Worklife after traumatic spinal cord injury

Relationship between employment and adaptive video gaming in individuals with physical disabilities

PURPOSE

The purpose of this study was to assess employment characteristics of individuals with physical disabilities who currently participate in adaptive gaming and determine if there is a positive association between adaptive gaming and employment.

MATERIALS AND METHODS

A survey was administered to individuals with disabilities who currently use adaptive video gaming equipment to gather information on demographics, gaming habits, employment characteristics, and subjective benefits of gaming on employment.

RESULTS

The study included 606 participants. Over 57% of participants reported full-time or part-time employment. Nearly half of the participants reported using their equipment either most or all of the time to complete tasks related to work. Participants using their equipment to complete work tasks most or all of the time were more likely to be employed full-time (p = 0.0021). Over 75% of participants reported subjective benefits of adaptive video gaming on their employment.

CONCLUSION

Participants in this study had higher rates of employment compared to national averages for individuals with physical disabilities. More frequent use of adaptive gaming equipment for work was associated with a higher likeliness of full-time employment. Most participants who were employed reported subjective benefits of adaptive gaming on employment through improvements in mental health, physical function, and cognition.

Psychosocial Consequences of Spinal Cord Injury: A Narrative Review

Consequences of a spinal cord injury (SCI) entail much more than damage to the spinal cord. The lives of people with SCI, along with those around them, experience profound long-lasting changes in nearly every life domain. SCI is a physical (biological) injury that is inextricably combined with various psychological and social consequences. The objective of this review is to present psychosocial challenges following SCI through the biopsychosocial model, beginning with acknowledgement of the larger societal effects of ableism and stigma before addressing the many unique psychosocial aspects of living with SCI. Included in this review are qualitative studies and systematic reviews on current psychosocial outcomes and consequences. This paper attempts to structure this information by dividing it into the following sections: relationships and family; changes in finances and employment; issues related to the person’s living situation; community reintegration; factors associated with mood and coping (e.g., depression, anxiety, substance use, and PTSD); self-harm behaviors (ranging from nonadherence to suicide); effects of traumatic brain injury; considerations regarding sexual health; aging with SCI; and concludes with a brief discussion about post-traumatic growth. Cultivating an understanding of the unique and interrelated psychosocial consequences of people living with SCI may help mitigate the psychosocial aftermath and serve as a reminder to providers to maintain a person-centered approach to care.

Perceived Clinical Barriers to Employment for Males with Spinal Cord Injury in Saudi Arabia

Return to work is a challenging aspect of community integration for individuals with disabilities. The reintegration of individuals with spinal cord injury (SCI) is multifactorial; hence, regional challenges need to be investigated in the context of their clinical attributes and perceptions. A total of 121 male participants above 18 years of age with diagnosis of SCI and living at home were included in this cross-sectional survey. The study was conducted at a tertiary care rehabilitation facility in Saudi Arabia. The most common reported clinical barriers to employment were mobility, bladder incontinence, spasticity, musculoskeletal pain, and neuropathic pain. Bladder incontinence and musculoskeletal pain were the most common perceived clinical barriers for individuals with paraplegia and tetraplegia, respectively. A significant difference was observed for bowel incontinence as a reported barrier (p = 0.024) among adults less than thirty years of age in comparison with those older than thirty years. Spasticity as a barrier was reported more among patients who were older than thirty years (54.0%) compared to those younger than thirty years of age (37.9%) (p = 0.077). Twenty-two (23.7%) participants with paraplegia reported transfers as a perceived barrier to employment, which was significant (p = 0.014), and it was also reported as a significant barrier (p = 0.001) in individuals with tetraplegia (56%). This study shows that clinical conditions associated with SCI are considered potential barriers to employment by individuals with SCI. In terms of priority, the perceived barriers between individuals with tetraplegia and paraplegia were mostly different. This shows the need to consider relevant secondary health care conditions in goal setting while planning for employment in individuals with SCI.

Factors associated with past and current employment of veterans with spinal cord injury

Objective: The purpose of this study was to examine variables predictive of post-SCI return to employment and current employment among a large cohort of veterans with Spinal Cord Injury (SCI) treated within the Veterans Health Administration (VHA) SCI System of Care.Design: Cross sectional analysis of data obtained during in-person baseline interviews and follow-up phone interviews.Setting: Seven SCI Centers within Veteran Affairs Medical Centers.Participants: 1047 veterans with SCI receiving inpatient or outpatient care in VHA.Results: Only 29.8% were employed post-SCI, 27.9% reported employment within the immediate 5 years before the baseline interview, but only 9.2% reported current employment at the time of the baseline interview. Significant predictors of current employment among these veterans with SCI included recent employment experience, history of legal problems, duration of SCI, education, and life satisfaction.Conclusions: The baseline employment rate following SCI of a large, representative sample, was 29.8%. Greater duration of SCI predicted unemployment, likely due to the older age of this population. Additional years of education promoted current and post-SCI employment, while a history of legal problems was a barrier to employment.

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.

Disparities in Health Care for Black Patients in Physical Medicine and Rehabilitation in the United States: A Narrative Review

Racial health disparities continue to disproportionately affect Black persons in the United States. Black individuals also have increased risk of worse outcomes associated with social determinants of health including socioeconomic factors such as income, education, and employment. This narrative review included studies originally spanning a period of approximately one decade (December 2009-December 2019) from online databases and with subsequent updates though June 2020. The findings to date suggest pervasive inequities across common conditions and injuries in physical medicine and rehabilitation for this group compared to other racial/ethnic groups. We found health disparities across several domains for Black persons with stroke, traumatic brain injury, spinal cord injury, hip/knee osteoarthritis, and fractures, as well as cardiovascular and pulmonary disease. Although more research is needed, some contributing factors include low access to rehabilitation care, fewer referrals, lower utilization rates, perceived bias, and more self-reliance, even after adjusting for hospital characteristics, age, disease severity, and relevant socioeconomic variables. Some studies found that Black individuals were less likely to receive care that was concordant with clinical guidelines per the reported literature. Our review highlights many gaps in the literature on racial disparities that are particularly notable in cardiac, pulmonary, and critical care rehabilitation. Clinicians, researchers, and policy makers should therefore consider race and ethnicity as important factors as we strive to optimize rehabilitation care for an increasingly diverse U.S. population.

International Comparison of Vocational Rehabilitation for Persons With Spinal Cord Injury: Systems, Practices, and Barriers

Background: Employment rates among people with spinal cord injury or spinal cord disease (SCI/D) show considerable variation across countries. One factor to explain this variation is differences in vocational rehabilitation (VR) systems. International comparative studies on VR however are nonexistent. Objectives: To describe and compare VR systems and practices and barriers for return to work in the rehabilitation of persons with SCI/D in multiple countries. Methods: A survey including clinical case examples was developed and completed by medical and VR experts from SCI/D rehabilitation centers in seven countries between April and August 2017. Results: Location (rehabilitation center vs community), timing (around admission, toward discharge, or after discharge from clinical rehabilitation), and funding (eg, insurance, rehabilitation center, employer, or community) of VR practices differ. Social security services vary greatly. The age and preinjury occupation of the patient influences the content of VR in some countries. Barriers encountered during VR were similar. No participant mentioned lack of interest in VR among team members as a barrier, but all mentioned lack of education of the team on VR as a barrier. Other frequently mentioned barriers were fatigue of the patient (86%), lack of confidence of the patient in his/her ability to work (86%), a gap in the team's knowledge of business/legal aspects (86%), and inadequate transportation/accessibility (86%). Conclusion: VR systems and practices, but not barriers, differ among centers. The variability in VR systems and social security services should be considered when comparing VR study results.

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.

Employment outcomes following spinal cord injury in Taiwan

It is important to maximize vocational achievement following spinal cord injury. Despite this recognition, unemployment remains a prevalent problem and continues to challenge rehabilitation professionals. This study aimed to examine the employment status and determinants of employability for individuals with spinal cord injury in Taiwan. A cross-sectional survey was conducted. A total of 353 participants aged 18-65 years were recruited from four branches of the Association of People with Spinal Cord Injury. The results showed that, of the participants, 107 were employed at the time of the survey, with an employment rate of 30.3%. Logistic regression analyses indicated that individuals with a college degree or higher [odds ratio (OR)=3.03; 95% confidence intervals (CI): 1.30-7.07], aged 26-40 years (OR=8.51; 95% CI: 3.14-23.02) and 41-55 years (OR=3.06; 95% CI: 1.31-7.18), sustaining injury longer than 10 years (OR=9.89; 95% CI: 2.61-37.46), experiencing less functional limitations (OR=0.90; 95% CI: 0.86-0.95), and perceiving greater social support (OR=1.04; 95% CI: 1.01-10.7) were associated with higher likelihood of employment. Vocational rehabilitation services can use the results to target efforts toward those at risk of unemployment.

Muscle activity and mood state during simulated plant factory work in individuals with cervical spinal cord injury

[Purpose] The present study investigated the physical and mental effects of plant factory work in individuals with cervical spinal cord injury and the use of a newly developed agricultural working environment. [Subjects] Six males with C5–C8 spinal cord injuries and 10 healthy volunteers participated. [Methods] Plant factory work involved three simulated repetitive tasks: sowing, transplantation, and harvesting. Surface electromyography was performed in the dominant upper arm, upper trapezius, anterior deltoid, and biceps brachii muscles. Subjects’ moods were monitored using the Profile of Mood States. [Results] Five males with C6–C8 injuries performed the same tasks as healthy persons; a male with a C5 injury performed fewer repetitions of tasks because it took longer. Regarding muscle activity during transplantation and harvesting, subjects with spinal cord injury had higher values for the upper trapezius and anterior deltoid muscles compared with healthy persons. The Profile of Mood States vigor scores were significantly higher after tasks in subjects with spinal cord injury. [Conclusion] Individuals with cervical spinal cord injury completed the plant factory work, though it required increased time and muscle activity. For individuals with C5–C8 injuries, it is necessary to develop an appropriate environment and assistive devices to facilitate their work.

It's All of the Above: Benefits of Working for Individuals with Spinal Cord Injury

BACKGROUND

The majority of research on employment among persons with spinal cord injury (SCI) focuses on the employment rate at a given point in time to the exclusion of quality employment outcomes.

OBJECTIVE

To identify the employment outcomes of greatest importance as defined by those with SCI who have worked since injury.

METHODS

A qualitative approach was used with 6 focus groups at 2 sites (Minnesota and Georgia). Participants (N = 44) were a minimum of 10 years after injury and had been employed at some point after SCI. We identified participants through a 40-year longitudinal study of SCI and a community resource. A combination of homogeneous (race/ethnic minority group, female group) and heterogeneous groups were convened. A semi-structured interview format queried participants about personal, environmental, and policy-related factors that impacted obtaining, maintaining, and advancing in employment.

RESULTS

Seven overlapping themes were identified under the 2 broad categories of compensation and subjective well-being: (1) salary and what it can support, (2) health insurance and other fringe benefits, (3) promotions and recognition, (4) social connection and support, (5) job satisfaction and enjoyment from working, (6) making a difference and helping others, and (7) psychological and emotional health.

CONCLUSION

The results indicate several common themes among persons with SCI who have successful employment histories, suggesting that the benefits of employment are multifaceted and go beyond monetary compensation.

Occupational characteristics of adults with pediatric-onset spinal cord injury

BACKGROUND

Employment rates among individuals with spinal cord injury (SCI) are lower than in the general population and little is known about the specific occupations in which they are employed.

OBJECTIVES

To describe specific occupations of adults with pediatric-onset SCI using the 2010 Standard Occupational Classification (SOC) system and to determine associations between SOC occupations and demographic factors.

METHODS

Cross-sectional data specific to education and employment were collected from the last interviews of a larger longitudinal study. Occupations were categorized according to the 2010 SOC system. SOC groups were compared within gender level of injury and final education.

RESULTS

Of the 461 total participants 219 (47.5%) were employed and specific occupations were available for 179. Among the SOC groups Education Law Community Service Arts and Media Occupations were most prevalent (30.2%) followed by Management Business and Finance Occupations (21.1%) Computer Engineering and Science Occupations (10.6%) Administrative and Office Support Occupations (10.0%) Service Occupations (7.3%) Healthcare Practitioners and Technical Occupations (3.9%) and Production Occupations (3.4%). Differences were found in the distribution of SOC groups between gender levels of injury and final education groups.

CONCLUSION

A wide variety of occupations were reported in adults with pediatric-onset SCI generally in concordance with final education and functional ability levels.

Quality of Life and Related Factors Among People With Spinal Cord Injuries in Tehran, Iran

Background:

Spinal Cord Injury (SCI) is one of the biggest health problems. Disabilities resulting from injuries such as spinal disability requires special attention because of their potential reduced to cause adverse effects in different systems of the body. Today, improving the Quality of Life (QOL) in patients with SCIs is an important goal of treatment.

Objectives:

The purpose of this study was to determine the QOL and related factors among people with SCIs.

Patients and Methods:

In this cross-sectional descriptive study, 106 patients with SCI were selected through sampling based on census. Data were collected using a demographic questionnaire and a Short-Form 36 (SF-36) health survey questionnaire for measuring the QOL among patients. Data were analyzed using SPSS 14 software and descriptive and inferential statistics. P < 0.05 was considered statistically significant.

Results:

The mean QOL in these patients was 37.1 ± 1.7 years (21 - 65 years) and mean disease duration was 7.3±6 years. The most common injury was paraplegia. Most of the patients have moderate QOL (54.7 %). The results showed a significant relationship between QOL and marital status and employment status (P < 0.05). Also, results showed a significant relationship between QOL and education levels (P = 0.002), age (P = 0.001), and duration of illness (P = 0.001).The highest and lowest scores were 64 ± 7.1 and 36 ± 5.3 for understanding General Health (GH) and role physical, respectively.

Conclusions:

The results show that patients with SCI have a moderate health-related QOL Determining the QOL is needed to focus on the strengths and weaknesses of patients with spinal cord injuries. Planning principles is recommended in order to reform the disability.

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.

Modifiable and non-modifiable factors associated with employment outcomes following spinal cord injury: A systematic review

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.

Longitudinal employment outcomes in adults with pediatric-onset spinal cord injury

STUDY DESIGN

Longitudinal survey.

OBJECTIVES

To determine in adults with pediatric-onset spinal cord injury (SCI) employment outcomes, longitudinal changes in employment over time and changes in psychosocial outcomes associated with employment status.

SETTING

Community setting.

METHODS

Adults who had sustained a SCI before 19 years of age and had completed at least three consecutive annual interviews were included in the study. Generalized estimating equation models were formulated to obtain odds ratio (OR) of change in employment status and outcomes over time.

RESULTS

Total 1691 interviews were conducted in 283 participants, 182 men and 101 women (88% Caucasian; age at baseline, 27.3±3.7 years; duration at baseline, 12.7±5.0 years). At the last interview (age, 34.4±5.2 years; duration, 19.9±6.1 years), 49.5% were employed and 47.0% had a baccalaureate or post-baccalaureate degree. There was no significant change in employment status over time (OR 1.01, confidence interval (CI) 0.98-1.04). Odds of employment increased over time in participants who were women (1.04, CI 1.00-1.08), married (1.05, CI 1.02-1.08) and attained baccalaureate (1.03, CI 1.00-1.07) or post-baccalaureate (1.05, CI 1.02-1.08) degree. Employment odds decreased with occurrence of autonomic dysreflexia (0.80, CI 0.65-0.99), spasticity (0.80, CI 0.59-0.99) or chronic medical condition (0.83, CI 0.71-0.98). Life satisfaction scores increased over time in those who remained employed (1.11, CI 1.01-1.22); odds of depression increased over time in those who remained unemployed (1.13, CI 1.04-1.23).

CONCLUSION

Employment status remained relatively stable in adults with pediatric-onset SCI; however, changes in employment were associated with education, secondary health conditions and psychosocial well-being.

Factors that influence employment after spinal cord injury in South Korea

Objective

To investigate employment status after spinal cord injury (SCI) and identify personal, family, and injury characteristics those affect their employment in South Korea.

Methods

Participants were 334 community-dwelling persons 20-64 years of age who had sustained SCI for more than one year. Investigators visited each participant's home to carry out the survey. Bivariate and binary logistic regression analyses were performed to identify personal, family, and injury characteristics that influenced employment after SCI.

Results

Employment rate decreased significantly from 82.5% to 27.5% after SCI. Logistic regression showed that the probability of employment was higher in men than women, and in individuals older than 45 years at the time of injury than those aged 31-45 years of age. Moreover, employment was higher in individuals injured for longer than 20 years than those injured for 1-5 years and in individuals with incomplete tetraplegia than those with complete paraplegia. Employment was lower in individuals with SCI caused by industrial accidents than those injured in non-industrial accidents.

Conclusion

Injury characteristics are the most important predictors of employment in persons with SCI. For persons with lower employment rate, individualized vocational rehabilitation and employment-support systems are required.

Geographic variation in participation for physically disabled adults: the contribution of area economic factors to employment after spinal cord injury

This study investigates the role of area economic characteristics in predicting employment-a key aspect of social participation for adults with physical disabilities-using data from a national registry of persons with spinal cord injury (SCI). SCI results in chronic impairment and most commonly occurs during young adulthood when working is a key aspect of the adult social role. Geocoded data were collected from two of the 14 SCI Model Systems (SCIMS) centers involved in the National SCIMS database and used to link individual-level data with area-level measures extracted from the 2000 US Census. The analysis included participants of working-age (18-64 years) and living in the community (N=1013). Hierarchical generalized linear modeling was used to estimate area-level variation in participation and the relative contribution of area-level economic indicators, adjusted for individual-level health, functioning, and background characteristics. The likelihood of employment for adults with SCI varied by area and was associated with area SES and urbanicity, but not area unemployment. These findings suggest that variation in area economic conditions may affect the feasibility of employment for persons who experience chronic physical disability during adulthood, thus limiting full participation in society.

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.

Returning to work after spinal cord injury: exploring young adults' early expectations and experience

PURPOSE

The study sought to explore experience and expectations about paid work among young adults on sick leave after spinal cord injury (SCI).

METHOD

Eight participants with traumatic SCI, who were 20-34 years of age, and had not yet returned to work 1-5 years post-injury, were interviewed. Selection was made with purposive sampling. Data were analysed using a constant comparative method.

RESULTS

Four main themes emerged as relevant: 'finding your way to an everyday life where work is possible', 'at the crossroads, expectations of work through education', 'expectations of paid work as part of a desired future life' and 'expectations of finding a solution within oneself or with help from others'. The findings reveal high expectations of work ability but at the same time difficulties to plan for return to work and lack of support in this process.

CONCLUSIONS

The participants represent a vulnerable group in vocational rehabilitation due to their young age and recent injury. Without formal training or suitable work experience, they need tailored work support as part of their general rehabilitation.

Trends in new injuries, prevalent cases, and aging with spinal cord injury

OBJECTIVE

To determine the characteristics of the newly injured and prevalent population with spinal cord injury (SCI) and assess trends over time.

DESIGN

Prospective cohort study.

SETTING

SCI Model Systems and Shriners Hospital SCI units.

PARTICIPANTS

The study population included people whose injuries occurred from 1935 to 2008 (N=45,442). The prevalent population was estimated based on those who were still alive in 2008. Losses to follow-up (approximately 10%) were excluded from the prevalent population.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Demographic and injury characteristics, mortality, self-reported health, rehospitalization, FIM, Craig Handicap Assessment and Reporting Technique, and the Diener Satisfaction with Life Scale.

RESULTS

Mean age at injury increased 9 years since the 1970s. Injuries caused by falls and injuries resulting in high-level tetraplegia and ventilator dependency are increasing, while neurologically complete injuries are decreasing. Discharge to a nursing home is increasing. The mean age of the prevalent population is slightly higher than that of newly injured individuals, and the percentage of incident and prevalent cases older than 60 years is the same (13%). Prevalent cases tend to be less severely injured than incident cases, and less than 5% of prevalent cases reside in nursing homes. Within the prevalent population, life satisfaction and community participation are greater among persons who are at least 30 years postinjury. These findings are a result of very high mortality rates observed after 60 years of age.

CONCLUSIONS

Within the prevalent population, the percentage of elderly persons will not increase meaningfully. Those who reach older ages will typically have incomplete and/or lower-level injuries and will have relatively high degrees of independence and overall good health.

Return to work after spinal cord injury in Malaysia

STUDY DESIGN

Cross-sectional survey.

OBJECTIVES

To determine the employment outcomes of persons with spinal cord injury (SCI) and to investigate the impact of various demographic, injury-related and work-related variables on these outcomes.

SETTING

People living with SCI in Malaysia who are members of a disability support organization.

METHODS

A total of 84 members of the Malaysian Spinal Injury Association, who have had traumatic SCI for at least 2 years and were between 15 and 64 years of age at the time of study, were interviewed through phone using a questionnaire to identify the association between demographic, injury-related and work-related variables and employment outcomes.

RESULTS

The return to work rate in this study was 57.1% (employed at the time of study). The overall employment rate after SCI was 76.2% (worked at some point after injury). Those who were younger at time of injury (<20 years of age), able to drive a modified vehicle, independent in personal care and mobility were positively related to being employed. On the other hand, being hospitalized in the preceding 1 year and receiving financial incentives were negatively related to employment.

CONCLUSION

Functional independence, especially ability to drive, was strongly associated with return to work and should be one of the priority goals of comprehensive rehabilitation of persons with SCI. The negative impact of recent hospitalization as well as financial compensation needs to be probed further.

Employment among spinal cord injured patients living in Turkey: a cross-sectional study

The aim of this study was to determine the rate of employment and to establish the factors affecting vocational status in spinal cord injured patients living in Turkey. One hundred and fifty-two traumatic spinal cord injured patients older than 18 years with injury duration of at least 1 year and living in the community were included in the study; homemakers were not taken into consideration. The demographic and clinical data were retrieved from the medical records. The patients were interviewed with a structured questionnaire about the employment status at the time of the injury and after the injury, seeking a job after the injury, possible causes for unemployment, educational activities after the injury, and being a member of a social association. Descriptive statistics, Mann-Whitney U test and Pearson's χ test were used to analyze the results. The rate of employment was 21% among this group of spinal cord injured patients. Female sex, young age at the time of the injury, longer time since injury, higher educational level, being educated after injury, and being a member of a social association have positive effects on vocational outcome; age at the time of the study and severity and level of the lesion did not affect employment. According to the results of this study, the employment rates after spinal cord injury are low in Turkey. There is a need to maximize the employment capacity. Social and educational activities after injury should be encouraged during rehabilitation.

Employment of persons with spinal cord lesions injured more than 20 years ago

PURPOSE

The primary objective was to study factors influencing post-injury employment and withdrawal from work in persons who sustained traumatic spinal cord injury (SCI) more than 20 years ago. A secondary objective was to study life satisfaction in the same patients.

METHOD

A cross-sectional study with retrospective data of 165 SCI-patients admitted to Sunnaas Rehabilitation Hospital 1961-1982. Multiple logistic regression was used to identify predictors for obtaining work post-injury. A Cox proportional hazards regression model was used to study factors influencing early withdrawal from work, i.e. time from injury until discontinuing employment.

RESULTS

Sixty-five percent of the participants were employed at some point after the injury. Thirty-five percent still had work at the time of the survey. The odds of obtaining work after injury were higher in persons of younger age at injury, higher in males versus females, higher for persons with paraplegia versus tetraplegia, and for persons classified as Frankel D-E compared to a more severe SCI. Factors associated with shorter time from injury until discontinuing employment were higher age at injury, incidence of injury after 1975 versus before, and a history of pre-injury medical condition(s). Life satisfaction was better for currently employed participants.

CONCLUSION

The study indicates a low employment-rate in persons with SCI, even several years after injury. From the results, we suggest more support, especially to persons of older age at injury and/or with a history of pre-injury medical condition(s), to help them to obtain work and sustain employed for more years after injury.

The Relationship of Chronological Age, Age at Injury, and Duration of Injury to Employment Status in Individuals with Spinal Cord Injury

Employment status following spinal cord injury (SCI) has important implications for financial and psychosocial well-being. Several age-related variables-in particular chronological age, duration of SCI, and age at SCI onset-have been identified as being associated with employment among individuals with SCI. Cross-sectional investigations of this topic are complicated by methodological and statistical issues associated with aging and disability. The purpose of the current study was to examine the associations between three aging variables and employment status in individuals with SCI through a series of regression analyses. Six hundred twenty individuals with SCI completed a survey that included measures of demographic characteristics, pain, psychological functioning, physical functioning, fatigue, and sleep. The results indicated that chronological age and age at SCI onset were significant predictors of employment status. A significantly greater proportion of individuals aged 45-54 were employed compared to those aged 55-64 even after controlling for biopsychosocial variables. Additionally, there was a negative linear relationship between percent employed and age at SCI onset, and this relationship was not accounted for by the biopsychosocial variables. The analyses used in this study provide one method by which to disentangle the effects of different age-related variables on important SCI outcomes in cross-sectional research. Continued research in this area is needed to better understand age-related effects on employment status, which could be used to help maximize the quality of life in individuals with SCI.

Review of critical factors related to employment after spinal cord injury: implications for research and vocational services

BACKGROUND/OBJECTIVE

Employment rates after spinal cord injury (SCI) vary widely because of discrepancies in studies' definition of employment and time of measurement. The objective of this study was to provide a comprehensive summary of the literature on employment rates, predictors of employment, and the benefits and barriers involved.

METHODS

A search using the terms spinal cord injury and employment in the databases PubMed, PsycINFO, and MEDLINE. The search included a review of published manuscripts from 1978 through 2008.

RESULTS

A total of 579 articles were found and reviewed to determine the presence of reported employment rates. Of these, 60 articles were found to include a report of employment rates for individuals with SCI. Results indicated that, in studies that examined paid employment, the average rate of any employment after SCI was approximately 35%.

CONCLUSIONS

Characteristics associated with employment after SCI include demographic variables, injury-related factors, employment history, psychosocial issues, and disability benefit status. It is recommended that researchers studying employment after SCI use common outcome measures such as competitive employment rates, duration of employment, and job tenure. Empirical evidence is lacking in regard to the most effective methods of vocational rehabilitation among this population. Evidence-based supported employment practices seem to be the most applicable model for assisting persons with SCI in restoring meaningful employment. Controlled studies are needed to test this assumption.

Occupation in spinal cord injury patients in Turkey

STUDY DESIGN

A cross-sectional survey.

OBJECTIVES

To investigate the changes in the occupation of patients after spinal cord injury (SCI) and the factors that cause this change.

SUBJECTS

The study involved 192 Turkish patients (41 female, 151 male) who had suffered SCI. The mean age of patients was 36.1+/-12.0 years. The mean follow-up time was 43.4+/-38.0 months. Before injury, 138 patients were employed in gainful occupations, 26 patients were housewives, 10 were retired, 7 were students and 11 patients were unemployed. Only 15 patients (7.8%) returned to their original occupations after injury. Thirteen patients (6.8%) are currently working in another job; 1 patient (0.5%) is a student; 10 (5.2%) are retired as was earlier; 40 (20.8%) are retired on grounds of disability; 26 (13.5%) are housewives; and 87 patients (45.3%) are currently unemployed.

METHODS

Prospective data collection through a face-to-face interview on an established SCI Turkish sample.

RESULTS

In our study, the rate of returning to work was found to be 14.6%. In the evaluation of factors affecting return to work after injury, educational level (P=0.00), pre-injury employment (P=0.01) and bladder-emptying method (P=0.03) were statistically significantly correlated with return to work.

CONCLUSION

In this study, education, pre-injury employment and bladder-emptying method were found to be important factors in returning to work after SCI.

Is the Ability to Ambulate Associated With Better Employment Outcomes in Participants With Traumatic Spinal Cord Injury?

The author compares current employment status after spinal cord injury between participants who were independent in ambulation (required no assistance from others) and those who were dependent in ambulation (required assistance from at least one other person to ambulate). Those who were independent of assistance from others in ambulation were significantly more likely to be employed. Rehabilitation counselors should consider the special needs and circumstances of those who ambulate with assistance.

Return to work following spinal cord injury: a review

PURPOSE

To review literature on return to work (RTW) and employment in persons with spinal cord injury (SCI), and present employment rates, factors influencing employment, and interventions aimed at helping people with SCI to obtain and sustain productive work.

METHODS

A systematic review for 2000 - 2006 was carried out in PubMed/Medline, AMED, (ISI) Web of Science, EMBASE, CINAHL, PsycInfo and Sociological abstracts database. The keywords 'spinal cord injuries', 'spinal cord disorder', 'spinal cord lesion' or 'spinal cord disease' were cross-indexed with 'employment', 'return to work', 'occupation' or 'vocational'.

RESULTS

Out of approximately 270 hits, 110 references were used, plus 13 more found elsewhere. Among individuals with SCI working at the time of injury 21 - 67% returned to work after injury. RTW was higher in persons injured at a younger age, had less severe injuries and higher functional independence. Employment rate improved with time after SCI. Persons with SCI employed ranged from 11.5% to 74%. Individuals who sustained SCI during childhood or adolescence had higher adult employment rates. Most common reported barriers to employment were problems with transportation, health and physical limitations, lack of work experience, education or training, physical or architectural barriers, discrimination by employers, and loss of benefits. Individuals with SCI discontinue working at younger age.

CONCLUSIONS

This review confirmed low employment rates after SCI. Future research should explore interventions aimed at helping people with SCI to obtain and sustain productive work.

Sir Ludwig Guttmann Lecture: Trends in spinal cord injury rehabilitation outcomes from model systems in the United States: 1973–2006

STUDY DESIGN

Consecutive case series with 5-year follow-up.

OBJECTIVE

To evaluate the spinal cord injury (SCI) model systems program in the United States by documenting improvements in treatment outcomes over time.

SETTING

SCI model systems throughout the United States.

METHODS

Initial data were collected on 24 332 patients injured between 1973 and 2006. Follow-up data were collected on 9225 of these patients 5 years post-injury. All data were grouped by calendar year. Descriptive statistics included means and percentages. Multiple linear or logistic regression was used to assess outcome trends after adjusting for demographics and injury severity.

RESULTS

Acute care and rehabilitation lengths of stay declined dramatically over time (P<0.01). Mean functional independence measure motor score at discharge and gain during rehabilitation decreased, whereas gain per day increased (P<0.01). The probability of neurologic improvement from admission to discharge increased. Odds of medical complications decreased during in-patient treatment, but increased post-discharge (P<0.05). Rehospitalizations declined over time (P<0.01). Community integration improved. First year mortality rates improved, but longer term mortality rates showed no improvement since 1982.

CONCLUSIONS

Steady improvements have occurred for many treatment outcomes. Newer and more effective methods of prevention and treatment need to be developed to target those outcomes that have not improved and remain suboptimal.