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Almalky HA, Alasmari AN. Employers' perceptions of supports provided to their employees with disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 149:104750. [PMID: 38723430 DOI: 10.1016/j.ridd.2024.104750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/16/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024]
Abstract
The employment of individuals with disabilities is significantly low. Many factors are associated with this issue; however, support and accommodations that can be provided to such individuals can improve their employment rate and outcomes. This study aimed to examine the support provided to employees with disabilities in Saudi Arabia. The descriptive approach was utilized, and a survey was used to collect the data. The sample consisted of 86 employer participants to examine the support of their employees with disabilities. Findings revealed that the support provided was high, and the participants reported that such support facilitates finding and maintaining a job. In addition, the variables were all found to have no significant differences. Providing needed and necessary support is an effective strategy that leads to competitive employment for individuals with disabilities, especially for the long term. Implications and recommendations are also discussed.
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Affiliation(s)
- Hussain A Almalky
- Department of Special Education, College of Education in Al-Kharj, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia.
| | - Ali N Alasmari
- Department of Special Education, College of Education in Al-Kharj, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
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Drake RE, Bond GR. Individual placement and support: History, current status, and future directions. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e122. [PMID: 38867819 PMCID: PMC11114326 DOI: 10.1002/pcn5.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/06/2023] [Accepted: 06/28/2023] [Indexed: 06/14/2024]
Abstract
Over the past three decades, Individual Placement and Support (IPS) has emerged as a robust evidence-based approach to helping people with severe mental illnesses, such as schizophrenia, bipolar disorder, and major depression, to obtain and succeed in competitive employment. This review addresses the history, principles, research, and future directions of IPS. It covers current evidence on employment outcomes, cost-effectiveness, and nonvocational outcomes. It also describes current attempts to extend IPS to new populations. The authors provide an overview of numerous systematic reviews and meta-analyses of randomized controlled trials involving people with serious mental illness. For studies addressing nonvocational outcomes and new populations, the review uses best available evidence. Published reviews agree that IPS enables patients with serious mental illness in high-income countries to succeed in competitive employment at a higher rate than patients who receive other vocational interventions. Within IPS programs, quality of implementation, measured by standardized fidelity scales, correlates with better outcomes. Employment itself leads to enhanced income, psychosocial outcomes, clinical improvements, and decreased mental health service use. As IPS steadily spreads to new populations and new settings, research is active across high-income countries and spreading slowly to middle-income countries. IPS is an evidence-based practice for people with serious mental illness in high-income countries. It shows promise to help other disability groups also, and emerging research aims to clarify adaptations and outcomes.
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Affiliation(s)
- Robert E. Drake
- Department of PsychiatryColumbia University Vagelos College of Physicians and SurgeonsNew York CityNew YorkUSA
- Westat CorporationRockvilleMarylandUSA
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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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Reims N, Tisch A. Employment effects for people with disabilities after participation in vocational training programmes: A cohort analysis using propensity score matching. Work 2022; 72:611-625. [PMID: 35527587 PMCID: PMC9398074 DOI: 10.3233/wor-205046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Vocational rehabilitation (VR) aims to help people with disabilities to return to the labour market. Though, there is not much evidence on its effectiveness. OBJECTIVES: We explore the effect of vocational training programmes in VR and the VR status itself on employment outcomes. METHODS: Using two samples from administrative data by the German Federal Employment Agency, we applied propensity score matching. We followed rehabilitants commencing VR in 2009/2010 (N = 7,905) for four years (comparison I) and general training participants with and without VR status completing training in 2012/2013 (N = 21,020) for one year (comparison II). For harmonisation purposes, we only considered individuals aged between 25 and 40 and excluded those in employment at the beginning of VR or training. RESULTS: Concerning the effect of training in VR (comparison I), we observe a lock-in effect during training (p < 0.001) due to an involvement in VR; after training, participants are more likely to obtain unsubsidised employment (0.05, p < 0.05) than non-participants, but there is no statistically significant income difference after four years. Regarding the effect of the VR status (comparison II), rehabilitants are more likely to take up (un-)subsidised employment (0.04, p < 0.01; 0.02, p < 0.001) after training, exhibit longer employment durations (19 days, p < 0.001) and achieve higher average incomes (2,414 euro/year, p < 0.001) compared to non-rehabilitants. CONCLUSIONS: Training participation helps to improve employment participation of rehabilitants. However, a longer observation period is recommended. Furthermore, the VR status itself leads to more sustainable and better-paid employment. This is due to more comprehensive support and longer-term subsidised employment opportunities.
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Affiliation(s)
- Nancy Reims
- Research Department “Joblessness and Social Inclusion”, Institute for Employment Research (IAB), Nuremberg, Germany
| | - Anita Tisch
- Research Unit “Changing World of Work”, Federal Institute for Occupational Safety and Health (BAuA), Dortmund, Germany
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Bond GR, Al-Abdulmunem M, Ressler DR, Drake RE, Davis LL, Meyer T, Gade DM, Frueh BC, Dickman RB. Evaluation of an Employment Intervention for Veterans Transitioning From the Military: A Randomized Controlled Trial. J Nerv Ment Dis 2022; 210:321-329. [PMID: 34937846 DOI: 10.1097/nmd.0000000000001472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Military personnel face numerous challenges transitioning from military jobs to meaningful civilian employment. The Independence Project compared an innovative employment program (National Career Coach Program) with standard employment services (Local Community Resources) in a randomized controlled trial. Study participants were transitioning veterans with self-reported service-connected disabilities seeking permanent employment. The primary outcomes were paid employment and disability ratings over 1 year. Secondary outcomes included health and well-being. At 1-year follow-up, National Career Coach Program participants were significantly more likely to work, had significantly greater earnings, and reported significantly greater improvements in physical and mental health compared with participants assigned to Local Community Resources. Both groups increased in disability ratings over 12 months, with no difference between groups. Multifaceted supports delivered by the National Career Coach Program increased employment, earnings, mental health, and physical health over 1 year. These significant differences appeared even though control group participants achieved considerable employment success.
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Affiliation(s)
- Gary R Bond
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire
| | - Monirah Al-Abdulmunem
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire
| | - Daniel R Ressler
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire
| | - Robert E Drake
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire
| | | | - Thomas Meyer
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Daniel M Gade
- Department of Public Administration and Policy, American University, Washington, DC
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A Randomized Controlled Trial of an Employment Program for Veterans Transitioning from the Military: Two-Year Outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:1072-1083. [PMID: 35819542 PMCID: PMC9616746 DOI: 10.1007/s10488-022-01208-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Military personnel face numerous challenges transitioning from military jobs to meaningful civilian employment. Many veterans seek help finding employment, but few veteran employment programs have been rigorously studied. Transitioning veterans generally have access to Local Community Resources (LCR), which include the Veterans Health Administration vocational rehabilitation services, the state-federal Vocational Rehabilitation program, and the Department of Labor's American Job Centers. By contrast, the innovative National Career Coach Program (NCCP) offers intensive career coaching and financial incentives for working. METHODS This study used a randomized controlled design to compare the NCCP and LCR approaches for 208 transitioning service members (recent or pending transition). Researchers conducted interviews by telephone every four months for two years. Outcomes included earnings, months worked, and standardized self-report measures of health and well-being. Findings At two-year follow-up, significantly more NCCP participants had worked in paid employment than LCR participants (95% vs. 83%). NCCP participants averaged $2568 in monthly earnings compared to $1865 for LCR participants, thus averaging $16,872 more total income per participant over the two-year period. Employment outcomes significantly improved between Year 1 and Year 2. NCCP participants also reported significantly greater improvements in both physical and mental health compared to LCR participants. Average monthly earnings correlated with changes in health outcomes. CONCLUSIONS Veterans receiving multi-faceted employment services early in the transition from the military showed sustained benefit over a two-year period with increased earnings over time and improved mental and physical outcomes. Positive employment outcomes may have contributed to improved health outcomes.
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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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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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [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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Mueller L, Wolfe WR, Neylan TC, McCaslin SE, Yehuda R, Flory JD, Kyriakides TC, Toscano R, Davis LL. Positive impact of IPS supported employment on PTSD-related occupational-psychosocial functional outcomes: Results from a VA randomized-controlled trial. Psychiatr Rehabil J 2019; 42:246-256. [PMID: 30932508 PMCID: PMC6991705 DOI: 10.1037/prj0000345] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) has significant negative effects on occupational, interpersonal, and social functioning. Supported employment is highly effective in helping people with a diagnosis of PTSD obtain and maintain competitive employment. However, less is known about the impact of supported employment on functioning in work or school, social, and interpersonal areas as specifically related to the symptoms of PTSD. METHOD The Veterans Individual Placement and Support Toward Advancing Recovery study was a prospective, multisite, randomized, controlled trial that compared Individual Placement and Support (IPS) supported employment with a stepwise vocational rehabilitation involving transitional work (TW) assignments with unemployed veterans with PTSD diagnoses (n = 541) at 12 Veterans Administration (VA) medical centers. This analysis focuses on the PTSD-related functional outcomes over the 18-month follow-up period. RESULTS Compared with those randomized to TW, the PTSD Related Functioning Inventory (PRFI) total score significantly improved for participants randomized to IPS (LSMeans difference = -3.92, 95% CI [-7.49, -.36]; p = .03) over 18 months. When the Work/School subscale of the PRFI was removed from the analysis, the IPS group continued to show significant improvements compared with the TW group on the PRFI relationship and lifestyle domains (LSMeans difference = -2.37, 95% CI [-4.74, .00]; p = .05), suggesting a positive impact of IPS beyond work/school functioning. CONCLUSION Compared with the usual-care VA vocational services for veterans with PTSD, IPS supported employment is associated with greater improvement in overall PTSD-related functioning, including occupational, interpersonal, and lifestyle domains. In addition to superior employment outcomes, IPS has a positive impact on occupational-psychosocial functioning outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Lisa Mueller
- Department of Psychology, Edith Nourse Rogers Memorial Veterans Hospital
| | | | | | | | | | | | - Tassos C Kyriakides
- Cooperative Studies Program Coordinating Center, Veterans Affairs Connecticut Healthcare System
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Zimmermann G, Bolter L, Sluka R, Höller Y, Bathke AC, Thomschewski A, Leis S, Lattanzi S, Brigo F, Trinka E. Sample sizes and statistical methods in interventional studies on individuals with spinal cord injury: A systematic review. J Evid Based Med 2019; 12:200-208. [PMID: 31231977 PMCID: PMC6771853 DOI: 10.1111/jebm.12356] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 05/12/2019] [Indexed: 12/13/2022]
Abstract
AIM Prevalence and incidence of spinal cord injury (SCI) are low. However, sample sizes have not been systematically examined yet, although this might represent useful information for study planning and power considerations. Therefore, our objective was to determine the median sample size in clinical trials on SCI individuals. Moreover, within small-sample size studies, statistical methods and awareness of potential problems regarding small samples were examined. METHODS We systematically reviewed all studies on human SCI individuals published between 2014 and 2015, where the effect of an intervention on one or more health-related outcomes was assessed by means of a hypothesis test. If at least one group had a size <20, the study was classified as a small sample size study. PubMed was searched for eligible studies; subsequently, data on sample sizes and statistical methods were extracted and summarized descriptively. RESULTS Out of 8897 studies 207 were included. Median total sample size was 18 (range 4-582). Small sample sizes were found in 167/207 (81%) studies, resulting limitations and implications for statistical analyses were mentioned in 109/167 (65%) studies. CONCLUSIONS Although most recent SCI trials have been conducted with small samples, the consequences on statistical analysis methods and the validity of the results are rarely acknowledged.
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Affiliation(s)
- Georg Zimmermann
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
- Spinal Cord Injury and Tissue Regeneration Centre SalzburgParacelsus Medical UniversitySalzburgAustria
- Department of MathematicsParis Lodron UniversitySalzburgAustria
| | | | - Ronny Sluka
- Department of PsychologyParis Lodron UniversitySalzburgAustria
| | - Yvonne Höller
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
| | - Arne C. Bathke
- Department of MathematicsParis Lodron UniversitySalzburgAustria
| | - Aljoscha Thomschewski
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
- Spinal Cord Injury and Tissue Regeneration Centre SalzburgParacelsus Medical UniversitySalzburgAustria
- Department of PsychologyParis Lodron UniversitySalzburgAustria
| | - Stefan Leis
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical MedicineMarche Polytechnic UniversityAnconaItaly
| | - Francesco Brigo
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
- Division of NeurologyFranz Tappeiner HospitalMeranoItaly
| | - Eugen Trinka
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
- Department of Public HealthHealth Services Research and Health Technology Assessment, UMITHall i. T.Austria
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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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MacLean MB, Keough J, Poirier A, McKinnon K, Sweet J. Labour market outcomes of Veterans. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2019. [DOI: 10.3138/jmvfh.2017-0016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction: Employment is important to health, well-being, and adjustment from military to civilian life. Given the importance of employment, we examine Veteran labour force outcomes in Canada. Methods: We examined labour market indicators from the 2010 and 2013 Life After Service Studies cross-sectional Survey on Transition to Civilian Life, along with the 2013 Income Study for Canadian Regular Force Veterans (released since 1998). Results: In Canada, most Regular Force Veterans surveyed were employed after release and satisfied with their work – both employment and satisfaction rates grew over time. The unemployment rate did not differ from that of the general Canadian population. However, Veterans were more likely than the general Canadian population to experience activity limitations at work. Variations in outcomes were found across diverse groups of the population. For example, unemployed Veterans were younger at release, had the fewest years of service, and were more likely to have served in the Army than employed Veterans. Veterans who were not in the labour force were older and had more years of service, and many were experiencing barriers to work. Employment rates were lower among female Veterans and among medically released Veterans. Discussion: Labour market outcomes vary across sub-groups of the Veteran population, suggesting targeted approaches to improve labour market outcomes. Findings suggest that the prevention of work disability is important for improving outcomes. Best practices in preventing work disability include restructuring compensation to recognize varying degrees of earnings capacity and to encourage labour market engagement and supported employment programs.
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Affiliation(s)
- Mary Beth MacLean
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Jacinta Keough
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Alain Poirier
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | | | - Jill Sweet
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
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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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16
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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, 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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18
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Gottlieb LM, Wing H, Adler NE. A Systematic Review of Interventions on Patients' Social and Economic Needs. Am J Prev Med 2017; 53:719-729. [PMID: 28688725 DOI: 10.1016/j.amepre.2017.05.011] [Citation(s) in RCA: 268] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/13/2017] [Accepted: 05/11/2017] [Indexed: 12/16/2022]
Abstract
CONTEXT Healthcare systems are experimenting increasingly with interventions to address patients' social and economic needs. This systematic review examines how often and how rigorously interventions bridging social and medical care have been evaluated. EVIDENCE ACQUISITION The review included literature from PubMed published between January 2000 and February 2017. Additional studies were identified by reference searches and consulting local experts. Included studies were based in the U.S.; addressed at least one social or economic determinant of health (e.g., housing, employment, food insecurity); and were integrated within the medical care delivery system. Data from included studies were abstracted in June 2015 (studies published January 2000-December 2014) and in March 2017 (studies published January 2015-February 2017). EVIDENCE SYNTHESIS Screening of 4,995 articles identified 67 studies of 37 programs addressing social needs. Interventions targeted a broad range of social needs and populations. Forty studies involved non-experimental designs. There was wide heterogeneity in outcome measures selected. More studies reported findings associated with process (69%) or social or economic determinants of health (48%) outcomes than health (30%) or healthcare utilization or cost (27%) outcomes. Studies reporting health, utilization, or cost outcomes reported mixed results. CONCLUSIONS Healthcare systems increasingly incorporate programs to address patients' social and economic needs in the context of care. But evaluations of these programs to date focus primarily on process and social outcomes and are often limited by poor study quality. Higher-quality studies that include common health and healthcare utilization outcomes would advance effectiveness research in this rapidly expanding field.
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Affiliation(s)
- Laura M Gottlieb
- Department of Family Medicine, University of California, San Francisco, San Francisco, California.
| | - Holly Wing
- Center for Health and Community, University of California, San Francisco, San Francisco, California
| | - Nancy E Adler
- Center for Health and Community, University of California, San Francisco, San Francisco, California
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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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Hilton G, Unsworth C, Murphy G. The experience of attempting to return to work following spinal cord injury: a systematic review of the qualitative literature. Disabil Rehabil 2017; 40:1745-1753. [PMID: 28395535 DOI: 10.1080/09638288.2017.1312566] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE This review sought to answer the question "What are the barriers and facilitators influencing people's experience of return to work following spinal cord injury?" METHODS Studies that met the selection criteria were identified, presented and critically appraised using National Institute for Health and Care Excellence guidelines. Thematic synthesis was completed with studies possessing strong methodological rigor. Synthesis and interpretation involved three stages; coding of primary data; development of descriptive themes reflective of the primary data; and establishment of analytical themes to answer the review question. RESULTS Data from nine papers were included in the thematic synthesis. Several descriptive themes and three analytical themes were drawn from the data to answer the research question. Analytical themes included: a matrix of personal and environmental factors exists requiring complex navigation in order to create possibilities and opportunities for postinjury employment; the process of seeking or gaining employment shares a reciprocal relationship with the temporal nature of adjustment to spinal cord injury; and there is an intrinsic need for occupational engagement through paid employment. CONCLUSIONS Returning to or gaining employment after spinal cord injury is a fundamentally difficult experience for people. Multiple strategies are required to support the navigation of the process. There is, however, a need in people with spinal cord injury, to be a worker, and with that comes the inherent benefits of being employed. Implications for rehabilitation Returning to work should be a significant focus of spinal cord injury rehabilitation. Employment is both possible and health promoting following spinal cord injury. Multiple strategies are required to support people to navigate the return to work process. It is important to be cognizant of the individual motivations for being a worker and the complexity of the adjustment process. Spinal cord injury centers can provide a consistent and supportive framework and culture of positivity about employment after spinal cord injury.
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Affiliation(s)
- Gillean Hilton
- a Department of Occupational Therapy , Central Queensland University , Melbourne , Australia.,b Victorian Spinal Cord Service , Austin Health , Melbourne , Australia
| | - Carolyn Unsworth
- a Department of Occupational Therapy , Central Queensland University , Melbourne , Australia.,c School of Health and Welfare , Jönköping University , Jönköping , Sweden.,d School of Occupational Therapy , Curtin University , Perth , Australia.,e School of Public Health La Trobe University , Melbourne , Australia
| | - Gregory Murphy
- e School of Public Health La Trobe University , Melbourne , Australia
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21
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Hilton G, Unsworth CA, Murphy GC, Browne M, Olver J. Longitudinal employment outcomes of an early intervention vocational rehabilitation service for people admitted to rehabilitation with a traumatic spinal cord injury. Spinal Cord 2017; 55:743-752. [DOI: 10.1038/sc.2017.24] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 11/09/2022]
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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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Schüssler-Fiorenza Rose SM, Eslinger JG, Zimmerman L, Scaccia J, Lai BS, Lewis C, Alisic E. Adverse Childhood Experiences, Support, and the Perception of Ability to Work in Adults with Disability. PLoS One 2016; 11:e0157726. [PMID: 27379796 PMCID: PMC4933396 DOI: 10.1371/journal.pone.0157726] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 06/03/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine the impact of adverse childhood experiences (ACEs) and support on self-reported work inability of adults reporting disability. PARTICIPANTS Adults (ages 18-64) who participated in the Behavioral Risk Factor Surveillance System in 2009 or 2010 and who reported having a disability (n = 13,009). DESIGN AND MAIN OUTCOME MEASURES The study used a retrospective cohort design with work inability as the main outcome. ACE categories included abuse (sexual, physical, emotional) and family dysfunction (domestic violence, incarceration, mental illness, substance abuse, divorce). Support included functional (perceived emotional/social support) and structural (living with another adult) support. Logistic regression was used to adjust for potential confounders (age, sex and race) and to evaluate whether there was an independent effect of ACEs on work inability after adding other important predictors (support, education, health) to the model. RESULTS ACEs were highly prevalent with almost 75% of the sample reporting at least one ACE category and over 25% having a high ACE burden (4 or more categories). ACEs were strongly associated with functional support. Participants experiencing a high ACE burden had a higher adjusted odds ratio (OR) [95% confidence interval] of 1.9 [1.5-2.4] of work inability (reference: zero ACEs). Good functional support (adjusted OR 0.52 [0.42-0.63]) and structural support (adjusted OR 0.48 [0.41-0.56]) were protective against work inability. After adding education and health to the model, ACEs no longer appeared to have an independent effect. Structural support remained highly protective, but functional support only appeared to be protective in those with good physical health. CONCLUSIONS ACEs are highly prevalent in working-age US adults with a disability, particularly young adults. ACEs are associated with decreased support, lower educational attainment and worse adult health. Health care providers are encouraged to screen for ACEs. Addressing the effects of ACEs on health and support, in addition to education and retraining, may increase ability to work in those with a disability.
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Affiliation(s)
- Sophia Miryam Schüssler-Fiorenza Rose
- Spinal Cord Injury Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States of America
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States of America
| | - Jessica G. Eslinger
- Center on Trauma and Children, Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, Kentucky, United States of America
| | - Lindsey Zimmerman
- Dissemination and Training Division, National Center for Posttraumatic Stress Disorders, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, United States of America
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America
| | - Jamie Scaccia
- Adler School of Professional Psychology, Chicago, Illinois, United States of America
| | - Betty S. Lai
- School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Catrin Lewis
- National Centre for Mental Health, Cardiff University Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, Wales, United Kingdom
| | - Eva Alisic
- Monash University Accident Research Centre, Monash University, Melbourne, Australia
- Department of Psychosomatics and Psychiatry, University Children’s Hospital Zurich, Zurich, Switzerland
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Ramakrishnan K, Johnston D, Garth B, Murphy G, Middleton J, Cameron I. Early Access to Vocational Rehabilitation for Inpatients with Spinal Cord Injury: A Qualitative Study of Patients' Perceptions. Top Spinal Cord Inj Rehabil 2016; 22:183-191. [PMID: 29339860 DOI: 10.1310/sci2203-183] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: A pilot early-intervention vocational rehabilitation program was conducted in Sydney, Australia, over a 2-year period. It was postulated that the early provision of integrated vocational rehabilitation services in the hospital settings for newly injured individuals would be well received and result in better employment and psychosocial health outcomes. Objective: The objective of this qualitative inquiry was to examine the perspectives of program participants who had completed the intervention about the timeliness, perceived value, and critical elements of the early intervention. Methods: A convenience sample of participants was selected by accessibility; participants were interviewed individually after discharge using a semi-structured approach. Transcripts of the interviews were created via audio recordings; interviews were transcribed verbatim, and the contents were analyzed thematically. Results: Thirteen participants aged from 19 to 60 years with varying levels of impairment and vocational backgrounds were interviewed from 7 to 21 months post injury. Overall, the early introduction of vocational rehabilitation services was well received and viewed positively. Emerging themes include sense of direction and distraction, advocacy, and support, with "hope" (early after injury) emerging as the overarching theme. Criticisms voiced about the program were that it was offered too early in the intensive care unit and there were competing interests and information overload in the early recovery phase. Conclusions: Vocational rehabilitation provided during inpatient rehabilitation appears appropriate, important, and valuable from patients' perspective. Early engagement results in feelings of hope and encourages patients to see the possibility of returning to work or education very early after injury, and it allows rehabilitation to be directed accordingly.
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Affiliation(s)
- Kumaran Ramakrishnan
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, The University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Deborah Johnston
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, The University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Belinda Garth
- Southern GP Training Ltd, Churchill, Victoria, Australia, and Department of General Practice, The University of Melbourne, Australia
| | | | - James Middleton
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, The University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Ian Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, The University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St. Leonards, NSW, Australia
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25
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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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26
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Abstract
BACKGROUND The unemployment rate is currently higher among women Veterans than among male Veterans and civilian women. Employment is a key social determinant of health, with unemployment being strongly associated with adverse health. OBJECTIVE To identify military-related and health-related characteristics associated with unemployment in women Veterans. RESEARCH DESIGN AND SUBJECTS Secondary analysis of workforce participants (n=1605) in the National Survey of Women Veterans telephone survey. MEASURES Demographics, mental health conditions, health care utilization, and military experiences and effects. Unemployment was defined as being in the labor force but unemployed and looking for work. ANALYSIS The χ analyses to identify characteristics of unemployed women Veterans; logistic regression to identify independent factors associated with unemployment. RESULTS Ten percent of women Veterans were unemployed. Independent correlates of unemployment were screening positive for depression [odds ratio (OR)=4.7; 95% confidence interval [CI], 1.8-12.4], military service during wartime (OR=2.9; 95%, CI 1.1-7.3), and service in the regular military (vs. in the National Guards/Reserves only) (OR=6.8; 95% CI, 2.2-20.5). Two postactive duty perceptions related to not being respected and understood as a Veteran were each independently associated with unemployment. CONCLUSIONS Whether depression underlies unemployment, is exacerbated by unemployment, or both, it is critical to identify and treat depression among women Veterans, and also to investigate women Veterans' experiences and identities in civilian life. Community-based employers may need education regarding women Veterans' unique histories and strengths. Women who served in the regular military and during wartime may benefit from job assistance before and after they leave the military. Gender-specific adaptation of employment services may be warranted.
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27
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Mueser KT, McGurk SR. Supported employment for persons with serious mental illness: current status and future directions. Encephale 2014; 40 Suppl 2:S45-56. [PMID: 24929974 DOI: 10.1016/j.encep.2014.04.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/29/2014] [Indexed: 11/27/2022]
Abstract
The individual placement and supported (IPS) model of supported employment is the most empirically validated model of vocational rehabilitation for persons with schizophrenia or another serious mental illness. Over 18 randomized controlled trials have been conducted throughout the world demonstrating the effectiveness of supported employment at improving competitive work compared to other vocational programs: IPS supported employment is defined by the following principles: 1) inclusion of all clients who want to work; 2) integration of vocational and clinical services; 3) focus on competitive employment; 4) rapid job search and no required prevocational skills training; 5) job development by the employment specialist; 6) attention to client preferences about desired work and disclosure of mental illness to prospective employers; 7) benefits counseling; and 8) follow-along supports after a job is obtained. Supported employment has been successfully implemented in a wide range of cultural and clinical populations, although challenges to implementation are also encountered. Common challenges are related to problems such as the failure to access technical assistance, system issues, negative beliefs and attitudes of providers, funding restrictions, and poor leadership. These challenges can be overcome by tapping expertise in IPS supported employment, including standardized and tested models of training and consultation. Efforts are underway to increase the efficiency of training methods for supported employment and the overall program, and to improve its effectiveness for those clients who do not benefit. Progress in IPS supported employment offers people with a serious mental illness realistic hope for achieving their work goals, and taking greater control over their lives.
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Affiliation(s)
- K T Mueser
- Departments of Occupational Therapy, Psychology, and Psychiatry; Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Avenue West, Boston, MA 02215, United States.
| | - S R McGurk
- Departments of Occupational Therapy, Psychology, and Psychiatry; Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Avenue West, Boston, MA 02215, United States
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28
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Sinnott PL, Joyce V, Su P, Ottomanelli L, Goetz LL, Wagner TH. Cost-effectiveness of supported employment for veterans with spinal cord injuries. Arch Phys Med Rehabil 2014; 95:1254-61. [PMID: 24486426 DOI: 10.1016/j.apmr.2014.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/07/2014] [Accepted: 01/09/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To estimate the cost-effectiveness of a supported employment (SE) intervention that had been previously found effective in veterans with spinal cord injuries (SCIs). DESIGN Cost-effectiveness analysis, using cost and quality-of-life data gathered in a trial of SE for veterans with SCI. SETTING SCI centers in the Veterans Health Administration. PARTICIPANTS Subjects (N=157) who completed a study of SE in 6 SCI centers. Subjects were randomly assigned to the intervention of SE (n=81) or treatment as usual (n=76). INTERVENTION A vocational rehabilitation program of SE for veterans with SCI. MAIN OUTCOME MEASURES Costs and quality-adjusted life years, which were estimated from the Veterans Rand 36-Item Health Survey, extrapolated to Veterans Rand 6 Dimension utilities. RESULTS Average cost for the SE intervention was $1821. In 1 year of follow-up, estimated total costs, including health care utilization and travel expenses, and average quality-adjusted life years were not significantly different between groups, suggesting the Spinal Cord Injury Vocational Integration Program intervention was not cost-effective compared with usual care. CONCLUSIONS An intensive program of SE for veterans with SCI, which is more effective in achieving competitive employment, is not cost-effective after 1 year of follow-up. Longer follow-up and a larger study sample will be necessary to determine whether SE yields benefits and is cost-effective in the long run for a population with SCI.
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Affiliation(s)
- Patricia L Sinnott
- VA Health Economics Resource Center, and Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA.
| | - Vilija Joyce
- VA Health Economics Resource Center, and Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA
| | - Pon Su
- VA Health Economics Resource Center, and Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA
| | - Lisa Ottomanelli
- Health Services Research and Development/Rehabilitation Research and Development Center of Excellence Maximizing Rehabilitation Outcomes, James A. Haley Veterans Hospital, Tampa, FL
| | - Lance L Goetz
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA
| | - Todd H Wagner
- VA Health Economics Resource Center, and Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA
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