Review of Critical Factors Related to Employment After Spinal Cord Injury: Implications for Research and Vocational Services

J Spinal Cord Med, 2009 · DOI: · Published: November 1, 2009

Spinal Cord Injury Occupational Health Rehabilitation

Simple Explanation

This study reviews existing research on employment rates after spinal cord injury (SCI). It examines the factors that affect employment, such as demographics, injury characteristics, and available support services. The goal is to identify ways to improve employment outcomes for individuals with SCI. The review indicates that employment rates vary significantly, with an average of approximately 35% in studies focused on paid employment. This variation is due to differences in how employment is defined, the characteristics of study participants, and the time since the injury occurred. The study suggests that factors like education, age at injury, and the type of vocational rehabilitation services available play a crucial role in whether individuals with SCI return to work. Supported employment practices, which offer ongoing support, appear to be the most promising approach.

Study Duration

1978 through 2008

Participants

579 articles reviewed, 60 with employment rates for individuals with SCI

Evidence Level

Review of published manuscripts

Key Findings

1
The average employment rate after SCI is approximately 35% in studies that examined paid employment.
2
Demographic variables, injury-related factors, employment history, psychosocial issues, and disability benefit status are characteristics associated with employment after SCI.
3
Evidence-based supported employment practices seem to be the most applicable model for assisting persons with SCI in restoring meaningful employment.

Research Summary

Employment rates after SCI vary widely depending on several factors, particularly the definition of employment and time of measurement. Characteristics associated with employment after SCI include demographic variables (education, sex, race, marital status), injury-related factors (age at injury, level of injury/impairment/functional status, time since injury), employment history (employment at or before injury), psychosocial issues (transportation, physical health, life satisfaction, locus of control, motivational level/expectation to work, social support), and disability benefit status. Vocational rehabilitation programs that address these barriers are essential. To date, the supported employment model of vocational rehabilitation has not yet been widely used or clinically tested among persons with physical disabilities, such as SCI.

Practical Implications

Standardized Outcome Measures

Researchers should use common outcome measures such as competitive employment rates, duration of employment, and job tenure to allow for comparison across studies.

Supported Employment

Evidence-based supported employment practices seem to be the most applicable model for assisting persons with SCI in restoring meaningful employment.

Further Research

Controlled studies are needed to test the assumption that supported employment is the most effective method of vocational rehabilitation among the SCI population.

Study Limitations

1
Discrepancies in studies’ definition of employment.
2
Variations in time of measurement across studies.
3
Lack of empirical evidence regarding the most effective methods of vocational rehabilitation.

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