Employment, health outcomes, and life satisfaction after spinal cord injury: comparison of veterans and nonveterans

The effect of rurality and distance from care on health outcomes, environmental barriers, and healthcare utilization patterns in persons with traumatic spinal cord injury

STUDY DESIGN

Cohort study.

OBJECTIVES

To evaluate the association between residential living location and health outcomes, environmental barriers, quality of life, and healthcare utilization patterns after traumatic spinal cord injury (tSCI).

SETTING

Community setting, Atlantic Canada.

METHODS

An ambispective study of data collected on a subset of individuals enrolled in the Rick Hansen Spinal Cord Injury Registry (RHSCIR) from 2012 to 2018. Outcomes were analyzed using two measures of rurality: postal codes at community follow-up (rural versus urban) and residential travel distance to the nearest RHSCIR facility (>100 km versus ≤100 km). Outcomes studied included the Craig Hospital Inventory of Environmental Factors-Short Form (CHIEF-SF), Short Form-36 Version 2 (SF36v2), Life Satisfaction Questionnaire (LISAT-11), Spinal Cord Independence Measure (SCIM), secondary health complications and healthcare utilization patterns. Outcomes were assessed 9 to 24 months post-discharge from initial hospitalization.

RESULTS

104 participants were studied, 21 rural and 83 urban based on postal codes at community follow-up. 59 participants lived more than 100 km away from the nearest RHSCIR facility, while 45 participants lived within 100 km. Individuals from urban area codes reported a greater magnitude of perceived barriers on the policies and work/school subscales of the CHIEF-SF. No differences in function, quality of life, and healthcare utilization patterns according to the measures of rurality were observed. Individuals living >100 km from the nearest RHSCIR facility reported greater rates of sexual dysfunction.

CONCLUSIONS

Despite differences in environmental barriers, individuals from urban and rural locations in Eastern Canada reported similar health outcomes and quality of life after tSCI.

Vocational rehabilitation resources from the perspective of people with spinal cord injury and service providers

BACKGROUND: Vocational rehabilitation for people with spinal cord injury (SCI) in Iran as one of the countries in the Middle East and North Africa region is under-studied. OBJECTIVES: The purpose of this study was to explore the perspective of people with SCI and service providers about vocational rehabilitation challenges. METHODS: We used an ethnographic methodology to collect data. Observation (2018 –2020) and semi-structured interviews with 21 persons with SCI and 11 service providers were the data collection methods, and a thematic analysis approach was used to analyze the data. RESULTS: Results demonstrate that career self-knowledge (knowledge about capabilities, aspirations, and interests) and career knowledge (the importance of career exploration, vocational support and job characteristics) were the main two vocational rehabilitation resources. CONCLUSIONS: Knowledge (about the self and careers) is the main resource mentioned by the participants regarding the vocational rehabilitation. Implications for professionals and policy makers are presented.