1
|
Krause JS, Dismuke-Greer CE, Reed K. Characteristics Associated With Perceived Underemployment Among Participants With Spinal Cord Injury. Arch Rehabil Res Clin Transl 2022; 4:100230. [PMID: 36545525 PMCID: PMC9761249 DOI: 10.1016/j.arrct.2022.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To identify job characteristics related to perceived underemployment among people with spinal cord injury (SCI), while controlling for demographic, injury, and educational factors. Design Cross-sectional, logistic regression with predicted probabilities of underemployment. Setting Medical University in the Southeastern United States. Participants 952 were adults with traumatic SCI, all of whom were a minimum of 1-year post-injury and employed at the time of the study. They averaged 46.7 years of age, the majority were male (70.5%), and over half (52%) were ambulatory (N=952). Interventions Not applicable. Main Outcome Measures Perceived underemployment was defined and measured by a dichotomous variable (yes/no). Results Demographic, injury, and educational factors explained only 4.8% of the variance in underemployment, whereas the full model explained 21.8%. Underemployment was significantly lower for women (odds ratio [OR]=0.66, 95% confidence interval [CI; .44, .98]), those who were either married or in a nonmarried couple (OR=0.63, 95% CI [.42, .93]), those with health benefits (OR=0.58, 95% CI [.37, .91]) and higher for those with lower earnings and occupations in the category of sales, professional/managerial. Postsecondary educational milestones, having received a promotion or recognition, and working full time were not identified as significant predictors in the multivariate model, although each was significantly related to a lower likelihood of underemployment when using a restricted model that controls only for demographics, SCI, and educational status (rather than all variables simultaneously). Age, years since injury, and injury severity were not significant. Conclusion Underemployment is a concern among people with SCI and is more prevalent in low-paying jobs, without benefits, and opportunities for recognition and promotion. Vocational counseling strategies need to promote quality employment, including jobs with recognition and benefits.
Collapse
Affiliation(s)
- James S. Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC
- Corresponding author James S. Krause, PhD, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Ave, MSC 962, Charleston, SC 29425.
| | | | - Karla Reed
- Spartanburg Methodist College, Spartanburg, SC
| |
Collapse
|
2
|
Swinney MJ, Sepehri A, Stokic DS. Perception and predictors of health locus of control at rehabilitation discharge and 1 year after traumatic spinal cord injury. Int J Rehabil Res 2021; 44:370-376. [PMID: 34678844 DOI: 10.1097/mrr.0000000000000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This retrospective study examined the perception and predictors of health locus of control (LOC) in 71 individuals with a spinal cord injury (SCI) at discharge from inpatient rehabilitation (average age 39 years, 77% male, 54% black, 51% cervical SCI, 51% incomplete SCI and average time post-SCI 20 days). We also determined if health LOC beliefs and predictors change over the 1st year after SCI in a representative subsample of 36 individuals. The participants completed surveys regarding the health LOC, self-esteem and depression whereas demographic and SCI information were retrieved from medical records. At inpatient discharge, 55% of SCI individuals endorsed the doctor LOC category compared to internal (14%), other people (6%), chance (3%) or multiple LOC categories (22%). A similar pattern was found at 1-year postinjury (doctor LOC 44% and non-doctor LOC combined 56%). A backward stepwise regression revealed that white race (P = 0.093), >12 years of education (P = 0.001) and cervical level of SCI (P = 0.033) were significant predictors of the doctor LOC category at inpatient discharge (overall classification accuracy 76%). Similarly, >12 years of education (P = 0.055), cervical level of SCI at inpatient discharge (P = 0.033) and higher self-esteem at 1-year post-SCI (P = 0.113) were significant predictors of the doctor LOC category at 1-year post-SCI (overall classification accuracy 78%). We conclude that health LOC remains stable over the 1st year after SCI with the majority of individuals believing that the control over outcomes of their health is in the hands of doctors. These findings have implications for the provision of rehabilitation services after SCI.
Collapse
Affiliation(s)
| | - Arash Sepehri
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Mississippi, USA
| | - Dobrivoje S Stokic
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Mississippi, USA
| |
Collapse
|
3
|
|
4
|
Gary KW, Cao Y, Burns SP, McDonald SD, Krause JS. Employment, health outcomes, and life satisfaction after spinal cord injury: comparison of veterans and nonveterans. Spinal Cord 2020; 58:3-10. [PMID: 31388121 PMCID: PMC6949385 DOI: 10.1038/s41393-019-0334-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 01/07/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To explore differences between veterans and nonveterans with spinal cord injury (SCI) for employment, health, and satisfaction with life outcomes after controlling for demographic and injury characteristics. SETTING Hospitals in the Spinal Cord Injury Model System of care. METHODS A total of 9754 (85% nonveterans and 15% veterans) adults with traumatic SCI interviewed from 2000 and 2015 and completed follow-up years 1, 5, and 10 were included in this study. Employment status and the Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF) measured employment. The SF-36 for self-perceived health status, CHART-SF, and rehospitalization determined health outcomes. Satisfaction with life was measured by the Satisfaction with Life Scale (SWLS). Secondary data analyses using χ2, t-tests, and generalized estimating equations (GEEs) model to determine group differences with control of demographic and injury characteristics. RESULTS There were no significant differences for employment and SWL between nonveterans and veterans. There were some differences in health outcomes; whereas, veterans had better physical independence and mobility compared with nonveterans. CONCLUSION Interventions for both groups should target adults with a disability from SCI, be customized for varying levels of injury that address differences in healthcare systems, demographic backgrounds, economic resources, disincentives, and motivation.
Collapse
Affiliation(s)
- Kelli W Gary
- Department of Occupational Therapy, Virginia Commonwealth University, Richmond, VA, USA.
| | - Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen P Burns
- Spinal Cord Injury Service, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Scott D McDonald
- Psychology Section (116B), Mental Health Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
5
|
Ordway AR, Johnson KL, Amtmann D, Bocell FD, Jensen MP, Molton IR. The Relationship Between Resilience, Self-Efficacy, and Employment in People With Physical Disabilities. REHABILITATION COUNSELING BULLETIN 2019. [DOI: 10.1177/0034355219886660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this cross-sectional study was to determine the importance of resilience and self-efficacy in explaining employment status for people with long-term physical disabilities when other sociodemographic and symptom variables were also examined. A multiple logistic regression with sequential predictor entry was used to predict employment status. Participants were individuals, 18 to 65 years of age, with a diagnosis of multiple sclerosis, muscular dystrophy, post-polio syndrome, or spinal cord injury ( N = 882). Results indicated resilience but not self-efficacy was uniquely predictive of employment status. The combined effects of resilience and self-efficacy, however, did not significantly contribute to the variance in employment status above and beyond the sociodemographic and symptom variables. Other variables uniquely predictive of employment included education, age, marital status, disability benefits, and anxiety. We found in this study preliminary evidence to suggest that rehabilitation counseling practitioners should consider a client’s resilience with respect to employment. Knowledge of sociodemographic and symptom factors in conjunction with psychometrically sound measures of resilience and self-efficacy may be used to identify individuals with long-term physical disabilities whose beliefs and behaviors may limit the extent to which they prepare for, obtain, or maintain employment.
Collapse
|
6
|
Krause JS, Dismuke-Greer CE, Jarnecke M, Reed KS. Differential Odds of Employment and Estimation of Earnings Among Those With Spinal Cord Injury. REHABILITATION COUNSELING BULLETIN 2019. [DOI: 10.1177/0034355219848493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
Collapse
Affiliation(s)
| | | | | | - Karla S. Reed
- Medical University of South Carolina, Charleston, USA
| |
Collapse
|
7
|
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
| |
Collapse
|
8
|
Meade MA, Reed KS, Krause JS. The Impact of Health Behaviors and Health Management on Employment After SCI: Physical Health and Functioning. Top Spinal Cord Inj Rehabil 2016; 22:39-48. [PMID: 29398892 DOI: 10.1310/sci2201-39] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Research has shown that employment following spinal cord injury (SCI) is related to health and functioning, with physical health and functioning after SCI frequently identified as a primary barrier to employment. Objective: To examine the relationship between employment and behaviors associated with the management of physical health and functioning as described by individuals with SCI who have been employed post injury. Methods: A qualitative approach using 6 focus groups at 2 sites included 44 participants with SCI who had worked at some time post injury. Heterogeneous and homogeneous groups were created based on specific characteristics, such as education, gender, or race. A semi-structured interview format asked questions about personal, environmental, and policy-related factors influencing employment after SCI. Groups were recorded, transcribed, and entered into NVivo before coding by 2 reviewers. Results: Within the area of behaviors and management of physical health and functioning, 4 overlapping themes were identified: (1) relearning your own body and what it can do; (2) general health and wellness behaviors; (3) communication, education, and advocacy; and (4) secondary conditions and aging. Specific themes articulate the many types of behaviors individuals must master and their impact on return to work as well as on finding, maintaining, and deciding to leave employment. Conclusions: Individuals with SCI who are successfully employed after injury must learn how to perform necessary behaviors to manage health and function in a work environment. The decision to leave employment often appears to be associated with secondary complications and other conditions that occur as persons with SCI age.
Collapse
Affiliation(s)
- Michelle A Meade
- Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor
| | - Karla S Reed
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston
| | - James S Krause
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston
| |
Collapse
|
9
|
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.
Collapse
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:
| | | | | |
Collapse
|