Delayed entry into employment after spinal cord injury: factors related to time to first job

Traumatic Cervical Spinal Cord Injury and Income and Employment Status

Importance

Spinal cord injury (SCI) causes drastic changes to an individual's physical health that may be associated with the ability to work.

Objective

To estimate the association of SCI with individual earnings and employment status using national administrative health databases linked to income tax data.

Design, Setting, and Participants

This was a retrospective, national, population-based cohort study of adults who were hospitalized with cervical SCI in Canada between January 2005 and December 2017. All acute care hospitalizations for SCI of adults ages 18 to 64 years were included. A comparison group was constructed by sampling from individuals in the injured cohort. Fiscal information from their preinjury years was used for comparison. The injured cohort was matched with the comparison group based on age, sex, marital status, province of residence, self-employment status, earnings, and employment status in the year prior to injury. Data were analyzed from August 2022 to January 2023.

Main outcomes and Measures

The first outcome was the change in individual annual earnings up to 5 years after injury. The change in mean yearly earnings was assessed using a linear mixed-effects differences-in-differences regression. Income values are reported in 2022 Canadian dollars (CAD $1.00 = US $0.73). The second outcome was the change in employment status up to 5 years after injury. A multivariable probit regression model was used to compare proportions of individuals employed among those who had experienced SCI and the paired comparison group of participants.

Results

A total of 1630 patients with SCI (mean [SD] age, 47 [13] years; 1304 male [80.0%]) were matched to patients in a preinjury comparison group (resampled from the same 1630 patients in the SCI group). The mean (SD) of preinjury wage earnings was CAD $46 000 ($48 252). The annual decline in individual earnings was CAD $20 275 (95% CI, -$24 455 to -$16 095) in the first year after injury and CAD $20 348 (95% CI, -$24 710 to -$15 985) in the fifth year after injury. At 5 years after injury, 52% of individuals who had an injury were working compared with 79% individuals in the preinjury comparison group. SCI survivors had a decrease in employment of 17.1 percentage points (95% CI, 14.5 to 19.7 percentage points) in the first year after injury and 17.8 percentage points (14.5 to 21.1 percentage points) in the fifth year after injury.

Conclusions and Relevance

In this study, SCI was associated with a decline in earnings and employment up to 5 years after injury for adults aged 18 to 64 years in Canada.

Factors influencing employment among people with spinal cord injury in South Africa

PURPOSE

The unemployment rate post spinal cord injury (SCI) in South Africa is high with limited knowledge of environmental factors outside the health services, especially in an unevenly developed resource setting like South Africa, affecting the employment rate in people with SCI. Our purpose was to investigate factors associated with employment in people with SCI in South Africa.

METHODS

Two hundred persons with SCI participated in a cross-sectional survey design. This study formed part of the International Spinal Cord Injury Community Survey. Subsections of the questionnaire responses were used as explanatory variables to predict employment after SCI using logistic regression analysis.

RESULTS

The response rate of the study was 54%. Of the 200 participants included, 61% reported being employed before SCI onset whereas only 25% reported being engaged in paid work at the time of this study. The logistic regression model showed not requiring physical assistance in the home environment (p = 0.016), the number of education years before SCI (p = 0.007), household income (p < 0.001), having worked before SCI onset (p = 0.041), and environmental factors (p = 0.029) to be factors associated with employment after SCI.

CONCLUSION

The finding suggests multiple factors influence the employment rate, advocating for interdisciplinary rehabilitation approaches and social development interventions to address meaningful occupations in persons with SCI in South Africa.Implications for rehabilitationRehabilitation programs should be adapted and tailored to enhance physical independence.Public policies regarding environmental factors such as access to reliable transport, assistive devices, and public places for wheelchair users are important and could potentially support individuals with spinal cord injury (SCI) becoming employed/re-employed.For successful social/community/civic reintegration for individuals with SCI an intersectional collaboration (i.e., between policymakers, health professionals, and the labor market) needs to be considered to improve the employment opportunities post-SCI.

United and flexible: a collaborative approach to early vocational rehabilitation on a spinal unit. A realist study

STUDY DESIGN

Qualitative study using realist review.

OBJECTIVES

To conceptualise how Early Intervention Vocational Rehabilitation (EIVR) functions within inpatient multidisciplinary contexts during spinal cord injury (SCI) rehabilitation.

SETTING

New Zealand Spinal Unit.

METHODS

People with newly acquired SCI and members of their rehabilitation team were observed in a range of rehabilitation sessions, team meetings and therapeutic interactions. Participants were also interviewed to explore how EIVR functioned alongside the multidisciplinary team (MDT). Interviews and observations were transcribed, coded and analysed using realist methods.

RESULTS

We identified three primary contexts which influenced how EIVR was delivered within the MDT: (1) a united approach, (2) a flexible approach, and (3) a hesitant approach. These contexts generated four work-related outcomes for people with SCI; enhanced work self-efficacy, strengthened hope for work, maintained work identity, and the less desirable outcome of increased uncertainty about work.

CONCLUSIONS

To optimise work outcomes for people after SCI, it is important to consider how EIVR is delivered and integrated within the wider MDT. Such an understanding can also inform the establishment of new EIVR services in different settings. Results suggest that unity, flexibility and clarity between EIVR services and the wider MDT are essential foundations for supporting people with SCI on their journey to employment.

SPONSORSHIP

This research was funded by Health Research Council NZ grant in partnership with Canterbury District Health Board.

Developing A Conceptual Framework for Early Intervention Vocational Rehabilitation for People Following Spinal Cord Injury

PURPOSE

Early intervention vocational rehabilitation (EIVR) can improve return to work (RTW) outcomes for people with spinal cord injury (SCI). However, mechanisms explaining how and why EIVR works are not well understood. This study aims to develop a conceptual framework describing key mechanisms of EIVR intervention effect following SCI.

METHODS

We synthesised data from a realist literature review with data from interviews of people with SCI (n = 30), a survey of people with SCI who had received EIVR (n = 37), a focus group of EIVR providers and a focus group of community vocational providers. We first synthesised the literature review and interviews to develop an initial programme theory describing the contexts in which mechanisms are activated to produce EIVR outcomes. Then we used data from the survey and focus groups to further refine the EIVR programme theory. Finally, a conceptual framework was developed to support knowledge dissemination.

RESULTS

By ensuring consistent messaging across the multi-disciplinary team, EIVR programmes establish and maintain hope that work is possible following injury. Conversations about work allow individuals to determine the priority of work following injury. These conversations can also improve self-efficacy by providing individualized support to envisage pathways toward RTW goals and maintain worker identity. The synthesised study findings highlight the contexts and resources required to trigger activation of these mechanisms.

CONCLUSIONS

EIVR key mechanisms of effect are not specific to SCI as a health condition, therefore enabling this framework to be applied to other populations who face similar impairments and return to work barriers.

Early Opportunities to Explore Occupational Identity Change: Qualitative Study of Return-To-Work Experiences After Stroke

BACKGROUND

Rates of return-to-work after stroke are low, yet work is known to positively impact people's wellbeing and overall health outcomes.

OBJECTIVE

To understand return-to-work trajectories, barriers encountered, and resources that may be used to better support participants during early recovery and rehabilitation.

PARTICIPANTS

The experiences of 31 participants (aged 25-76 years) who had or had not returned to work after stroke were explored.

METHODS

Interview data were analysed using reflexive thematic analysis methods within a broader realist research approach.

RESULTS

Participants identified an early need to explore a changed and changing occupational identity within a range of affirming environments, thereby ascertaining their return-to-work options early after stroke. The results articulate resources participants identified as most important for their occupational explorations. Theme 1 provides an overview of opportunities participants found helpful when exploring work options, while theme 2 explores fundamental principles for ensuring the provided opportunities were perceived as beneficial. Finally, theme 3 provides an overview of prioritized return-to-work service characteristics.

CONCLUSION

The range and severity of impairments experienced by people following stroke are broad, and therefore their return-to-work needs are diverse. However, all participants, irrespective of impairment, highlighted the need for early opportunities to explore their changed and changing occupational identity.

Factors associated with sustaining work with chronic spinal cord injury: a scoping review

PURPOSE

Work participation remains challenging for people with spinal cord injury (SCI), as reflected in lower employment rates compared to the general population. To promote work participation for people with SCI, practitioners and policymakers need a better understanding of the factors associated with sustaining work in the long term. This study aimed to identify such factors.

MATERIALS AND METHODS

Scoping review synthesizing quantitative and qualitative research published between 2000 and 2021. The databases searched were PubMed, CINAHL Complete, PsycINFO, Scopus, and Web of Science.

RESULTS

Initially, 1221 articles were identified. Three quantitative studies investigating socio-demographic and injury-related factors and eight qualitative studies exploring mainly personal and environmental facilitators and barriers to working in the long term were retained. The results of the quantitative studies showed the importance of time since injury, age, and education. The qualitative findings emphasized the positive influence of self-advocacy, managing health behaviors, and a supportive work environment. Main barriers were time organization and societal attitudes.

CONCLUSIONS

Future interventions should address the identified factors to promote working in the long term of people with SCI. Policymakers should adapt and enforce legal standards that address environmental and social barriers to creating supportive work environments for persons with SCI.Implications for rehabilitationPeople with spinal cord injury (SCI) experience difficulties in maintaining employment.Personal factors identified as crucial for working in the long term, such as self-advocacy and self-management of health behaviors, should be strengthened by future interventions.People with SCI should be offered a supportive work environment with work accommodations and flexible working hours to facilitate their labor market participation.

Results from phase one of an early intervention vocational rehabilitation trial for people with spinal cord injury conducted in Queensland, Australia

BACKGROUND: The Back2Work Early Intervention Vocational Rehabilitation (EIVR) program was developed in response to the low employment rate of people with spinal cord injuries (SCI) and their lack of access to early, specialised vocational rehabilitation (VR). The program has been delivered by qualified rehabilitation counsellors to hospital patients with newly acquired SCI since 2016. OBJECTIVE: The objective of the study was to evaluate the effectiveness and consumer perspective of the Back2Work EIVR Program. METHODS: The program was evaluated using a mixed-methods, longitudinal, prospective design. RESULTS: Data analysis revealed a return to work rate (RTW) of 43% by 12 months post-discharge. Qualitative data indicated positive participant experiences with the program, emphasising the hopefulness brought about by early vocational support. CONCLUSIONS: The Back2Work program has a positive impact on participants’ RTW outcomes, through the provision of early specialist vocational rehabilitation interventions. This includes building a positive culture around RTW after SCI and engagement with employers to maximise the likelihood of timely and sustainable re-employment. The RTW outcomes and emergent themes will help inform service development in the field of early vocational rehabilitation after SCI.

Vocational wayfinding following spinal cord injury: In what contexts, how and why does early intervention vocational rehabilitation work?

BACKGROUND: Early intervention vocational rehabilitation (EIVR) is used to optimize return to work (RTW) outcomes for people following spinal cord injury (SCI). However, theoretical clarity is required about how EIVR works, for whom and under what circumstances. OBJECTIVE: To develop a theoretical understanding of how people respond to EIVR following SCI and the contexts in which mechanisms of intervention effect are likely to be activated. METHODS: Realist research methods were used to analyze interviews with 30 participants who had received EIVR following SCI. RESULTS: We conceptualized the reporting of our analyses using a travel metaphor, encapsulating the types and degree of wayfinding support participants required to think about, plan and action their vocational aspirations. Developing, maintaining and enacting hope, supporting self-identity and vocational identity, and focusing on environmental context adaptations required to enact vocational aspirations, appear to be critical mechanisms of intervention effect within EIVR. CONCLUSIONS: Various contexts and mechanisms of EIVR contribute to successful negotiation, achievement and sustainability of RTW outcomes for people following SCI. These theoretical understandings can refine EIVR service provision within SCI rehabilitation and inform how EIVR can improve RTW outcomes for people with acquired neurological conditions in other rehabilitation contexts.

Early vocational rehabilitation after spinal cord injury: A survey of service users

BACKGROUND: Early vocational rehabilitation following spinal cord injury (SCI) improves return to work (RTW) outcomes, but there is limited information about who benefits from such interventions, why and in what contexts. OBJECTIVE: We aimed to describe demographic and clinical characteristics and RTW outcomes of adults with SCI who received early vocational rehabilitation. We sought to identify key mechanisms of early vocational rehabilitation. METHODS: This is a cross-sectional survey of people with SCI recruited from the New Zealand Spinal Trust Vocational Rehabilitation Service, who had sustained an SCI within the previous five years. RESULTS: Of the 37 people who responded to the survey, 54% returned to paid work (90% of whom retained their pre-injury employment). Those in autonomous roles returned to work faster with greater odds of returning to their pre-injury employer and role. Participants highlighted the importance of feeling hopeful about RTW while still in the spinal unit as a key mechanism of effect within the early vocational intervention. CONCLUSIONS: Findings suggested key mechanisms of early vocational intervention could be framed by models of hope. However, for gains to be optimised, continuity of support beyond the acute stage was suggested as an area for future research.

Spinal cord injury and work challenges: an analysis of paid work status and pathways of return to work in Brazil

DESIGN

Retrospective cohort study.

OBJECTIVES

To investigate paid work status and return to work (RTW) pathways after spinal cord injury (SCI).

SETTING

SARAH Network of Rehabilitation Hospitals.

METHODS

Participants were adults with traumatic SCI, aged between 18 and 60 years at the time of the injury, admitted between 2000 and 2017. In the first stage, socio-demographic, injury-related, and functional status data were collected from medical records. In the second stage, data on paid work, means of mobility, driving ability, return to study, ability to work, and satisfaction with the work status were collected through an online survey conducted between January and March 2020.

RESULTS

A total of 154 participants were included in the sample. Of these, 90% were working at the time of SCI and 23% were engaged in paid work at the time of the study. Three RTW pathways were identified among those who were working at the time of the injury and: did not return to work (78%); returned to a different occupation (12%) and returned to the same occupation (9%). Number of post-injury complications, returning to study, good work ability, and satisfaction with the work status were predictors of paid work. The model's adjusted coefficient was 56.5% (p = 0.001).

CONCLUSION

Working-age people with SCI who underwent rehabilitation in Brazil had a low rate of paid work. Fewer complications at the time of the injury, returning to study, good ability to work and greater satisfaction with the work status increased the likelihood of being engaged in paid work.

30 Years After the Americans with Disabilities Act: Perspectives on Employment for Persons with Spinal Cord Injury

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.

Employment status, hours working, and gainful earnings after spinal cord injury: relationship with pain, prescription medications for pain, and nonprescription opioid use

STUDY DESIGN

Cross-sectional self-report assessment. Econometric modeling.

OBJECTIVES

Identify the relationship of multiple pain indicators, prescription pain medication, nonprescription opioid use, and multiple indicators of quality employment among those with spinal cord injury (SCI).

SETTING

Data were collected at a medical university in the Southeastern United States (US).

METHODS

Participants included 4670 adults with traumatic SCI of at least one-year duration who were enrolled in a study of health and longevity. They were identified from three sources including a specialty hospital and two population-based state SCI surveillance systems. Econometric modeling was used for three outcome variables: employment status, hours per week spent working, and earnings.

RESULTS

Several pain parameters were significantly related to multiple employment outcomes. Prescription medication to treat pain was associated with lower odds of employment, fewer hours working, and lower conditional earnings. Nonprescription opioid use was only related to fewer hours working. Painful days, number of painful conditions, and pain intensity were all related to employment outcomes, but the pattern varied by outcome. The number of painful conditions was most consistently related to employment. Multiple demographic, injury, and educational factors were related to employment, with better outcomes among those with less severe SCI and greater educational achievements.

CONCLUSIONS

The presence of significant pain and use of either prescription pain medications or the use of nonprescription opioids may have a significant adverse effect on both the probability of employment and quality of employment. Rehabilitation and vocational professionals should routinely assess pain and associated medications in vocational and career planning.

Differential Odds of Employment and Estimation of Earnings Among Those With Spinal Cord Injury

Our purpose was to identify demographic, educational, and injury-related characteristics associated with odds of employment and estimates of differential earnings among participants with spinal cord injury (SCI). Self-report assessments were obtained from 1,983 participants who had traumatic SCI, were 18+ years old, and less than 65 years of age. All were recruited into the current cross-sectional study from previous studies of health and aging from the Midwestern and Southeastern United States. Midwestern participants had 2.41 higher odds of employment. Older age at injury was associated with lower odds of employment. There were no sex differences in the odds of employment, but women had an estimated US$19,431 lower conditional earnings. Non-Hispanic Blacks had 69% lower odds of employment, and those working had an estimated US$12,058 lower earnings. Ambulatory participants had higher odds of employment (odds ratio [OR] = 4.66) and higher conditional earnings (US$17,277) than those with the most severe SCI. Those with 4-year or postgraduate degrees had substantially higher odds of employment (OR = 4.15, OR = 5.72, respectively) and higher conditional earnings (US$29,990, US$44,580, respectively) compared with those with a high school certificate or less. These findings underscore the importance of policies to promote the optimal quality employment outcomes for people with SCI.

Work and wellbeing-related consequences of different return-to-work pathways of persons with spinal cord injury living in Switzerland

STUDY DESIGN

Observational study based on the 2012 community survey of the Swiss Spinal Cord Injury Cohort Study (SwiSCI).

OBJECTIVES

To investigate work and wellbeing-related consequences of different return-to-work (RTW) pathways after SCI.

SETTING

Community-based.

METHODS

Using a subsample of 243 SwiSCI participants, we determined whether a respondent had returned to the pre-injury employer, started with a new employer or had not returned to gainful employment post-SCI. For each pathway, descriptive statistics were provided and work and wellbeing-related consequences were examined with regression analyses.

RESULTS

One hundred eleven (45.7%) participants had returned to their pre-injury employer, 80 (32.9%) had changed employers and 52 (21.4%) had never returned to paid work post-SCI. Although returning to the pre-injury employer was associated with a shorter RTW time and a higher current weekly work time compared with starting work with a new employer, no significant differences were found with regard to current employment status and post-SCI work duration. Concerning wellbeing-related outcomes (i.e., income, quality of life and life satisfaction), the two pathways did not differ.

CONCLUSIONS

Although lasting RTW had beneficial wellbeing outcomes, the specific pathway initially taken (i.e., pre-injury vs. new employer) appeared less crucial. Although the two pathways seem equally viable, longitudinal data are required to corroborate the present findings, and future research needs to clarify the role of the client triage system and of vocational rehabilitation practices with regard to person-job match and its impact on job satisfaction and job performance.

Return to work in the context of everyday life 7-11 years after spinal cord injury - a follow-up study

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.

Integrated services and early intervention in the vocational rehabilitation of people with spinal cord injuries

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).

Labor Market Integration of People with Disabilities: Results from the Swiss Spinal Cord Injury Cohort Study

Objectives

We aimed to describe labor market participation (LMP) of persons with spinal cord injury (SCI) in Switzerland, to examine potential determinants of LMP, and to compare LMP between SCI and the general population.

Methods

We analyzed data from 1458 participants of employable age from the cross-sectional community survey of the Swiss Spinal Cord Injury Cohort Study. Data on LMP of the Swiss general population were obtained from the Swiss Federal Statistical Office. Factors associated with employment status as well as the amount of work performed in terms of full-time equivalent (FTE) were examined with regression techniques.

Results

53.4% of the participants were employed at the time of the study. Adjusted odds of being employed were increased for males (OR = 1.73, 95% CI 1.33–2.25) and participants with paraplegia (OR = 1.78, 95% CI 1.40–2.27). The likelihood of being employed showed a significant concave relationship with age, peaking at age 40. The relation of LMP with education was s-shaped, while LMP was linearly related to time since injury. On average, employment rates were 30% lower than in the general population. Males with tetraplegia aged between 40 and 54 showed the greatest difference. From the 771 employed persons, the majority (81.7%) worked part-time with a median of 50% FTE (IRQ: 40%-80%). Men, those with younger age, higher education, incomplete lesions, and non-traumatic etiology showed significantly increased odds of working more hours per week. Significantly more people worked part-time than in the general population with the greatest difference found for males with tetraplegia aged between 40 and 54.

Conclusions

LMP of persons with SCI is comparatively high in Switzerland. LMP after SCI is, however, considerably lower than in the general population. Future research needs to show whether the reduced LMP in SCI reflects individual capacity adjustment, contextual constraints on higher LMP or both.

Return-to-work intentions during spinal cord injury rehabilitation: an audit of employment outcomes

STUDY DESIGN

Single-centre, retrospective cohort study.

OBJECTIVES

To analyse the return-to-work intentions during spinal cord injury (SCI) rehabilitation.

SETTING

Tertiary care, spinal cord injury rehabilitation unit, National Spinal Injuries Centre, Stoke Mandeville Hospital, Ayelsbury, UK.

METHODS

Employment outcomes were obtained from the Needs Assessment Checklist (NAC), for all patients admitted to the unit between February 2008 and October 2014. NAC1 is completed within 4 weeks post-mobilisation and NAC2 upon the patient moving to the pre-discharge ward. Data from 362 participants were analysed for return-to-work intentions, by gender, age and injury severity.

RESULTS

Seventy-six percent of the sample population was employed at the time of their injury. At NAC1, 22.4% of individuals had made plans to return to work, whereas 44.2% had not; at NAC2, 34.3% had made plans to return to work and 31.2% had not. This difference was found to be statistically significant. There were significant differences in return-to-work intentions by injury severity at NAC1 but not NAC2, and by age group at NAC2 but not NAC1.

CONCLUSION

Less than half of those employed at the time of their injury had made plans to return to work before their discharge from the unit. The low proportion of individuals with SCI returning to work--just one in three--is concerning in view of the lost health and psychosocial benefits, and requires greater prominence during rehabilitation. Future research into effective employment interventions to improve employment outcomes in this population is required.

"The final piece of the puzzle to fit in": an interpretative phenomenological analysis of the return to employment in New Zealand after spinal cord injury

PURPOSE

Little is known about employment experience after spinal cord injury (SCI) because most research to date concentrates on employment predictors. We explored the experiences of people with SCI, and vocational rehabilitation (VR) professionals working for a VR programme, in pursuing a return to employment in New Zealand (NZ) post-SCI.

METHODS

Twelve people with SCI (four employed, three job-seeking, five unemployed) and six VR professionals were interviewed, and the transcripts subjected to an Interpretative Phenomenological Analysis.

RESULTS

The core meaning of employment post-SCI was to live a normal life. Work advantages were social connectedness, a sense of self-worth, earning a living, and being occupied. Employment was the zenith of rehabilitation but not the first priority post-SCI. Employment barriers and facilitators were congruent with those found in similar studies. The role of VR was to sow the seeds of return to employment and to partner with the SCI client.

CONCLUSIONS

For persons employed pre-SCI, we posit that employment identity modification is part of the return to employment process, alongside a supportive social context and networks, and adapted work environments. VR professionals may facilitate return to employment through understanding and fostering the process of employment identity modification and supporting clients to find work opportunities congruent with employment identity.

Prediction of postinjury employment and percentage of time worked after spinal cord injury

OBJECTIVE

To use a 2-part model to identify biographic, injury, educational, and vocational predictors of postinjury employment and the percentage of time employed after spinal cord injury (SCI) onset.

DESIGN

Survey.

SETTING

Data were collected at 3 hospitals in the Southeastern and Midwestern United States.

PARTICIPANTS

Participants were adults with traumatic SCI of at least 1 year duration, all under 65 years at the time of SCI onset. A total of 1329 observations were used in the analysis.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Postinjury employment, defined by whether the individual had ever been employed after SCI and percentage of time employed after SCI onset.

RESULTS

Almost 52% of participants worked at some point in time postinjury. Among those who had worked postinjury, the mean portion of time spent working was 0.56. Several factors were significantly related to postinjury employment and portion of time worked postinjury. The probability of postinjury employment increased with successively less severe injury. However, only ambulatory participants were found to have a significantly greater portion of time postinjury among those who became employed. Having obtained either a 4-year or graduate degree after injury was associated with a greater likelihood of postinjury employment. Conversely, among those who worked postinjury, having obtained those degrees prior to injury was associated with a greater portion of time employed. Being white, a man, having completed a 4-year degree or a graduate degree, and having worked in the service industry prior to SCI onset were all associated with a greater portion of time working among those who had worked.

CONCLUSIONS

The factors precipitating PE are not identical to those associated with a greater portion of time employed after SCI onset.

Occurrence and predictors of employment after traumatic spinal cord injury: the GISEM Study

STUDY DESIGN

Multicenter, prospective study.

OBJECTIVES

To assess the occurrence and predictors of return to work after traumatic spinal cord injury (SCI).

SETTING

Italian rehabilitation centers.

METHODS

We evaluated patients previously included in the Italian Group for the Epidemiological Study of Spinal Cord Injuries study. A standardised telephone interview was used to collect data after a mean follow-up of 3.8 years. The main outcome measure was employment at the end of follow-up.

RESULTS

A total of 403 patients, 336 men and 67 women, with a mean age of 41.8±16.3 years, were included in the follow-up. In all, 42.1% of patients were employed at the moment of the interview, though 62% reported a worsening in their employment level. Predictors of employment were education (P<0.0001), bowel continence (P=0.02), independence in mobility (P=0.0004), ability to drive (P<0.0001), participating in the community (P=0.0001) and ability to live alone (P<0.0001) while age (P<0.0001), being married (P<0.0001), tetraplegia (P=0.03), occurrence of recent medical problems (P=0.002), re-hospitalization (P=0.02), presence of architectonic barriers (P=0.009) and having a public welfare subsidy (P<0.0001), predicted unemployment. On the basis of multivariate analysis, younger age, education, absence of tetraplegia, ability to drive, ability to live alone, previous employment were independent predictors of employment after SCI. Employment at follow-up was related to several indicators of quality of life.

CONCLUSION

Employment after SCI was rather frequent and was related to several patient characteristics and social factors. Specific interventions on the patient and on the social environment may favor employment after SCI and improve quality of life.

Employment after paraplegia in India: a postal survey

STUDY DESIGN

This study was carried out as a postal survey.

OBJECTIVES

The aim of this study was to ascertain employment after paraplegia in India.

SETTING

This study was conducted in India.

METHODS

The study was conducted by means of a questionnaire. This questionnaire was mailed to the identified individuals (n=600) on the addresses obtained from the medical records section of hospitals and from various organisations. Data analysis was carried out by using descriptives.

RESULTS

The return rate was 46% (276/600) and the employment rate was 41% (114/276). Among 114 subjects who were employed, 68 (59.6%) were living in centres run by armed force and 46 (40.4%) were living in specialised centres or under the region of non-governmental organisations.

CONCLUSIONS

Individuals who were employed were living either in centres run by armed force or in specialised centres. None of the individuals living in community was employed.