Skip to main content
SpringerLink
Log in

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

  • Published:
Quality of Life Research Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

CE:

Competitive employment

HRQOL:

Health-related quality of life

IPS:

Individualized placement and support

IRB:

Institutional review board

SCI:

Spinal cord injury

SCI-VIP:

Spinal Cord Injury-Vocational Integration Program

SE:

Supported employment

TAU:

Treatment as usual

TAU-IS:

Treatment as usual–interventional site

TAU-OS:

Treatment as usual–observational site

TBI:

Traumatic brain injury

US:

United States

VAMC:

Veterans Affairs Medical Center

VHA:

Veterans Health Administration

VR:

Vocational rehabilitation

VRC:

Vocational rehabilitation counselor

References

  1. Westgren, N., & Levi, R. (1998). Quality of life and traumatic spinal cord injury. Archives of Physical Medicine and Rehabilitation, 79(11), 1433–1439.

    Article  PubMed  CAS  Google Scholar 

  2. Krause, J. S. (1990). The relationship between productivity and adjustment following spinal cord injury. Rehabilitation Counseling Bulletin, 33, 188–199.

    Google Scholar 

  3. Krause, J. S. (1992). Adjustment to life after spinal cord injury: A comparison among three participant groups based on employment status. Rehabilitation Counseling Bulletin, 35, 218–229.

    Google Scholar 

  4. Krause, J. S. (1992). Longitudinal changes in adjustment after spinal cord injury: A 15-year study. Archives of Physical Medicine and Rehabilitation, 73(6), 564–568.

    PubMed  CAS  Google Scholar 

  5. Chapin, M. H., & Kewman, D. G. (2001). Factors affecting employment following spinal cord injury: A qualitative study. Rehabilitation Psychology, 46(4), 400–416.

    Article  Google Scholar 

  6. Clayton, K. S., & Chubon, R. A. (1994). Factors associated with the quality of life of long-term spinal cord injured persons. Archives of Physical Medicine and Rehabilitation, 75(6), 633–638.

    Article  PubMed  CAS  Google Scholar 

  7. Leduc, B. E., & Lepage, Y. (2002). Health-related quality of life after spinal cord injury. Disability and Rehabilitation, 24(4), 196–202.

    Article  PubMed  Google Scholar 

  8. Jain, N. B., Sullivan, M., Kazis, L. E., Tun, C. G., & Garshick, E. (2007). Factors associated with health-related quality of life in chronic spinal cord injury. American Journal of Physical Medicine and Rehabilitation, 86(5), 387–396.

    Article  PubMed  Google Scholar 

  9. Ottomanelli, L., Goetz, L. L., Suris, A., McGeough, C., Sinnott, P. L., Toscano, R., et al. (2012). Effectiveness of supported employment for veterans with spinal cord injuries: Results from a randomized multisite study. Archives of Physical Medicine and Rehabilitation, 93(5), 740–747.

    Article  PubMed  Google Scholar 

  10. Becker, D., & Drake, R. E. (2006). Supported employment interventions are effective for people with severe mental illness. Evidence-Based Mental Health, 9(1), 22.

    Article  PubMed  Google Scholar 

  11. Bond, G. R., Becker, D. R., Drake, R. E., Rapp, C. A., Meisler, N., Lehman, A. F., et al. (2001). Implementing supported employment as an evidence-based practice. Psychiatric Services, 52(3), 313–322.

    Article  PubMed  CAS  Google Scholar 

  12. Bond, G. R. (2004). Supported employment: Evidence for an evidence-based practice. Psychiatric Rehabilitation Journal, 27(4), 345–359.

    Article  PubMed  Google Scholar 

  13. Murphy, G. C., Middleton, J., Quirk, R., De Wolf, A., & Cameron, I. D. (2011). Predicting employment status at 2 years’ postdischarge from spinal cord injury rehabilitation. Rehabilitation Psychology, 56(3), 251–256.

    Article  PubMed  Google Scholar 

  14. Cohen, J. T., Marino, R. J., Sacco, P., & Terrin, N. (2012). Association between the functional independence measure following spinal cord injury and long-term outcomes. Spinal Cord, 50(10), 728–733.

    Google Scholar 

  15. Ottomanelli, L., Goetz, L., McGeough, C., Suris, A., Sippel, J., Sinnott, P., et al. (2009). Methods of a multisite randomized clinical trial of supported employment among veterans with spinal cord injury. Journal of Rehabilitation Research and Development, 46(7), 919–930.

    Article  PubMed  Google Scholar 

  16. Kazis, L. E., Ren, X. S., Lee, A., Skinner, K., Rogers, W., Clark, J., et al. (1999). Health status in VA patients: results from the Veterans health study. American Journal of Medical Quality, 14(1), 28–38.

    Article  PubMed  CAS  Google Scholar 

  17. Kazis, L. E., Lee, A., Spiro, A., Rogers, W., Ren, X. S., Miller, D. R., et al. (2004). Measurement comparisons of the medical outcomes study and veterans SF-36 health survey. Health Care Financing Review, 25(4), 43–58.

    PubMed  Google Scholar 

  18. Kazis, L. E., Miller, D. R., Clark, J. A., Skinner, K. M., Lee, A., Ren, X. S., et al. (2004). Improving the response choices on the veterans SF-36 health survey role functioning scales: Results from the Veterans Health Study. The Journal of Ambulatory Care Management, 27(3), 263–280.

    Article  PubMed  Google Scholar 

  19. Kazis, L. E., Miller, D. R., Skinner, K. M., Lee, A., Ren, X. S., Clark, J. A., et al. (2006). Applications of methodologies of the Veterans health study in the VA healthcare system: conclusions and summary. The Journal of Ambulatory Care Management, 29(2), 182–188.

    Article  PubMed  Google Scholar 

  20. Whiteneck, G. G., Charlifue, S. W., Gerhart, K. A., Overholser, J. D., & Richardson, G. N. (1992). Quantifying handicap: A new measure of long-term rehabilitation outcomes. Archives of Physical Medicine and Rehabilitation, 73(6), 519–526.

    PubMed  CAS  Google Scholar 

  21. Linacre, J. M., Heinemann, A. W., Wright, B. D., Granger, C. V., & Hamilton, B. B. (1994). The structure and stability of the functional independence measure. Archives of Physical Medicine and Rehabilitation, 75(2), 127–132.

    PubMed  CAS  Google Scholar 

  22. Hamilton, B. B., Laughlin, J. A., Fiedler, R. C., & Granger, C. V. (1994). Interrater reliability of the 7-level functional independence measure (FIM). Scandinavian Journal of Rehabilitation Medicine, 26(3), 115–119.

    PubMed  CAS  Google Scholar 

  23. Bond, G. R., Becker, D. R., Drake, R. E., & Vogler, K. M. (1997). A fidelity scale for the individual placement and support model of supported employment. Rehabilitation Counseling Bulletin, 40, 265–284.

    Google Scholar 

  24. Bond, G. R., Vogler, K. M., & Sandra. (2001). Dimensions of supported employment: Factor structure of the IPS fidelity scale. Journal of Mental Health, 10(4) 383–393.

  25. Krause, J. S., & Anson, C. A. (1996). Employment after spinal cord injury: Relation to selected participant characteristics. Archives of Physical Medicine and Rehabilitation, 77(8), 737–743.

    Article  PubMed  CAS  Google Scholar 

  26. Bush, M. B. A., Drake, M. D., Xie, P. D., McHugo, P. D., & Haslett, M. A. (2009). The long-term impact of employment on mental health service use and costs for persons with severe mental Illness. Psychiatric Services, 60(8), 1024–1031.

    Article  PubMed  Google Scholar 

  27. Krause, J. S., & Coker, J. L. (2006). Aging after spinal cord injury: A 30-year longitudinal study. Journal of Spinal Cord Medicine, 29(4), 371–376.

    PubMed  Google Scholar 

  28. Becker, D. R., Bond, G. R., McCarthy, D., Thompson, D., Xie, H., McHugo, G. J., et al. (2001). Converting day treatment centers to supported employment programs in Rhode Island. Psychiatric Services, 52(3), 351–357.

    Article  PubMed  CAS  Google Scholar 

  29. Drake, R. E., McHugo, G. J., Becker, D. R., Anthony, W. A., & Clark, R. E. (1996). The New Hampshire study of supported employment for people with severe mental illness. Journal of Consulting and Clinical Psychology, 64(2), 391–399.

    Article  PubMed  CAS  Google Scholar 

  30. Drake, R. E., Becker, D. R., Clark, R. E., & Mueser, K. T. (1999). Research on the individual placement and support model of supported employment. Psychiatric Quarterly, 70(4), 289–301.

    Article  PubMed  CAS  Google Scholar 

  31. Burns, T., Catty, J., White, S., Becker, T., Koletsi, M., Fioritti, A., et al. (2009). The impact of supported employment and working on clinical and social functioning: Results of an international study of individual placement and support. Schizophrenia Bulletin, 35(5), 949–958.

    Article  PubMed  Google Scholar 

  32. Mueser, K. T., Clark, R. E., Haines, M., Drake, R. E., McHugo, G. J., Bond, G. R., et al. (2004). The Hartford study of supported employment for persons with severe mental illness. Journal of Consulting and Clinical Psychology, 72(3), 479–490.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This material is based upon work supported by the Office of Research and Development, Rehabilitation Research and Development Service, Department of Veterans Affairs (#B3773R). Contents of this presentation do not represent the views of the Department of Veterans Affairs or the United States Government. The authors acknowledge the kind support of Compensated Work Therapy and Spinal Cord Injury and Disorders Services, Department of Veterans Affairs. We also acknowledge the contributions of our study coordinators, program and data managers, Compensated Work Therapy program managers, and vocational rehabilitation clinicians. We thank Lynn Dirk, MAMC, for editorial assistance. Finally, we greatly appreciate the Veterans who participated in this study.

Author information

Authors and Affiliations

  1. Health Services Research and Development Service (HSR&D) and Rehabilitation Research and Development Service (RR&D) Center of Excellence Maximizing Rehabilitation Outcomes, James A. Haley Veterans’ Hospital, 8900 Grand Oak Circle (118M), Tampa, FL, 33637, USA

    Lisa Ottomanelli & Scott D. Barnett

  2. Department of Rehabilitation and Mental Health Counseling, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA

    Lisa Ottomanelli

  3. Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA

    Lance L. Goetz

  4. Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA

    Lance L. Goetz

Authors
  1. Lisa Ottomanelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Scott D. Barnett
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lance L. Goetz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lisa Ottomanelli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ottomanelli, L., Barnett, S.D. & Goetz, L.L. 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 22, 2133–2141 (2013). https://doi.org/10.1007/s11136-013-0353-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-013-0353-5

Keywords

Search

Navigation