Opportunities for research to improve employment for people with spinal cord injuries

Bridges of perspectives: representation of people with lived experience of spinal cord injury in editorial boards and peer review

BACKGROUND

Diversity among editorial boards and in the peer review process maximizes the likelihood that the dissemination of reported results is both relevant and respectful to readers and end users. Past studies have examined diversity among editorial board members and reviewers for factors such as gender, geographic location, and race, but limited research has explored the representation of people with disabilities. Here, we sought to understand the landscape of inclusivity of people with lived experience of spinal cord injury specifically in journals publishing papers (2012-2022) on their quality of life.

METHODS

An open and closed 12-question adaptive survey was disseminated to 31 journal editors over a one-month period beginning December 2022.

RESULTS

We received 10 fully completed and 5 partially completed survey responses (response rate 48%). Notwithstanding the small sample, over 50% (8/15) of respondents indicated that their journal review practices involve people with lived experience of spinal cord injury, signaling positive even if incomplete inclusivity practices. The most notable reported barriers to achieving this goal related to identifying and recruiting people with lived experience to serve in the review and editorial process.

CONCLUSIONS

In this study we found positive but incomplete trends toward inclusivity in journal practices involving people with lived experience of spinal cord injury. We recommend, therefore, that explicit and genuine efforts are directed toward recruitment through community-based channels. To improve representation even further, we suggest that editors and reviewers be offered the opportunity to self-identify as living with a disability without discrimination or bias.

Predicting change in labour market participation of people with spinal cord injury (SCI): longitudinal evidence from the Swiss SCI community survey

Study Design

Longitudinal, population-based survey.

Objective

To examine change in labour market participation (LMP) of people with spinal cord injury (SCI) living in Switzerland and to identify predictors of increase, decrease and stability in LMP between 2012 and 2017.

Setting

Community.

Methods

Longitudinal information on LMP (i.e., weekly workload) was obtained from 311 gainfully employed, working-age individuals who participated in the Swiss Spinal Cord Injury Cohort Study (SwiSCI) community survey in 2012 and were still of working age at the time of completing the 2017 questionnaire. Statistical preselection of the predictors of change in LMP was carried out by implementing the least absolute shrinkage and selection operator (LASSO) in a multinomial logistic regression model. The final set of predictors was selected by comparison of several multinomial logistic regression models.

Results

Out of 311 participants, almost half (43%) changed their LMP between 2012 and 2017, 48 increased their weekly workload, 49 reduced and 37 participants left the labour market prematurely. Age at time of the survey, years of education, having children, intention to change weekly workload, high satisfaction with daily routine, extra-time needs for transportation and managing support were associated with change in LMP.

Conclusions

Modifiable factors like education and satisfaction with daily routine should receive particular attention in the context of job retention strategies. More longitudinal research focusing on key employment transitions and trajectories over the life course of persons with SCI is needed to complement, validate and extend our findings.

Current Approaches in Telehealth and Telerehabilitation for Spinal Cord Injury (TeleSCI)

Purpose of Review

Telehealth and telerehabilitation in spinal cord injury (teleSCI) is a growing field that can improve access to care and improve health outcomes in the spinal cord injury population. This review provides an overview of the recent literature on the topic of teleSCI and provides insights on current evidence, future directions, and considerations when using teleSCI for clinical care.

Recent Findings

TeleSCI is used most often for preventive health; management of chronic pain, anxiety, and depression; and rehabilitation-related interventions. As video telehealth becomes mainstream, growth in wearable monitors, bio and neurofeedback mechanisms, and app-based care is expected.

Summary

TeleSCI is growing in prevalence, demonstrates positive impact on health outcomes, and requires ongoing study to identify, refine, and implement best practices.

Labor market participation of individuals with spinal cord injury living in Switzerland: determinants of between-person differences and counterfactual evaluation of their instrumental value for policy

STUDY DESIGN

Longitudinal, population-based survey.

OBJECTIVE

To examine determinants of between-person differences in labor market participation of individuals with spinal cord injury (SCI) living in Switzerland and their potential importance for policy.

SETTING

Community.

METHODS

Longitudinal information on labor market participation (i.e., paid work or not) was obtained from 1198 and 1035 individuals of working-age participating in the 2012 and 2017 SwiSCI community survey, respectively. Determinants of between-person variation in labor market participation were examined using mixed effects logistic regression, controlling for within-person variation. Employment rates were predicted using counterfactual data for modifiable determinants.

RESULTS

The employment rate was 56% for the 2012 and 61% for the 2017 survey. Labor market participation was affected mostly by static (sex, nationality, SCI severity), temporal (age), dynamic (education level, functional independence, chronic pain), and policy-related (general pension, disability pension level) determinants. Counterfactual (what-if) predictions indicated the highest improvement of employment rates for strategies that increase functional independence (up to 6% increase), foster education (5%), reduce chronic pain (2%), or promote a shift to partial disability pensions (15%).

CONCLUSIONS

Between-person variation in labor market participation of persons with SCI is influenced by various temporal, static, dynamic, and policy-related determinants. Our results suggest that policy strategies aimed at enhancing the employment rate of the Swiss SCI population may particularly invest in programs promoting functional independence, education, and partial pension levels that are more adequate for ensuring sustainable employment.

Heterogeneity and Its Impact on Rehabilitation Outcomes and Interventions for Community Reintegration in People With Spinal Cord Injuries: An Integrative Review

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.

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.

Changing Demographics and Injury Profile of New Traumatic Spinal Cord Injuries in the United States, 1972-2014

OBJECTIVE

To document trends in the demographic and injury profile of new spinal cord injury (SCI) over time.

DESIGN

Cross-sectional analysis of longitudinal data by injury years (1972-1979, 1980-1989, 1990-1999, 2000-2009, 2010-2014).

SETTING

Twenty-eight Spinal Cord Injury Model Systems centers throughout the United States.

PARTICIPANTS

Persons with traumatic SCI (N=30,881) enrolled in the National Spinal Cord Injury Database.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Age, sex, race, education level, employment, marital status, etiology, and severity of injury.

RESULTS

Age at injury has increased from 28.7 years in the 1970s to 42.2 years during 2010 to 2014. This aging phenomenon was noted for both sexes, all races, and all etiologies except acts of violence. The percentage of racial minorities expanded continuously over the last 5 decades. Virtually among all age groups, the average education levels and percentage of single/never married status have increased, which is similar to the trends noted in the general population. Although vehicular crashes continue to be the leading cause of SCI overall, the percentage has declined from 47.0% in the 1970s to 38.1% during 2010 to 2014. Injuries caused by falls have increased over time, particularly among those aged ≥46 years. Progressive increases in the percentages of high cervical and motor incomplete injuries were noted for various age, sex, race, and etiology groups.

CONCLUSIONS

Study findings call for geriatrics expertise and intercultural competency of the clinical team in the acute and rehabilitation care for SCI. This study also highlights the need for a multidimensional risk assessment and multifactorial intervention, especially to reduce falls and SCI in older adults.

The association of mobility disability, weight status and job strain: A cross-sectional study

AIMS

The study investigated whether people with mobility disability (MD) and/or obesity had higher job strain than people without it, and whether social support at work modifies this association.

METHODS

The study included 35,160 individuals (25-64 years of age) from the Stockholm Public Health Surveys of 2006 and 2010. Data on MD and obesity (BMI ⩾ 30 kg/m(2)calculated from weight (kg) and height (m)) were self-reported. According to the Demand-Control-Support theory job strain, collective strain, and isolated strain were calculated for six groups of people based on the presence of MD and obesity, using the subtraction approach (demand minus control). Differences in job strain mean scores were estimated by multivariate linear regression. Social support at work was analyzed as a potential effect modifier (high/low).

RESULTS

Obese people with MD had the highest job strain (β = 0.92, 95% CI 0.64-1.19), compared to normal weight people without MD (reference group). We found that social support at work significantly (p<0.001) modifies the association between job strain, MD and obesity. Obese people with MD had the highest isolated strain (β = 2.92, 95% CI 2.52-3.31), and the highest collective strain, although of smaller magnitude (β = 0.34, 95% CI 0.05-0.63), compared to the reference group.

CONCLUSIONS

Obese people with MD perceive higher job strain than non-disabled people of normal weight. Strategies aiming to increase the social support at work may be important for this group of people to prevent them from experiencing unhealthy job strain.

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 person with a spinal cord injury: an evolving prototype for life care planning

The sequela of spinal cord injury (SCI) can provide a prototype for life care planning because the segmental design of the vertebrate body allows assessments to be quantitative, repeatable, and predictive of the injured person's impairments, self-care capabilities, and required assistance. Life care planning for patients with SCI uses a standard method that is comparable between planner, yet individualizes assessment and seeks resources that meet unique patient-centered needs in their communities of choice. Clinical care and rehabilitation needs organized with an SCI problem list promotes collaboration by the interdisciplinary team, caregivers, and family in efficient achievement of patient-centered goals and completion of daily care plans.