Factors associated with employment among veterans with spinal cord injury

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.

Employment, health outcomes, and life satisfaction after spinal cord injury: comparison of veterans and nonveterans

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.

The Relationship Between Resilience, Self-Efficacy, and Employment in People With Physical Disabilities

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.

Using Sensory, Functional, and Activity Limitation Data to Estimate Employment Outcomes for Working-Age Persons With Disabilities in the United States

Using data from the 2010–2012 American Community Survey (ACS), we estimate employment outcomes among persons with different combinations of sensory, functional, and activity limitations while controlling for individual characteristics. We consider activity limitations as indicators of barriers to independent living and of a need for support services. We find that the presence of an activity limitation is strongly associated with decreased odds of employment for persons with sensory or functional limitations. Results provide support for the targeted allocation of resources to increase independent living among persons with disabilities as a means to improve employment outcomes among persons with disabilities.

Spinal cord injury combined with felony history: effect on supported employment for Veterans

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.

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.

Effectiveness of supported employment for veterans with spinal cord injuries: results from a randomized multisite study

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.