1
|
Ottomanelli L, Goetz LL, Barnett SD, Njoh E, Fishalow J. Factors associated with past and current employment of veterans with spinal cord injury. J Spinal Cord Med 2022; 45:137-147. [PMID: 32634338 PMCID: PMC8890580 DOI: 10.1080/10790268.2020.1769950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Lisa Ottomanelli
- James A. Haley Veterans’ Hospital and Clinics, Tampa, Florida, USA,Department of Mental Health and Rehabilitation Counseling, University of South Florida, Tampa, Florida, USA,Correspondence to: Lisa Ottomanelli, James A. Haley Veterans’ Hospital and Clinics, 8900 Grand Oaks Circle, Tampa, FL33637, USA.
| | - Lance L. Goetz
- Hunter Holmes McGuire VA Medical Center and Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Scott D. Barnett
- James A. Haley Veterans’ Hospital and Clinics, Tampa, Florida, USA
| | - Eni Njoh
- James A. Haley Veterans’ Hospital and Clinics, Tampa, Florida, USA
| | - Jaclyn Fishalow
- James A. Haley Veterans’ Hospital and Clinics, Tampa, Florida, USA
| |
Collapse
|
2
|
Probyn K, Engedahl MS, Rajendran D, Pincus T, Naeem K, Mistry D, Underwood M, Froud R. The effects of supported employment interventions in populations of people with conditions other than severe mental health: a systematic review. Prim Health Care Res Dev 2021; 22:e79. [PMID: 34879882 PMCID: PMC8724223 DOI: 10.1017/s1463423621000827] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/20/2021] [Accepted: 11/15/2021] [Indexed: 11/07/2022] Open
Abstract
AIM To assess the effectiveness of supported employment interventions for improving competitive employment in populations of people with conditions other than only severe mental illness. BACKGROUND Supported employment interventions have been extensively tested in severe mental illness populations. These approaches may be beneficial outside of these populations. METHODS We searched PubMed, Embase, CINAHL, PsycInfo, Web of Science, Scopus, JSTOR, PEDro, OTSeeker, and NIOSHTIC for trials including unemployed people with any condition and including severe mental illness if combined with other co-morbidities or other specific circumstances (e.g., homelessness). We excluded trials where inclusion was based on severe mental illness alone. Two reviewers independently assessed risk of bias (RoB v2.0) and four reviewers extracted data. We assessed rates of competitive employment as compared to traditional vocational rehabilitation or waiting list/services as usual. FINDINGS Ten randomised controlled trials (913 participants) were included. Supported employment was more effective than control interventions for improving competitive employment in seven trials: in people with affective disorders [risk ratio (RR) 10.61 (1.49, 75.38)]; mental disorders and justice involvement [RR 4.44 (1.36,14.46)]; veterans with posttraumatic stress disorder (PTSD) [RR 2.73 (1.64, 4.54)]; formerly incarcerated veterans [RR 2.17 (1.09, 4.33)]; people receiving methadone treatment [RR 11.5 (1.62, 81.8)]; veterans with spinal cord injury at 12 months [RR 2.46 (1.16, 5.22)] and at 24 months [RR 2.81 (1.98, 7.37)]; and young people not in employment, education, or training [RR 5.90 (1.91-18.19)]. Three trials did not show significant benefits from supported employment: populations of workers with musculoskeletal injuries [RR 1.38 (1.00, 1.89)]; substance abuse [RR 1.85 (0.65, 5.41)]; and formerly homeless people with mental illness [RR 1.55 (0.76, 3.15)]. Supported employment interventions may be beneficial to people from more diverse populations than those with severe mental illness alone. Defining competitive employment and increasing (and standardising) measurement of non-vocational outcomes may help to improve research in this area.
Collapse
Affiliation(s)
- Katrin Probyn
- Department of Psychology, Royal Holloway, University of London, Egham Hill, Egham, Surrey, UK
| | | | | | - Tamar Pincus
- Department of Psychology, Royal Holloway, University of London, Egham Hill, Egham, Surrey, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Khadija Naeem
- Department of Psychology, Royal Holloway, University of London, Egham Hill, Egham, Surrey, UK
| | - Dipesh Mistry
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- University Hospitals Coventry & Warwickshire, University of Warwick, Coventry, UK
| | - Robert Froud
- Department of Health Sciences, Kristiana University College, Oslo, Norway
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
3
|
Rogers JR, Lee J, Zhou Z, Cheung YK, Hripcsak G, Weng C. Contemporary use of real-world data for clinical trial conduct in the United States: a scoping review. J Am Med Inform Assoc 2021; 28:144-154. [PMID: 33164065 DOI: 10.1093/jamia/ocaa224] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/11/2020] [Accepted: 09/02/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Real-world data (RWD), defined as routinely collected healthcare data, can be a potential catalyst for addressing challenges faced in clinical trials. We performed a scoping review of database-specific RWD applications within clinical trial contexts, synthesizing prominent uses and themes. MATERIALS AND METHODS Querying 3 biomedical literature databases, research articles using electronic health records, administrative claims databases, or clinical registries either within a clinical trial or in tandem with methodology related to clinical trials were included. Articles were required to use at least 1 US RWD source. All abstract screening, full-text screening, and data extraction was performed by 1 reviewer. Two reviewers independently verified all decisions. RESULTS Of 2020 screened articles, 89 qualified: 59 articles used electronic health records, 29 used administrative claims, and 26 used registries. Our synthesis was driven by the general life cycle of a clinical trial, culminating into 3 major themes: trial process tasks (51 articles); dissemination strategies (6); and generalizability assessments (34). Despite a diverse set of diseases studied, <10% of trials using RWD for trial process tasks evaluated medications or procedures (5/51). All articles highlighted data-related challenges, such as missing values. DISCUSSION Database-specific RWD have been occasionally leveraged for various clinical trial tasks. We observed underuse of RWD within conducted medication or procedure trials, though it is subject to the confounder of implicit report of RWD use. CONCLUSION Enhanced incorporation of RWD should be further explored for medication or procedure trials, including better understanding of how to handle related data quality issues to facilitate RWD use.
Collapse
Affiliation(s)
- James R Rogers
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Junghwan Lee
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Ziheng Zhou
- Institute of Human Nutrition, Columbia University, New York, New York, USA
| | - Ying Kuen Cheung
- Department of Biostatistics, Columbia University, New York, New York, USA, and
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, New York, USA.,Medical Informatics Services, New York-Presbyterian Hospital, New York, New York, USA
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| |
Collapse
|
4
|
Examining implicit procedural learning in tetraplegia using an oculomotor serial reaction time task. PLoS One 2020; 15:e0232124. [PMID: 32324808 PMCID: PMC7179886 DOI: 10.1371/journal.pone.0232124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/07/2020] [Indexed: 11/19/2022] Open
Abstract
Background and objective Clinical observations indicate that implicit procedural learning, a central component of physical and psychosocial rehabilitation, is impeded following spinal cord injury. In accordance, previous research has revealed a specific deficit in implicit sequence learning among individuals with paraplegia using a standard, manual version of the serial reaction time task. To extend these findings and shed light on the underlying sources of potential spinal cord injury-related deficits in sequence learning, we used an ocular activated serial reaction time task to compare sequence learning performance between individuals with tetraplegia and healthy controls. Participants and measures Twelve participants with spinal cord injury in C5-T1 were compared to 12 matched control participants on measures derived from an ocular activated serial reaction time task. Depression and additional cognitive measures were assessed to explore the source and specificity of potential sequence learning deficits. Results Like controls, and in contrast with previous findings in paraplegia, the spinal cord injury group showed intact implicit sequence learning, evidenced by declining reaction times and improved anticipation over the first six blocks of the serial reaction time task, and an advantage for the initial learning sequence over a novel interference sequence. Conclusions The ocular activated serial reaction time task elicited a performance pattern similar to standard motor versions, such that participants with tetraplegia demonstrated unimpaired sequence learning. This suggests that previously reported implicit sequence learning deficits in spinal cord injury directly involved motor functioning rather than cognitive aspects of the task, and that the ocular activated sequence learning task could be a valid alternative for assessing implicit sequence learning in populations that cannot perform spinal-cord dependent motor tasks. Implications for post-spinal cord injury rehabilitation and adjustment are discussed.
Collapse
|
5
|
Ma Z, Dhir P, Perrier L, Bayley M, Munce S. The Impact of Vocational Interventions on Vocational Outcomes, Quality of Life, and Community Integration in Adults with Childhood Onset Disabilities: A Systematic Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:1-21. [PMID: 31535267 DOI: 10.1007/s10926-019-09854-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Despite the desire and ability to work, individuals with childhood onset disabilities are under-represented in employment. Vocational interventions alleviate some barriers to obtaining and maintaining employment for this population. The research question addressed is: What is the impact of vocational interventions on vocational outcomes, quality of life (QoL), and community integration (CI) in adults with childhood onset neurological disabilities including cerebral palsy (CP), spina bifida, and acquired brain injury (ABI)? Methods A literature search was conducted in multiple electronic databases. All experimental and observational studies with comparator group(s) were included. Two reviewers independently completed titles and abstracts screening, full text screening, data abstraction, and risk of bias assessment. Results Seventeen studies were eligible for final inclusion including three randomized-controlled trials, four non-randomized studies, and ten observational studies. Sixteen of seventeen studies included only individuals with ABI, while one study included individuals with CP. Vocational interventions from experimental studies were mainly components of multi-faceted interventions. Most observational studies were from the United States Vocational Rehabilitation Service. Conclusions Vocational interventions may be effective in improving vocational outcomes, QoL, and CI for individuals with ABI. There is limited experimental evidence on interventions that specifically target employment. Observational data suggest that receiving job placement assistance, on-the-job training and supports, counselling/guidance, maintenance, and supported employment successfully predicted employment outcomes.
Collapse
Affiliation(s)
- Zechen Ma
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Priya Dhir
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Sarah Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
- LIFEspan Service, Toronto Rehabilitation Institute, Rumsey Centre -University Health Network, 345 Rumsey Road, Toronto, ON, M4G 1R7, Canada.
| |
Collapse
|
6
|
Sutton BS, Ottomanelli L, Njoh E, Barnett S, Goetz L. Economic evaluation of a supported employment program for veterans with spinal cord injury. Disabil Rehabil 2019; 42:1423-1429. [PMID: 31099272 DOI: 10.1080/09638288.2018.1527955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To estimate the net monetary benefit of an individual placement and support-based supported employment program for Veterans with spinal cord injuries.Design: Economic evaluation comparing a supported employment program to treatment as usual, using cost and quality-of-life data from a longitudinal study of Veterans with spinal cord injuries.Setting: Spinal cord injury centers in the Veterans Health Administration.Participants: Subjects (N = 213) who participated in a 24-month supported employment program at seven spinal cord injury centers. Supported employment participants were compared with a group of spinal cord injury Veterans who received treatment as usual in a prior study.Main outcome measures: Costs and quality-adjusted life years using the Veterans Rand-6 Dimension, estimated from the Veterans Rand 36-Item Health Survey.Results: The supported employment program was more effective at both 1- and 2-year periods compared with treatment as usual. Outpatient costs were significantly higher for supported employment, but inpatient costs were not significantly different from treatment as usual. When cost and effectiveness were compared jointly using net monetary benefit, a supported employment program following the core principles of Individual Placement and Supported employment was more effective but not cost-effective at standard willingness to pay thresholds. When we considered a sub-group of the supported employment participants who more closely resemble the treatment as usual group from a randomized trial, there was no significant difference in the cost-effectiveness of supported employment when compared to treatment as usual.Conclusions: With higher effectiveness and similar costs, supported employment for spinal cord injury Veterans has the potential to be cost-effective. Future studies need to randomize participants or carefully match participants based on observable patient characteristics to improve cost-effectiveness evaluations of this population.Implications for RehabilitationSupported employment as part of ongoing rehabilitation care helps individuals with spinal cord injury return to work and improve their quality of life.Many studies show that supported employment programs are cost effective for persons with mental disabilities, but there is only limited economic evaluation data on use of supported employment with persons with spinal cord injury.This study shows that supported employment integrated with ongoing rehabilitation care is more effective in restoring employment and health-related quality of life.
Collapse
Affiliation(s)
- Bryce S Sutton
- Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL, USA
| | - Lisa Ottomanelli
- Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL, USA.,Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa, FL, USA
| | - Eni Njoh
- Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL, USA
| | - Scott Barnett
- Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL, USA
| | - Lance Goetz
- Hunter Holmes McGuire VA Medical Center, Richmond, VI, USA.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VI, USA
| |
Collapse
|
7
|
Ottomanelli L, Goetz LL, Barnett SD, Njoh E. Predictors of employment outcomes among supported employment program participants with spinal cord injury. JOURNAL OF VOCATIONAL REHABILITATION 2018. [DOI: 10.3233/jvr-180960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lisa Ottomanelli
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans’ Hospital, Tampa, FL, USA
- Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa, FL, USA
| | - Lance L. Goetz
- Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Scott D. Barnett
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans’ Hospital, Tampa, FL, USA
| | - Eni Njoh
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans’ Hospital, Tampa, FL, USA
| | | |
Collapse
|
8
|
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
|
9
|
Cotner BA, Ottomanelli L, O'Connor DR, Njoh EN, Barnett SD, Miech EJ. Quality of Life Outcomes for Veterans With Spinal Cord Injury Receiving Individual Placement and Support (IPS). Top Spinal Cord Inj Rehabil 2018; 24:325-335. [PMID: 30459495 DOI: 10.1310/sci17-00046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Individual Placement and Support (IPS) is an evidence-based practice that helps persons with mental and/or physical disabilities, including spinal cord injury, find meaningful employment in the community. While employment is associated with positive rehabilitation outcomes, more research is needed on the impact of IPS participation on non-vocational outcomes, particularly quality of life (QOL). Objective: To identity QOL outcomes experienced with (1) IPS participation and (2) IPS participation leading to employment. Methods: Using a mixed method design, data on quality of life outcomes were collected from 151 interviews and 213 surveys completed by veterans with SCI participating in IPS. Results: At 12 months, participants who obtained competitive employment (CE) and those who did not (no-CE) showed improvement on most measures. In months 12-24, the CE group showed improvements on all study measures while the no-CE group declined on many indices. Statistically significant changes were observed between participants who obtained CE versus no-CE on several measures. Themes were identified from interview data related to productivity and well-being. Productivity themes were (1) contributing to society, (2) earning an income, and (3) maintaining employment. Themes for well-being were (1) mental health/self-confidence, (2) physical health, and (3) goal setting. Themes were associated with IPS participation irrespective of employment outcomes. Conclusion: IPS participants who were competitively employed report consistent improvement in handicap, health-related QOL, and life satisfaction measures across time. Qualitative findings revealed improved QOL outcomes in productivity and well-being for veterans participating in IPS overall, regardless of employment outcomes.
Collapse
Affiliation(s)
- Bridget A Cotner
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, Tampa, Florida.,Department of Anthropology, University of South Florida, Tampa, Florida
| | - Lisa Ottomanelli
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, Tampa, Florida.,Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa, Florida
| | - Danielle R O'Connor
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, Tampa, Florida
| | - Eni N Njoh
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, Tampa, Florida
| | - Scott D Barnett
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, Tampa, Florida
| | - Edward J Miech
- VA HSR&D Center for Health Information & Communication, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana.,VA Health Services Research and Development (HSR&D) PRISM QUERI, Indianapolis, Indiana.,Regenstrief Institute, Indianapolis, Indiana.,Department of Emergency Medicine & Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
10
|
Cotner BA, Ottomanelli L, Keleher V, Dirk L. Scoping review of resources for integrating evidence-based supported employment into spinal cord injury rehabilitation. Disabil Rehabil 2018; 41:1719-1726. [PMID: 29485303 DOI: 10.1080/09638288.2018.1443161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE Individual placement and support (IPS), an evidence-based supported employment (SE) program, has helped Veterans with spinal cord injury (SCI) receiving care in the Veterans Health Administration to obtain work. To facilitate integration of IPS into SCI rehabilitation, resources are needed. A scoping review was conducted to identify tools and resources suitable for providers of SCI care. METHODS Applying a modified version of Arksey and O'Malley's framework, a scoping review of literature on SE tools or resources was conducted. The original review focused on resources published between 2002 and 2015 and available in English. Prior to publication an updated review through 2017 was conducted. RESULTS From 1822 tools and resources identified in the initial review, 24 met criteria for inclusion and were evaluated by an advisory panel of experts, who selected 16 tools that addressed five topics: IPS in SCI (n = 2) orientation to SCI (n = 3); IPS SE (n = 7), job accommodations (n = 2), and benefits planning (n = 2). The updated review yielded no tools or resources that met inclusion criteria. CONCLUSION Despite few resources to guide implementation of IPS in SCI, 16 essential resources were identified that, combined into a toolkit, may facilitate translation of IPS in SCI from research to clinical care. Implications for rehabilitation The toolkit consists of 16 essential resources and is currently available online to all persons involved in spinal cord injury rehabilitation to educate them about this effective means of assisting persons with spinal cord injury to find employment and to facilitate translation of individual placement and support in spinal cord injury from research to clinical care. While expert-informed, the toolkit is being field tested with both clinical and vocational providers to facilitate the adoption of individual placement and support by spinal cord injury rehabilitation programs. The revised version will be made available online.
Collapse
Affiliation(s)
- Bridget A Cotner
- a VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR) , James A. Haley Veterans' Hospital , Tampa , FL , USA.,b Department of Anthropology , University of South Florida , Tampa , FL , USA
| | - Lisa Ottomanelli
- a VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR) , James A. Haley Veterans' Hospital , Tampa , FL , USA.,c Department of Rehabilitation and Mental Health Counseling , University of South Florida , Tampa , FL , USA
| | - Virginia Keleher
- a VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR) , James A. Haley Veterans' Hospital , Tampa , FL , USA
| | - Lynn Dirk
- a VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR) , James A. Haley Veterans' Hospital , Tampa , FL , USA
| |
Collapse
|
11
|
Hilton G, Unsworth CA, Stuckey R, Murphy GC. The experience of seeking, gaining and maintaining employment after traumatic spinal cord injury and the vocational pathways involved. Work 2018; 59:67-84. [DOI: 10.3233/wor-172660] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Gillean Hilton
- Central Queensland University, Melbourne, VIC, Australia
- Austin Health, Melbourne, VIC, Australia
| | - Carolyn A. Unsworth
- Central Queensland University, Melbourne, VIC, Australia
- Jonkoping University, Jonkoping, Sweden
- Curtin University, Perth, WA, Australia
- La Trobe University, Melbourne, VIC, Australia
| | | | | |
Collapse
|
12
|
Ottomanelli L, Goetz LL, Barnett SD, Njoh E, Dixon TM, Holmes SA, LePage JP, Ota D, Sabharwal S, White KT. Individual Placement and Support in Spinal Cord Injury: A Longitudinal Observational Study of Employment Outcomes. Arch Phys Med Rehabil 2017; 98:1567-1575.e1. [PMID: 28115071 DOI: 10.1016/j.apmr.2016.12.010] [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] [Received: 05/06/2016] [Revised: 12/07/2016] [Accepted: 12/10/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the effects of a 24-month program of Individual Placement and Support (IPS) supported employment (SE) on employment outcomes for veterans with spinal cord injury (SCI). DESIGN Longitudinal, observational multisite study of a single-arm, nonrandomized cohort. SETTING SCI centers in the Veterans Health Administration (n=7). PARTICIPANTS Veterans with SCI (N=213) enrolled during an episode of either inpatient hospital care (24.4%) or outpatient care (75.6%). More than half the sample (59.2%) had a history of traumatic brain injury (TBI). INTERVENTION IPS SE for 24 months. MAIN OUTCOME MEASURE Competitive employment. RESULTS Over the 24-month period, 92 of 213 IPS participants obtained competitive jobs for an overall employment rate of 43.2%. For the subsample of participants without TBI enrolled as outpatients (n=69), 36 obtained competitive jobs for an overall employment rate of 52.2%. Overall, employed participants averaged 38.2±29.7 weeks of employment, with an average time to first employment of 348.3±220.0 days. Nearly 25% of first jobs occurred within 4 to 6 months of beginning the program. Similar employment characteristics were observed in the subsample without TBI history enrolled as outpatients. CONCLUSIONS Almost half of the veterans with SCI participating in the 24-month IPS program as part of their ongoing SCI care achieved competitive employment, consistent with their expressed preferences at the start of the study. Among a subsample of veterans without TBI history enrolled as outpatients, employment rates were >50%. Time to first employment was highly variable, but quite long in many instances. These findings support offering continued IPS services as part of ongoing SCI care to achieve positive employment outcomes.
Collapse
Affiliation(s)
- Lisa Ottomanelli
- Veterans Affairs Health Services Research & Development Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital, Tampa, FL; Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa, FL.
| | - Lance L Goetz
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA
| | - Scott D Barnett
- Veterans Affairs Health Services Research & Development Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital, Tampa, FL
| | - Eni Njoh
- Veterans Affairs Health Services Research & Development Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital, Tampa, FL
| | - Thomas M Dixon
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
| | | | - James P LePage
- Veterans Affairs North Texas Healthcare System, Dallas, TX; Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX
| | - Doug Ota
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA
| | - Sunil Sabharwal
- Veterans Affairs Boston Health Care System, Boston, MA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
| | - Kevin T White
- Veterans Affairs Health Services Research & Development Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital, Tampa, FL
| |
Collapse
|
13
|
Bloch A, Tamir D, Vakil E, Zeilig G. Specific Deficit in Implicit Motor Sequence Learning following Spinal Cord Injury. PLoS One 2016; 11:e0158396. [PMID: 27355834 PMCID: PMC4927174 DOI: 10.1371/journal.pone.0158396] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 06/15/2016] [Indexed: 12/04/2022] Open
Abstract
Background Physical and psychosocial rehabilitation following spinal cord injury (SCI) leans heavily on learning and practicing new skills. However, despite research relating motor sequence learning to spinal cord activity and clinical observations of impeded skill-learning after SCI, implicit procedural learning following spinal cord damage has not been examined. Objective To test the hypothesis that spinal cord injury (SCI) in the absence of concomitant brain injury is associated with a specific implicit motor sequence learning deficit that cannot be explained by depression or impairments in other cognitive measures. Methods Ten participants with SCI in T1-T11, unharmed upper limb motor and sensory functioning, and no concomitant brain injury were compared to ten matched control participants on measures derived from the serial reaction time (SRT) task, which was used to assess implicit motor sequence learning. Explicit generation of the SRT sequence, depression, and additional measures of learning, memory, and intelligence were included to explore the source and specificity of potential learning deficits. Results There was no between-group difference in baseline reaction time, indicating that potential differences between the learning curves of the two groups could not be attributed to an overall reduction in response speed in the SCI group. Unlike controls, the SCI group showed no decline in reaction time over the first six blocks of the SRT task and no advantage for the initially presented sequence over the novel interference sequence. Meanwhile, no group differences were found in explicit learning, depression, or any additional cognitive measures. Conclusions The dissociation between impaired implicit learning and intact declarative memory represents novel empirical evidence of a specific implicit procedural learning deficit following SCI, with broad implications for rehabilitation and adjustment.
Collapse
Affiliation(s)
- Ayala Bloch
- The National Institute for the Rehabilitation of the Brain Injured, Tel Aviv, Israel
- * E-mail:
| | - Dror Tamir
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eli Vakil
- Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
14
|
LePage J, Ottomanelli L, Barnett SD, Njoh EN. Spinal cord injury combined with felony history: effect on supported employment for Veterans. ACTA ACUST UNITED AC 2015; 51:1497-504. [PMID: 25856266 DOI: 10.1682/jrrd.2014.02.0045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED In this secondary analysis of data from a randomized controlled trial comparing supported employment with treatment as usual, we sought to evaluate the study incident rate of legal involvement and subsequent effects of legal involvement on employment among 157 job-seeking Veterans with spinal cord injury. The supported employment vocational rehabilitation program, called the Spinal Cord Injury-Vocational Integration Program, adhered as closely as possible to principles of supported employment as developed and described in the individual placement and support model of supported employment for persons with mental illness. Rates of misdemeanor and felony arrests and convictions were analyzed, and their relationship to finding employment was evaluated. Findings indicate that 47% had been arrested and 25% had been convicted of a felony. Overall, those who found employment had fewer average arrests and were significantly less likely to have been convicted of a felony. Future directions and limitations are discussed. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; NCT00117806.
Collapse
|
15
|
Thomas FP, Goetz LL, Dixon T, Ho C, Holmes SA, Sandford P, Smith S, Ottomanelli L. Optimizing medical care to facilitate and sustain employment after spinal cord injury. ACTA ACUST UNITED AC 2015; 51:xi-xxii. [PMID: 25479192 DOI: 10.1682/jrrd.2014.05.0119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
16
|
Sutton BS, Ottomanelli L, Njoh E, Barnett SD, Goetz LL. The impact of social support at home on health-related quality of life among veterans with spinal cord injury participating in a supported employment program. Qual Life Res 2015; 24:1741-7. [PMID: 25577499 DOI: 10.1007/s11136-014-0912-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the impact of social support at home on health-related quality of life (HRQOL) as measured by the VR-6D utility index for spinal cord injury (SCI) veterans participating in a program of supported employment (SE). METHODS We calculated a preference-based utility index called the VR-6D from the responses from a 36-item instrument called the VR-36. We estimated a growth curve model to examine the change in the VR-6D utility index over time adjusting for social support status, demographics, and chronic comorbidities. RESULTS Study participants experienced an increase in HRQOL over time. The initial level and the rate of increase in HRQOL varied by groups based on their support status. The rate of increase in HRQOL diminished over time. Participants reporting no support at home experienced lower initial HRQOL but reached the same level of those who reported having support at home by the ninth month of follow-up. Quality-adjusted life-years, as measured by the area under the curves, were approximately the same for both groups after 2 years. CONCLUSIONS Differences in the rate of change in HRQOL by support status have important implications for evaluations of SE programs. Participants in this program of SE experienced improvement in HRQOL beyond 12 months and extending to 2 years. Follow-up times for evaluations should extend beyond 12 months to assess complete improvements in HRQOL. Future comparison groups in comparative effectiveness evaluations of SE need to be balanced carefully on support status in addition to other factors.
Collapse
Affiliation(s)
- Bryce S Sutton
- Health Services Research and Development/Rehabilitation Research and Development, Center of Innovation on Disability and Rehabilitation Research, Veterans Integrated Systems Network 8, James A. Haley Hospital, 8900 Grand Oak Circle (151R), Tampa, FL, 33637-1022, USA,
| | | | | | | | | |
Collapse
|
17
|
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]
|
18
|
Ottomanelli L, Barnett SD, Goetz LL. Effectiveness of Supported Employment for Veterans With Spinal Cord Injury: 2-Year Results. Arch Phys Med Rehabil 2014; 95:784-90. [DOI: 10.1016/j.apmr.2013.11.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 11/19/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
|
19
|
Sinnott PL, Joyce V, Su P, Ottomanelli L, Goetz LL, Wagner TH. Cost-effectiveness of supported employment for veterans with spinal cord injuries. Arch Phys Med Rehabil 2014; 95:1254-61. [PMID: 24486426 DOI: 10.1016/j.apmr.2014.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/07/2014] [Accepted: 01/09/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To estimate the cost-effectiveness of a supported employment (SE) intervention that had been previously found effective in veterans with spinal cord injuries (SCIs). DESIGN Cost-effectiveness analysis, using cost and quality-of-life data gathered in a trial of SE for veterans with SCI. SETTING SCI centers in the Veterans Health Administration. PARTICIPANTS Subjects (N=157) who completed a study of SE in 6 SCI centers. Subjects were randomly assigned to the intervention of SE (n=81) or treatment as usual (n=76). INTERVENTION A vocational rehabilitation program of SE for veterans with SCI. MAIN OUTCOME MEASURES Costs and quality-adjusted life years, which were estimated from the Veterans Rand 36-Item Health Survey, extrapolated to Veterans Rand 6 Dimension utilities. RESULTS Average cost for the SE intervention was $1821. In 1 year of follow-up, estimated total costs, including health care utilization and travel expenses, and average quality-adjusted life years were not significantly different between groups, suggesting the Spinal Cord Injury Vocational Integration Program intervention was not cost-effective compared with usual care. CONCLUSIONS An intensive program of SE for veterans with SCI, which is more effective in achieving competitive employment, is not cost-effective after 1 year of follow-up. Longer follow-up and a larger study sample will be necessary to determine whether SE yields benefits and is cost-effective in the long run for a population with SCI.
Collapse
Affiliation(s)
- Patricia L Sinnott
- VA Health Economics Resource Center, and Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA.
| | - Vilija Joyce
- VA Health Economics Resource Center, and Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA
| | - Pon Su
- VA Health Economics Resource Center, and Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA
| | - Lisa Ottomanelli
- Health Services Research and Development/Rehabilitation Research and Development Center of Excellence Maximizing Rehabilitation Outcomes, James A. Haley Veterans Hospital, Tampa, FL
| | - Lance L Goetz
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA
| | - Todd H Wagner
- VA Health Economics Resource Center, and Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA
| |
Collapse
|
20
|
A prospective examination of the impact of a supported employment program and employment on health-related quality of life, handicap, and disability among Veterans with SCI. Qual Life Res 2013; 22:2133-41. [PMID: 23345022 DOI: 10.1007/s11136-013-0353-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 10/27/2022]
Abstract
PURPOSES To investigate impact of participation in a supported employment program and impact of employment itself on health-related quality of life (HRQOL), disability, and handicap among Veterans with spinal cord injury (SCI). METHODS We used a prospective, randomized, controlled, multi-site trial of supported employment (SE) versus treatment as usual (TAU) for vocational issues. Subjects were 157 Veterans with SCI who received either SE or TAU for vocational issues. Outcomes were examined in terms of type of vocational treatment received and whether competitive employment was obtained. Outcomes investigated were HRQOL as measured by the Veterans RAND 36-item health survey (VR-36), handicap as measured by the Craig Handicap Assessment and Reporting Technique (CHART), and disability as measured by the functional independence measure (FIM). Subjects were assessed at baseline and at 3, 6, 9, and 12 months. RESULTS There were no significant differences between Veterans who participated in SE compared to those who received TAU in study measures. Participants obtaining competitive employment demonstrated significantly higher scores on the Social Integration, Mobility, and Occupation dimensions of the CHART. There were no observed differences in VR-36 scores or FIM scores for those obtaining competitive employment. CONCLUSION(S) This study suggests that employment has a positive effect on an individual's ability to participate in social relationships, move about their home and community, and spend time in productive and usual roles. Inability to detect differences across other domains of handicap or any changes in HRQOL may have been due to several factors including level and intensity of employment, insufficient follow-up period, or measurement limitations.
Collapse
|
21
|
Hay-Smith EJC, Dickson B, Nunnerley J, Anne Sinnott K. "The final piece of the puzzle to fit in": an interpretative phenomenological analysis of the return to employment in New Zealand after spinal cord injury. Disabil Rehabil 2012; 35:1436-46. [PMID: 23167432 DOI: 10.3109/09638288.2012.737079] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Little is known about employment experience after spinal cord injury (SCI) because most research to date concentrates on employment predictors. We explored the experiences of people with SCI, and vocational rehabilitation (VR) professionals working for a VR programme, in pursuing a return to employment in New Zealand (NZ) post-SCI. METHODS Twelve people with SCI (four employed, three job-seeking, five unemployed) and six VR professionals were interviewed, and the transcripts subjected to an Interpretative Phenomenological Analysis. RESULTS The core meaning of employment post-SCI was to live a normal life. Work advantages were social connectedness, a sense of self-worth, earning a living, and being occupied. Employment was the zenith of rehabilitation but not the first priority post-SCI. Employment barriers and facilitators were congruent with those found in similar studies. The role of VR was to sow the seeds of return to employment and to partner with the SCI client. CONCLUSIONS For persons employed pre-SCI, we posit that employment identity modification is part of the return to employment process, alongside a supportive social context and networks, and adapted work environments. VR professionals may facilitate return to employment through understanding and fostering the process of employment identity modification and supporting clients to find work opportunities congruent with employment identity.
Collapse
Affiliation(s)
- E Jean C Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand.
| | | | | | | |
Collapse
|
22
|
Ottomanelli L, Goetz LL, Suris A, McGeough C, Sinnott PL, Toscano R, Barnett SD, Cipher DJ, Lind LM, Dixon TM, Holmes SA, Kerrigan AJ, Thomas FP. Effectiveness of supported employment for veterans with spinal cord injuries: results from a randomized multisite study. Arch Phys Med Rehabil 2012; 93:740-7. [PMID: 22541306 DOI: 10.1016/j.apmr.2012.01.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 01/09/2012] [Accepted: 01/10/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine whether supported employment (SE) is more effective than treatment as usual (TAU) in returning veterans to competitive employment after spinal cord injury (SCI). DESIGN Prospective, randomized, controlled, multisite trial of SE versus TAU for vocational issues with 12 months of follow-up data. SETTING SCI centers in the Veterans Health Administration. PARTICIPANTS Subjects (N=201) were enrolled and completed baseline interviews. In interventional sites, subjects were randomly assigned to the SE condition (n=81) or the TAU condition (treatment as usual-interventional site [TAU-IS], n=76). In observational sites where the SE program was not available, 44 subjects were enrolled in a nonrandomized TAU condition (treatment as usual-observational site [TAU-OS]). INTERVENTIONS The intervention consisted of an SE vocational rehabilitation program called the Spinal Cord Injury Vocational Integration Program, which adhered as closely as possible to principles of SE as developed and described in the individual placement and support model of SE for persons with mental illness. MAIN OUTCOME MEASURES The primary study outcome measurement was competitive employment in the community. RESULTS Subjects in the SE group were 2.5 times more likely than the TAU-IS group and 11.4 times more likely than the TAU-OS group to obtain competitive employment. CONCLUSIONS To the best of our knowledge, this is the first and only controlled study of a specific vocational rehabilitation program to report improved employment outcomes for persons with SCI. SE, a well-prescribed method of integrated vocational care, was superior to usual practices in improving employment outcomes for veterans with SCI.
Collapse
Affiliation(s)
- Lisa Ottomanelli
- Veterans Affairs (VA) North Texas Health Care System, Dallas, TX, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Sorani MD, Beattie MS, Bresnahan JC. A quantitative analysis of clinical trial designs in spinal cord injury based on ICCP guidelines. J Neurotrauma 2012; 29:1736-46. [PMID: 22369673 DOI: 10.1089/neu.2011.2162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Clinical studies of spinal cord injury (SCI) have evolved into multidisciplinary programs that investigate multiple types of neurological deficits and sequelae. In 2007, the International Campaign for Cures of SCI Paralysis (ICCP) proposed best practices for interventional trial designs, end-points, and inclusion criteria. Here we quantitatively assessed the extent to which SCI trials follow ICCP guidelines and reflect the overall patient population. We obtained data for all 288 SCI trials in ClinicalTrials.gov. We calculated summary statistics and observed trends pre-2007 versus 2007 onward. To compare the trial population to the overall SCI population, we obtained statistics from the National SCI Statistical Center. We generated tag clouds to describe heterogeneous trial outcomes. Most interventional studies were randomized (147, 73.1%), and utilized active (55, 36.7%) or placebo controls (49, 32.7%), both increasing trends (p=0.09). Most trials were open label (116, 53.5%), rather than double- (62, 28.6%) or single-blinded (39, 18.0%), but blinding has increased (p=0.01). Tag clouds of outcomes suggest an emphasis on assessment using scores and scales. Inclusion criteria related to American Spinal Injury Association (ASIA) status and neurological level allowed inclusion of most SCI patients. Age inclusion criteria were most commonly 18-65 or older. Consistent with ICCP recommendations, most trials were randomized and controlled, and blinding has increased. Age inclusion criteria skew older than the overall population. ASIA status criteria reflect the population, but neurological lesion criteria could be broadened. Investigators should make trial designs and results available in a complete manner to enable comparisons of populations and outcomes.
Collapse
Affiliation(s)
- Marco D Sorani
- University of California, Department of Neurological Surgery, San Francisco, California 94110-0899, USA.
| | | | | |
Collapse
|
24
|
Rahbar MH, Wyatt G, Sikorskii A, Victorson D, Ardjomand-Hessabi M. Coordination and management of multisite complementary and alternative medicine (CAM) therapies: experience from a multisite reflexology intervention trial. Contemp Clin Trials 2011; 32:620-9. [PMID: 21664296 DOI: 10.1016/j.cct.2011.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/21/2011] [Accepted: 05/25/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Multisite randomized clinical trials allow for increased research collaboration among investigators and expedite data collection efforts. As a result, government funding agencies typically look favorably upon this approach. As the field of complementary and alternative medicine (CAM) continues to evolve, so do increased calls for the use of more rigorous study design and trial methodologies, which can present challenges for investigators. PURPOSE To describe the processes involved in the coordination and management of a multisite randomized clinical trial of a CAM intervention. METHODS Key aspects related to the coordination and management of a multisite CAM randomized clinical trial are presented, including organizational and site selection considerations, recruitment concerns and issues related to data collection and randomization to treatment groups. Management and monitoring of data, as well as quality assurance procedures are described. Finally, a real world perspective is shared from a recently conducted multisite randomized clinical trial of reflexology for women diagnosed with advanced breast cancer. RESULTS The use of multiple sites in the conduct of CAM-based randomized clinical trials can provide an efficient, collaborative and robust approach to study coordination and data collection that maximizes efficiency and ensures the quality of results. CONCLUSIONS Multisite randomized clinical trial designs can offer the field of CAM research a more standardized and efficient approach to examine the effectiveness of novel therapies and treatments. Special attention must be given to intervention fidelity, consistent data collection and ensuring data quality. Assessment and reporting of quantitative indicators of data quality should be required.
Collapse
Affiliation(s)
- Mohammad H Rahbar
- Epidemiology and Biostatistics, The University of Texas School of Public Health at Houston, Houston, TX 77030, United States.
| | | | | | | | | |
Collapse
|
25
|
Sinnott P, Cheng A, Wagner T, Goetz L, Ottomanelli L. Cost-Effectiveness Analysis of the Spinal Cord Injury Vocational Integration Program (SCI-VIP). Top Spinal Cord Inj Rehabil 2011. [DOI: 10.1310/sci1604-80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
26
|
Return to work and school: a model mentoring program for youth and young adults with spinal cord injury. Spinal Cord 2010; 49:544-8. [DOI: 10.1038/sc.2010.166] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|