational counseling that involves only job preparation.
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Affiliation(s)
- Lisa Ottomanelli
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital , Tampa, Florida ; Department of Rehabilitation and Mental Health Counseling, University of South Florida , Tampa, Florida
| | - Scott D Barnett
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital , Tampa, Florida ; VA HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital , Tampa, Florida
| | - Lance L Goetz
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond, Virginia ; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University , Richmond, Virginia
| | - Richard Toscano
- Office of Research & Development, Department of Veterans Affairs, Tuscaloosa VA Medical Center , Tuscaloosa, Alabama
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Russell HF, Richardson EJ, Bombardier CH, Dixon TM, Huston TA, Rose J, Sheaffer D, Smith SA, Ullrich PM. Professional standards of practice for psychologists, social workers, and counselors in SCI rehabilitation. J Spinal Cord Med 2015; 39:127-45. [PMID: 26707599 PMCID: PMC5072492 DOI: 10.1080/10790268.2015.1119966] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
| | - Elizabeth J. Richardson
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | - Jon Rose
- VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Dawn Sheaffer
- Shriners Hospitals for Children, Philadelphia, PA, USA
| | | | - Philip M. Ullrich
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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LePage J, Ottomanelli L, Barnett SD, Njoh EN. Spinal cord injury combined with felony history: effect on supported employment for Veterans. ACTA ACUST UNITED AC 2015; 51:1497-504. [PMID: 25856266 DOI: 10.1682/jrrd.2014.02.0045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED In this secondary analysis of data from a randomized controlled trial comparing supported employment with treatment as usual, we sought to evaluate the study incident rate of legal involvement and subsequent effects of legal involvement on employment among 157 job-seeking Veterans with spinal cord injury. The supported employment vocational rehabilitation program, called the Spinal Cord Injury-Vocational Integration Program, adhered as closely as possible to principles of supported employment as developed and described in the individual placement and support model of supported employment for persons with mental illness. Rates of misdemeanor and felony arrests and convictions were analyzed, and their relationship to finding employment was evaluated. Findings indicate that 47% had been arrested and 25% had been convicted of a felony. Overall, those who found employment had fewer average arrests and were significantly less likely to have been convicted of a felony. Future directions and limitations are discussed. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; NCT00117806.
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Roels EH, Aertgeerts B, Ramaekers D, Peers K. Hospital- and community-based interventions enhancing (re)employment for people with spinal cord injury: a systematic review. Spinal Cord 2015; 54:2-7. [PMID: 26305872 DOI: 10.1038/sc.2015.133] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 05/14/2015] [Accepted: 07/01/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To investigate the effect of interventions enhancing (re)employment following spinal cord injury (SCI). SETTING Studies from multiple countries were included. METHODS MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, PsycINFO and SPORTDISCUS databases were searched. Randomized controlled trials (RCTs) and non-randomized studies (NRSs) describing a hospital- or a community-based intervention aiming at employment in a SCI population were selected. Quality appraisal was done using the SIGN methodology, and the quality of evidence was graded using the Grade approach. Data extraction was performed according to the Cochrane Handbook. Employment rate and duration were primary outcomes. RESULTS Only one RCT, including 201 patients describing an intervention over 1 and 2 years, was of sufficient quality. In this study, the employment rate was 26% after 1 and 31% after 2 years for competitive work, compared with 10% in the treatment as usual-intervention site (TAU-IS) control group and 2% in the treatment as usual observational site (TAU-OS) after 1 and 2 years. Other studies were of low quality and describe higher employment rates from 36 to 100%. CONCLUSIONS Only one RCT was of sufficient quality and showed evidence that a vocational rehabilitation programme based on the principles of supported employment integrated in a multidisciplinary team enhances employment for SCI people. As the vast majority of studies included in this review are of low methodological quality, further research is needed.
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Affiliation(s)
- E H Roels
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B Aertgeerts
- Department of Public Health and Primary Care, Academic Center of General Practice, KU Leuven, Belgium
| | - D Ramaekers
- Department of Public Health and Primary Care, Center for Health Services and Nursing Research, KU Leuven, Belgium
| | - K Peers
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Belgium
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