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Streibelt M, Zollmann P, Völler H, Falk J, Salzwedel A. [Work Participation after Multimodal Rehabilitation due to Cardiovascular Diseases - Representative Analyses using Routine Data of the German Pension Insurance]. DIE REHABILITATION 2024; 63:169-179. [PMID: 37709287 DOI: 10.1055/a-2133-2552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
PURPOSE Cardiovascular diseases represent a large proportion of the disease burden of the adult population in Germany. Their importance in rehabilitation has increased continuously in recent years. Several studies have investigated return to work of cardiac patients after rehabilitation, which is relevant from the perspective of pension insurance. However, there is a lack of representative findings for the German region on employment trajectories and their influencing factors. METHODS The rehabilitation statistics database of the German Pension Insurance (GPI) was used for this study. Subjects were patients with cardiovascular diseases undergoing rehabilitation in 2017. Analyses were performed for the total group and differentiated by relevant diagnosis groups. Occupational participation was operationalized via a monthly state variable up to 24 months after rehabilitation and the rate of all persons who were employed at the 12- and 24- month follow-up and in the 3 months before, respectively. Multiple logistic regression models were calculated to analyze the influencing factors. RESULTS The total sample comprised 59,667 patients. The average age in all groups was between 53 and 56 years. Men were disproportionately represented; 70% of the services were provided as follow-up rehabilitations and 88% in the inpatient setting. Stable employment rates were 66% after one year and 63% after two years in the overall group (disease groups: 49% to 71%). The strongest influencing factors were the amount of pay and the number of sickness absence days before rehabilitation, active employment before rehabilitation, and age. CONCLUSION For the first time, representative data on occupational participation following rehabilitation on behalf of the GPI are available for the disease groups considered. The analyses underline the need to focus on occupational perspectives already in medical rehabilitation or directly thereafter.
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Affiliation(s)
- Marco Streibelt
- Dezernat Reha-Wissenschaften, Deutsche Rentenversicherung Bund, Berlin
| | - Pia Zollmann
- Dezernat Reha-Wissenschaften, Deutsche Rentenversicherung Bund, Berlin
| | - Heinz Völler
- Professur für Rehabilitationsmedizin, Universität Potsdam, Potsdam
| | - Johannes Falk
- Dezernat Reha-Qualitätssicherung, Epidemiologie und Statistik, Deutsche Rentenversicherung Bund, Berlin
| | - Annett Salzwedel
- Professur für Rehabilitationsmedizin, Universität Potsdam, Potsdam
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Keihanian F, Homaie Rad E, Samadi Shal S, Pourreza N, Eramsadati LK, Hosseini Malekroudi SM, Khodadadi-Hassankiadeh N. Return to work after traumatic spinal fractures and spinal cord injuries: a retrospective cohort study. Sci Rep 2023; 13:22573. [PMID: 38114786 PMCID: PMC10730843 DOI: 10.1038/s41598-023-50033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023] Open
Abstract
This study aimed to determine the factors associated with return to work (RTW) after traumatic spinal fracture and spinal cord injury. It provided a predictive model for RTW among patients with spinal fractures and spinal cord injury and determined important factors influencing the time to RTW after injury. A retrospective cohort study was conducted in Poursina Tertiary Hospital, Guilan, Iran between May 2017 and May 2020. Patients aged 18 to 65 who were hospitalized with traumatic spinal fractures and spinal cord injuries were included. Demographic and clinical data were collected from the National Spinal Column/Cord Injury Registry of Iran (NSCIR-IR). A researcher-administered questionnaire was used through a telephone interview to obtain complementary data on social and occupational variables. Kaplan-Meier survival analysis was used to estimate the average time to RTW and the predictors of RTW were determined by multivariate Cox regression model. Of the 300 patients included, 78.6% returned to work and the average time to RTW was about 7 months. The mean age of the participants was 45.63 ± 14.76 years old. Among the study variables, having a Bachelor's degree (HR 2.59; 95% CI 1.16-5.77; P = 0.019), complications after injury (HR 0.47; 95% CI 0.35-0.62; P = 0.0001), full coverage health insurance (HR 1.73; 95% CI 1.10-2.72; P = 0.016), opium use (HR 0.48; 95% CI 0.26-0.90; P = 0.023), number of vertebral fractures (HR 0.82; 95% CI 0.67-0.99; P = 0.046), and length of hospital stay (HR 0.95; 95% CI 0.93-0.98; P = 0.001) were found to be significant in predicting RTW in Cox regression analysis. Our analysis showed that wealthier people and those with high job mobility returned to work later.
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Affiliation(s)
- Fateme Keihanian
- Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran
| | - Enayatollah Homaie Rad
- Social Determinants of Health Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran
| | - Simin Samadi Shal
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Nooshin Pourreza
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | | | | | - Naema Khodadadi-Hassankiadeh
- Guilan Road Trauma Research Center, Poursina Hospital, Trauma Institute, Guilan University of Medical Sciences, Namjoo St, Rasht, Iran.
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Bloom J, McLennan V, Dorsett P. Results from phase one of an early intervention vocational rehabilitation trial for people with spinal cord injury conducted in Queensland, Australia. JOURNAL OF VOCATIONAL REHABILITATION 2022. [DOI: 10.3233/jvr-221214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Julia Bloom
- School of Health Sciences and Social Work, Griffith University, Queensland, QLD, Australia
- Menzies Health Institute Queensland, Brisbane, QLD, Australia
| | - Vanette McLennan
- School of Health Sciences and Social Work, Griffith University, Queensland, QLD, Australia
- Menzies Health Institute Queensland, Brisbane, QLD, Australia
| | - Pat Dorsett
- School of Health Sciences and Social Work, Griffith University, Queensland, QLD, Australia
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Soendergaard PL, Norup A, Kruse M, Biering-Sørensen F. Socioeconomic consequences of traumatic and non-traumatic spinal cord injuries: a Danish nationwide register-based study. Spinal Cord 2022; 60:647-654. [PMID: 34999725 DOI: 10.1038/s41393-021-00724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A nationwide population-based register study. OBJECTIVES To investigate the socioeconomic consequences of traumatic (tSCI) and non-traumatic (ntSCI) spinal cord injuries (SCI) in relation to health care costs, risk of job loss, and divorce. SETTING Denmark. METHODS All survivors admitted for specialized SCI rehabilitation from 2008 to 2018 were included (n = 1751), together with their relatives (n = 3084). Control groups for the SCI group (n = 8139) and their relatives (n = 15,921) were identified. Data on socioeconomics up to 2 years before and up to 4 years after the injury year were included. RESULTS Survivors of tSCI and ntSCI had significantly increased health care costs 2 years before injury compared to their controls, and increased health care cost was maintained 4 years after the injury (all p values < 0.0001). The SCI group had significantly increased risk of job loss (OR = 9.26; 95% CI: 7.70-11.15) and higher risk of divorce (OR = 1.44; 95% CI: 1.08-1.87) the 3 following years after injury compared to controls, but risk of divorce was only significant for the ntSCI group (OR = 1.58; 95% CI: 1.09-2.29). No significant differences on health care cost and job loss between the group of relatives of SCI survivors and their controls were found, except for the relatives (n = 1604) of SCI survivors <18 years old, where a higher risk of job loss was found (OR = 1.43, 95% CI 0.97-2.1). CONCLUSION These results emphasize that socioeconomic consequences for survivors of both tSCI and ntSCI are pervasive and long-lasting.
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Affiliation(s)
- Pernille Langer Soendergaard
- Neurorehabilitation Research and Knowledge Centre, Rigshospitalet, Glostrup, Denmark. .,Department of Psychology, University of Southern Denmark, Odense, Denmark. .,Department of Brain and Spinal Cord Injuries, Rigshospitalet, Copenhagen University Hospital, Glostrup, Denmark.
| | - Anne Norup
- Neurorehabilitation Research and Knowledge Centre, Rigshospitalet, Glostrup, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Marie Kruse
- DaCHE - Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Fin Biering-Sørensen
- Department of Brain and Spinal Cord Injuries, Rigshospitalet, Copenhagen University Hospital, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Ceballos-Sáenz DP, García-Calderón N, Jiménez-Ávila JM. [Return to work in patients with traumatic spinal cord injury in a medical center in Mexico]. Rehabilitacion (Madr) 2020; 55:98-103. [PMID: 32660843 DOI: 10.1016/j.rh.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/13/2020] [Accepted: 05/10/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE One of the most important outcomes regarding social reintegration after a traumatic spinal cord injury is social reinsertion; despite its huge impact, very few studies in Mexico have measured community reintegration in these patients. The objective of this study was to analyse the working situation of patients with traumatic spinal cord injury at a hospital centre in Mexico. MATERIAL AND METHODS Cross-sectional descriptive study. Working patients, aged 19-55 years, diagnosed with traumatic spinal cord injury at a hospital centre in Mexico were included; a telephone survey was performed. RESULTS Eighteen patients were included (15 men, 3 women), with a mean age of 38 years (± 10.3). The most common levels of injury were cervical and thoracic; the most common Asia Impairment Scale grades were A and E; 17 patients were included at a rehabilitation programme at discharge; the average Spinal Cord Independence Measure score was 65.22 (± 35.11). Five patients were hired after the injury in a mean period of 7 months (± 2.9). The main factors associated with occupational reintegration were young age, lower injury levels, an adequate rehabilitation programme, high Spinal Cord Independence Measure scale score, and being married or cohabiting. CONCLUSION This study shows the low return to work rate after a traumatic spinal cord injury, as well as the main factorsa affecting it; highlighting the importance of an adeaquate rehabilitation program with a multidisciplinary approach.
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Affiliation(s)
- D P Ceballos-Sáenz
- Servicio de Medicina de Rehabilitación, Hospital de Especialidades, Centro Médico Nacional de Occidente del Instituto Mexicano del Seguro Social, Guadalajara, México.
| | - N García-Calderón
- Servicio de Medicina de Rehabilitación, Hospital de Especialidades, Centro Médico Nacional de Occidente del Instituto Mexicano del Seguro Social, Guadalajara, México
| | - J M Jiménez-Ávila
- Servicio de Traumatología y Ortopedia, Hospital de Especialidades, Centro Médico Nacional de Occidente del Instituto Mexicano del Seguro Social, Guadalajara, México
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Pefile N, Mothabeng JD, Naidoo S. Profile of patients with spinal cord injuries in Kwazulu-Natal, South Africa: Implications for vocational rehabilitation. J Spinal Cord Med 2019; 42:709-718. [PMID: 29388905 PMCID: PMC6830293 DOI: 10.1080/10790268.2018.1428264] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives: To describe the demographic and socio-economic profiles, and injury related characteristics of people who sustain SCIs in KZN in order to provide baseline information to instigate a model that guides employment outcomes amongst PLWSCI.Design: Retrospective analysis of medical files was done.Setting: King Dinizulu Hospital Spinal Unit (KDHSU), this being the biggest provider of acute care for people who sustain SCI in KwaZulu-Natal and the Eastern Cape Provinces, South Africa was the setting for our study.Participants: Medical files of individuals who sustained SCI between 2009 and 2012 were perused (n = 1049) were perused and 188 met the inclusion criteria.Outcome Measures: Key information from the KDHSU patient's files were extracted using a tool developed using literature and the international spinal cord injury core data set.Results: The average annual incidence rate was 12.3 per 100 000 population. The male to female ratio was 6:4 with the mean age of 36.69 years, ranging from 16-64. Out of those employed (34%), 72% were working fulltime, mostly in the service industry (31%) and 59% were classified as laborers. The majority (61%) of the participants completed high school. The major cause of SCI was non-traumatic (54%) and 66% were classified as incomplete (ASIA). Furthermore, 80% were classified as paraplegia and 19% tetraplegia. The mean LOS was 42.9 days, ranging from 1-764 days, influenced by level of injury, completeness and classification of injury and surgical intervention.Conclusion: The profile of SCI in KwaZulu-Natal is slightly different when compared to other provinces in South Africa and the rest of Africa. There is a need to use epidemiological information (including factors that influence employment) to develop rehabilitation models to guide employment outcomes amongst people living with spinal cord injuries in KZN.
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Affiliation(s)
- Ntsikelelo Pefile
- Department of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Joyce Diphale Mothabeng
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Saloshni Naidoo
- Discipline of Public Health Medicine, School of Public Health and Nursing, University of KwaZulu-Natal, Durban, South Africa
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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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Jorge A, White MD, Agarwal N. Outcomes in socioeconomically disadvantaged patients with spinal cord injury: a systematic review. J Neurosurg Spine 2019; 29:680-686. [PMID: 30265226 DOI: 10.3171/2018.5.spine171242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 05/15/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEIndividuals with a spinal cord injury (SCI) in socioeconomically disadvantaged settings (e.g., rural or low income) have different outcomes than their counterparts; however, a contemporary literature review identifying and measuring these outcomes has not been published. Here, the authors' aim was to perform a systematic review and identify these parameters in the hope of providing tangible targets for future clinical research efforts.METHODSA systematic review was performed to find English-language articles published from 2007 to 2017 in the PubMed/MEDLINE, EMBASE, and SCOPUS databases. Studies evaluating any outcomes related to patients with an SCI and in a low-resource setting were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and a flowchart was created. Of the 403 articles found, 31 underwent complete review and 26 were eligible for study inclusion. According to the current study criteria, any case studies, studies in less developed countries, studies including and not separating other types of neurological disorders, studies not assessing the effects of a low-resource setting on outcomes in patients with SCI, and studies evaluating the causes of SCI in a low-resource setting were excluded.RESULTSIn SCI patients, a lower income was a predictor of death (OR 2.1, 95% CI 1.7-2.6, p = 0.0002). Moreover, secondary outcomes such as pain intensities (OR 3.32, 95% CI 2.21-4.49, p < 0.001), emergency room visits (11% more likely, p = 0.006), and pressure ulcer formation (OR 2.1, 95% CI 1.5-3.0, p < 0.001) were significantly higher in the lower income brackets. Rurality was also a factor and was significantly associated with increased emergency room visits (OR 1.5, 95% CI 1.1-2.1, p = 0.01) and lower outpatient service utilization (incidence rate ratio [IRR] 0.57, 95% CI 0.35-0.93, p < 0.05).CONCLUSIONSThe authors showed that individuals in a low-resource setting who have suffered an SCI have significantly different outcomes than their counterparts. These specific outcomes are promising targets for future research efforts that focus on improving health conditions among this population.
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Gupta S, Jaiswal A, Norman K, DePaul V. Heterogeneity and Its Impact on Rehabilitation Outcomes and Interventions for Community Reintegration in People With Spinal Cord Injuries: An Integrative Review. Top Spinal Cord Inj Rehabil 2019; 25:164-185. [PMID: 31068748 DOI: 10.1310/sci2502-164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Various injury characteristics such as cause, level, severity, and time since injury divide individuals with spinal cord injury (SCI) into many subgroups. The heterogeneity among individuals' injuries and personal characteristics has significant implications for SCI rehabilitation practice, specifically directed toward community reintegration, which is a key goal of rehabilitation interventions for people with disabilities. Purpose: This study aims to summarize the evidence on attributes that make the SCI population heterogeneous, the impact of these attributes on community reintegration, and the implications of heterogeneity for rehabilitation interventions directed toward optimizing community reintegration. Methods: We used an integrative review approach to conduct this study. MEDLINE, PubMed, CINAHL, EMBASE, Google Scholar, and PsycINFO were searched from inception until May 2017. Out of 670 articles retrieved, 49 provided evidence on the impact of various attributes that make SCI heterogeneous on rehabilitation outcomes related to community reintegration. Results: An array of injury-related, personal, social, and environmental factors are associated with various rehabilitation outcomes that affect community reintegration of people with SCI. There is level 1 evidence that social support, self-efficacy, and self-esteem facilitate community reintegration among people with SCI while there is level 5 evidence that presence of psychological or medical complications decreases it. There is lack of clarity on the impact of injury-related factors on community reintegration. Conclusion: This integrative review found that social support and individuals' self-efficacy can improve community reintegration of people with SCI. However, evidence regarding the impact of injury characteristics on community reintegration is still underdeveloped. Approaches directed at community reintegration should involve components of psychosocial, physical, and vocational rehabilitation while considering personal and societal aspects of an individual's life.
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Affiliation(s)
- Shikha Gupta
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Atul Jaiswal
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Kathleen Norman
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Vincent DePaul
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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Dorsett P, McLennan V. Exploring the ‘status quo’ in vocational rehabilitation and employment outcomes following spinal cord injury. JOURNAL OF VOCATIONAL REHABILITATION 2019. [DOI: 10.3233/jvr-180995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Pat Dorsett
- School of Human Services and Social Work, Griffith University, Queensland, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Vanette McLennan
- School of Allied Health Sciences, Griffith University, Queensland, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
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Abstract
Many survivors after trauma suffer from long-term morbidity. The aim of this observational cohort study was to develop a prognostic prediction tool for early assessment of full-time sick leave one year after trauma. Potential predictors were assessed combining individuals from a trauma register with national health registers. Two models were developed using logistic regression and stepwise backward elimination. 4458 individuals were included out of which 488 were on sick leave full-time 12 months after the trauma. One comprehensive and one simplified model were developed including nine and seven predictors respectively. Both models showed excellent discrimination (AUC 0.81). The comprehensive model had very good calibration, and the simplified model good calibration. Prediction models can be used to assess post-trauma sick leave using injury-related variables as well as factors not related to the trauma per se. Among included variables, pre-injury sick leave was the single most important predictor for full-time sick leave one year after trauma. These models could facilitate a more efficient use of resources, targeting groups for follow-up interventions to improve outcome. External validation is necessary in order to evaluate generalizability.
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12
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Bloom J, Dorsett P, McLennan V. Investigating employment following spinal cord injury: outcomes, methods, and population demographics. Disabil Rehabil 2018; 41:2359-2368. [DOI: 10.1080/09638288.2018.1467968] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Julia Bloom
- School of Human Services and Social Work, Griffith University, Meadowbrook, Queensland, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience Menzies Health Institute Queensland, Australia
| | - Pat Dorsett
- School of Human Services and Social Work, Griffith University, Meadowbrook, Queensland, Australia
- The Hopkins Centre: Research for Rehabilitation and Resilience Menzies Health Institute Queensland, Australia
| | - Vanette McLennan
- The Hopkins Centre: Research for Rehabilitation and Resilience Menzies Health Institute Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
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Oranye NO, Wallis B, Roer K, Archer-Heese G, Aguilar Z. Do Personal Factors or Types of Physical Tasks Predict Workplace Injury? Workplace Health Saf 2017; 64:141-51. [PMID: 27056936 DOI: 10.1177/2165079916630552] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Occupational health research has shown that certain worker and job characteristics are risk factors for workplace injuries. Workers who engage in physically demanding jobs, especially those jobs that involve repetitive motion, are at greater risk for work-related musculoskeletal disorders (WMSD). These risks are particularly prevalent in the health care sector. It is often reported that nurses are at higher risk of workplace musculoskeletal injury than other health care workers due to frequent lifting and transfer of patients and the prevalence of workplace violence. However, many analyses of the physical requirements of jobs do not consider the modifying effect of time spent on a physical task and the risk of WMSD. This study compared the risks of WMSD among workers in health care facilities based on the type of physical tasks and amount of time workers spent on such tasks. Workers who worked longer on a physical task reported more WMSD than those who spent less time on the same physical task. The risk of WMSD was twice as high (odds ratio [OR] = 2.3) among workers who sit less than 2 hours each day compared with those who sit longer. This study found that physical tasks associated with health care jobs and the amount of time spent on these tasks constitutes serious risk factors for WMSD.
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14
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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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Trenaman L, Miller WC, Querée M, Escorpizo R. Modifiable and non-modifiable factors associated with employment outcomes following spinal cord injury: A systematic review. J Spinal Cord Med 2015; 38:422-31. [PMID: 25989899 PMCID: PMC4612197 DOI: 10.1179/2045772315y.0000000031] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT Employment rates in individuals with spinal cord injury (SCI) are approximately 35%, which is considerably lower than that of the general population. In order to improve employment outcomes a clear understanding of what factors influence employment outcomes is needed. OBJECTIVE To systematically review factors that are consistently and independently associated with employment outcomes in individuals with SCI, and to understand the magnitude of their influence. METHODS Through an electronic search of MEDLINE/PubMed, EMBASE, CINAHL, PsycINFO, Social Science Abstracts and Social Work databases, we identified studies published between 1952-2014 that investigated factors associated with employment outcomes following SCI. Exclusion criteria included: (1) reviews (2) studies not published in English (3) studies not controlling for potential confounders through a regression analysis, or (4) studies not providing an effect measure in the form of OR, RR, or HR. Data were categorized based on the International Classification of Functioning, Disability and Health framework, with each domain sub-categorized by modifiability. First author, year of publication, sample size, explanatory and outcome variables, and effect measures were extracted. RESULTS Thirty-nine studies met the inclusion criteria. Twenty modifiable and twelve non-modifiable factors have been investigated in the context of employment following SCI. Education, vocational rehabilitation, functional independence, social support, and financial disincentives were modifiable factors that have been consistently and independently associated with employment outcomes. CONCLUSION A number of key modifiable factors have been identified and can inform interventions aimed at improving employment outcomes for individuals with SCI. Future research should focus on determining which factors have the greatest effect on employment outcomes, in addition to developing and evaluating interventions targeted at these factors.
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Affiliation(s)
| | - William C Miller
- Correspondence to: William C Miller, FCAOT, Department of Occupational Science and Occupational Therapy, University of British Columbia, T325–2211 Wesbrook Mall, Vancouver, BC, Canada V6 T 2B5. E-mail:
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Kastenberg ZJ, Hurley MP, Weiser TG, Cole TS, Staudenmayer KL, Spain DA, Ratliff JK. Adding insult to injury: discontinuous insurance following spine trauma. J Bone Joint Surg Am 2015; 97:141-6. [PMID: 25609441 DOI: 10.2106/jbjs.n.00148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Spine trauma patients may represent a group for whom insurance fails to provide protection from catastrophic medical expenses, resulting in the transfer of financial burden onto individual families and public payers. This study compares the rate of insurance discontinuation for patients who underwent surgery for traumatic spine injury with and without spinal cord injury with the rate for matched control subjects. METHODS We used the MarketScan database to perform a retrospective cohort study of privately insured spine trauma patients who underwent surgery from 2006 to 2010. Kaplan-Meier survival analysis was used to assess the time to insurance discontinuation. Cox proportional-hazards regression was used to determine hazard ratios for insurance discontinuation among spine trauma patients compared with the matched control population. RESULTS The median duration of existing insurance coverage was 20.2 months for those with traumatic spinal cord injury, 25.6 months for those with traumatic spine injury without spinal cord injury, and 48.0 months for the matched control cohort (log-rank p < 0.0001). After controlling for multiple covariates, the hazard ratios for discontinuation of insurance were 2.02 (95% CI [confidence interval], 1.83 to 2.23) and 2.78 (95% CI, 2.31 to 3.35) for the trauma patients without and with spinal cord injury, respectively, compared with matched controls. CONCLUSIONS Rates of insurance discontinuation are significantly higher for trauma patients with severe spine injury compared with the uninjured population, indicating that patients with disabling injuries are at increased risk for loss of insurance coverage.
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Affiliation(s)
- Zachary J Kastenberg
- Section of Trauma and Critical Care, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, S067, Stanford, CA 94305
| | - Michael P Hurley
- Section of Trauma and Critical Care, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, S067, Stanford, CA 94305
| | - Thomas G Weiser
- Section of Trauma and Critical Care, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, S067, Stanford, CA 94305
| | - Tyler S Cole
- Section of Trauma and Critical Care, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, S067, Stanford, CA 94305
| | - Kristan L Staudenmayer
- Section of Trauma and Critical Care, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, S067, Stanford, CA 94305
| | - David A Spain
- Section of Trauma and Critical Care, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, S067, Stanford, CA 94305
| | - John K Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, R291 MC 5327, Stanford, CA 94305. E-mail address:
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Interventions for improving employment outcomes among individuals with spinal cord injury: A systematic review. Spinal Cord 2014; 52:788-94. [DOI: 10.1038/sc.2014.149] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 07/16/2014] [Accepted: 07/30/2014] [Indexed: 11/08/2022]
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Trezzini B, Phillips B. Impact of legal regulations and administrative policies on persons with SCI: identifying potential research priorities through expert interviews. Disabil Rehabil 2014; 36:1883-91. [DOI: 10.3109/09638288.2014.881564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Krause JS, Dismuke CE, Acuna J, Sligh-Conway C, Walker E, Washington K, Reed KS. Race-ethnicity and poverty after spinal cord injury. Spinal Cord 2013; 52:133-8. [PMID: 24296805 PMCID: PMC3946286 DOI: 10.1038/sc.2013.147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 10/04/2013] [Accepted: 10/24/2013] [Indexed: 11/09/2022]
Abstract
Objective Our objective was to examine the relationship between race-ethnicity and poverty status after spinal cord injury (SCI). Study Design Secondary analysis of existing data. Setting A large specialty hospital in the southeastern United States (US). Methods Participants were 2,043 adults with traumatic SCI in the US. Poverty status was measured using criteria from the US Census Bureau. Results Whereas only 14% of non-Hispanic White participants were below the poverty level, 41.3% of non-Hispanic Blacks were in poverty. Logistic regression with three different models identified several significant predictors of poverty including marital status, years of education, level of education, age, and employment status. Non-Hispanic Blacks had 2.75 greater odds of living in poverty after controlling for other factors, including education and employment. Conclusions We may need to consider quality of education and employment to better understand the elevated risk of poverty among non-Hispanic Blacks in the US.
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Affiliation(s)
- J S Krause
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - C E Dismuke
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - J Acuna
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - C Sligh-Conway
- Rehabilitation Counseling Program, South Carolina State University, Orangeburg, SC, USA
| | - E Walker
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - K Washington
- Rehabilitation Counseling Program, South Carolina State University, Orangeburg, SC, USA
| | - K S Reed
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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