Vocational rehabilitation to empower consumers following newly acquired spinal cord injury

Perceived vocational support needs and return-to-work outcomes in the first 12-months post-discharge in individuals with acquired brain injury and spinal cord injury: A retrospective cohort study

BACKGROUND

Return-to-work (RTW) is often viewed as an important outcome following acquired brain injury (ABI) and spinal cord injury (SCI), although not all individuals have vocational goals and many experience barriers to RTW.

OBJECTIVE

This study investigated the relationship between RTW and psychosocial functioning at 12-months post-discharge after ABI and SCI and examined patterns of RTW according to perceived need for and receipt of vocational support.

METHODS

A file audit was conducted for 69 participants with ABI (n = 44) and SCI (n = 25). Data on employment status and perceived vocational support at 3- and 12-months post-discharge, home and community participation, psychological distress, and health-related quality of life were extracted.

RESULTS

Individuals in paid employment at 12-months post-discharge (22%, n = 15) reported significantly better psychosocial functioning at this timepoint compared to those not employed (78%; n = 54). For those not employed, three subgroups were identified: 1) Did not perceive the need for or receive vocational support (50%; n = 27); 2) Perceived vocational support needs were unmet (19%; n = 10); and 3) Perceived and received vocational support (31%; n = 17). Psychological distress was highest for those who perceived and received vocational support but were not employed.

CONCLUSION

RTW was associated with better psychosocial functioning after acquired neurological injury. The findings highlight the need for clinicians to explore and revisit individuals' perceived need for and preferences for vocational support and monitor the psychological well-being of those with RTW goals that are not yet successful.

United and flexible: a collaborative approach to early vocational rehabilitation on a spinal unit. A realist study

STUDY DESIGN

Qualitative study using realist review.

OBJECTIVES

To conceptualise how Early Intervention Vocational Rehabilitation (EIVR) functions within inpatient multidisciplinary contexts during spinal cord injury (SCI) rehabilitation.

SETTING

New Zealand Spinal Unit.

METHODS

People with newly acquired SCI and members of their rehabilitation team were observed in a range of rehabilitation sessions, team meetings and therapeutic interactions. Participants were also interviewed to explore how EIVR functioned alongside the multidisciplinary team (MDT). Interviews and observations were transcribed, coded and analysed using realist methods.

RESULTS

We identified three primary contexts which influenced how EIVR was delivered within the MDT: (1) a united approach, (2) a flexible approach, and (3) a hesitant approach. These contexts generated four work-related outcomes for people with SCI; enhanced work self-efficacy, strengthened hope for work, maintained work identity, and the less desirable outcome of increased uncertainty about work.

CONCLUSIONS

To optimise work outcomes for people after SCI, it is important to consider how EIVR is delivered and integrated within the wider MDT. Such an understanding can also inform the establishment of new EIVR services in different settings. Results suggest that unity, flexibility and clarity between EIVR services and the wider MDT are essential foundations for supporting people with SCI on their journey to employment.

SPONSORSHIP

This research was funded by Health Research Council NZ grant in partnership with Canterbury District Health Board.

Developing A Conceptual Framework for Early Intervention Vocational Rehabilitation for People Following Spinal Cord Injury

PURPOSE

Early intervention vocational rehabilitation (EIVR) can improve return to work (RTW) outcomes for people with spinal cord injury (SCI). However, mechanisms explaining how and why EIVR works are not well understood. This study aims to develop a conceptual framework describing key mechanisms of EIVR intervention effect following SCI.

METHODS

We synthesised data from a realist literature review with data from interviews of people with SCI (n = 30), a survey of people with SCI who had received EIVR (n = 37), a focus group of EIVR providers and a focus group of community vocational providers. We first synthesised the literature review and interviews to develop an initial programme theory describing the contexts in which mechanisms are activated to produce EIVR outcomes. Then we used data from the survey and focus groups to further refine the EIVR programme theory. Finally, a conceptual framework was developed to support knowledge dissemination.

RESULTS

By ensuring consistent messaging across the multi-disciplinary team, EIVR programmes establish and maintain hope that work is possible following injury. Conversations about work allow individuals to determine the priority of work following injury. These conversations can also improve self-efficacy by providing individualized support to envisage pathways toward RTW goals and maintain worker identity. The synthesised study findings highlight the contexts and resources required to trigger activation of these mechanisms.

CONCLUSIONS

EIVR key mechanisms of effect are not specific to SCI as a health condition, therefore enabling this framework to be applied to other populations who face similar impairments and return to work barriers.

Career satisfaction among working age individuals with multiple sclerosis or spinal cord injury

BACKGROUND: Joint studies of multiple sclerosis (MS) and spinal cord injury (SCI), both types of spinal cord dysfunction, have identified barriers and facilitators to employment and key outcomes including earnings and job benefits. However, there has been an absence of research on satisfaction with employment over one’s career. Such knowledge would help to establish the foundation for targeted vocational rehabilitation interventions. as well as differences in quality of employment outcomes, establishing the foundation for targeted vocational rehabilitation interventions. OBJECTIVE: Identify and quantify demographic, educational, vocational, and functional characteristics associated with career satisfaction, a quality employment outcome, among people with MS and SCI. METHODS: There were a total of 3,371 participants, 1,229 with MS and 2,142 with SCI, all of whom were in the traditional working age range (<  65 years old). Participants were identified from the Southeastern and Midwestern regions of the USA and data were collected, processed, and analyzed at a medical university in the Southeastern USA. Econometric modeling identified factors associated with career satisfaction, as defined by a five-item composite scale that was converted to Z-scores, integrating analysis using both diagnostic groups. RESULTS: Participants who were gainfully employed and those who had left the labor force (unemployed with no hopes to return to work), reported higher career satisfaction than those who were unemployed and hoping to return to work. Higher career satisfaction scores were associated with more formal education and having worked in management/professional, natural resources, or service occupations. Higher scores were also observed among those older, not single, and who had fewer functional deficits. No differences were identified as a function of diagnosis, race-ethnicity, sex, or time since injury/diagnosis. CONCLUSION: Career satisfaction was more strongly related to educational attainment, vocational history, and labor force participation, than to demographic and disability factors. Vocational counselors should target those still in the labor force for skills development, job retention and reacquisition to promote career satisfaction.

Vocational wayfinding following spinal cord injury: In what contexts, how and why does early intervention vocational rehabilitation work?

BACKGROUND: Early intervention vocational rehabilitation (EIVR) is used to optimize return to work (RTW) outcomes for people following spinal cord injury (SCI). However, theoretical clarity is required about how EIVR works, for whom and under what circumstances. OBJECTIVE: To develop a theoretical understanding of how people respond to EIVR following SCI and the contexts in which mechanisms of intervention effect are likely to be activated. METHODS: Realist research methods were used to analyze interviews with 30 participants who had received EIVR following SCI. RESULTS: We conceptualized the reporting of our analyses using a travel metaphor, encapsulating the types and degree of wayfinding support participants required to think about, plan and action their vocational aspirations. Developing, maintaining and enacting hope, supporting self-identity and vocational identity, and focusing on environmental context adaptations required to enact vocational aspirations, appear to be critical mechanisms of intervention effect within EIVR. CONCLUSIONS: Various contexts and mechanisms of EIVR contribute to successful negotiation, achievement and sustainability of RTW outcomes for people following SCI. These theoretical understandings can refine EIVR service provision within SCI rehabilitation and inform how EIVR can improve RTW outcomes for people with acquired neurological conditions in other rehabilitation contexts.

Employment outcomes following spinal cord injury: a population-based cross-sectional study in Australia

STUDY DESIGN

Self-reported cross-sectional data for the Australian cohort participating in the International Spinal Cord Injury Community survey.

OBJECTIVES

To contextualise post-injury employment for people with spinal cord injury (SCI) in Australia, including work participation rates, time to resuming work, underemployment and pre- and post-SCI employment changes.

SETTING

Australian survey data from four state-wide SCI services, one government insurance agency and three not-for-profit consumer organisations across New South Wales, Queensland, South Australia and Victoria.

METHODS

Data were analysed from 1579 participants with SCI who are at least 1-year post discharge from an inpatient facility. Survey measures included 16-items dedicated to employment. Pre- and post-injury job titles were based on the International Standard Classification of Occupations (ISCO-08) major classification. A mix of chi-squared, t-test and negative binomial regression were used to analyse data.

RESULTS

The absolute post-injury employment rate was 49.9%, with one-third of the sample currently working. Pre-injury employment and engagement with vocational rehabilitation resulted in higher employment rates. Individuals who were unable to return immediately following inpatient rehabilitation took mean 28 months (SD, 35.9) to return. Time to employment was significantly lengthier for those without pre-injury jobs, at 59.7 months [SD, 43.8] (p < 0.001). Engagement in less manual roles increased post-injury, accounting for three quarters of post-SCI jobs. Underemployment was identified by 16.6% of those currently working.

CONCLUSIONS

While there are current services and programmes in place in Australia that support post-injury employment, findings indicate a need for more comprehensive early intervention focused services targeted towards employers and individuals.