Journal of Occupational Rehabilitation

, Volume 20, Issue 1, pp 69–80 | Cite as

Understanding Decisions About Work After Spinal Cord Injury

  • Joanna K. FadylEmail author
  • Kathryn M. McPherson


Introduction Research has consistently shown that many people with spinal cord injury (SCI) do not return to work (RTW), despite evidence that being employed is associated with better quality of life, participation and physical and psychological well-being. While some factors associated with RTW outcome have been identified, very little is known about what influences people’s own decisions about their employment following SCI. This qualitative study sought to identify factors that influenced decisions about whether and when to RTW for people with SCI. Methods Participants were recruited through rehabilitation and support services in Aotearoa/New Zealand, and sampling sought to capture variation in the population, particularly with regard to pre-injury occupation, physical impairment, age, ethnicity and education. In-depth interviews were conducted which were audio-taped and transcribed. Interviews were analysed using rigorous methods drawn from grounded theory. Results Thirteen participants took part in the research. Findings identified four main themes that synthesised experiences about what influenced decisions about employment after SCI: (1) ability to work (given work demands and current resources); (2) presence of responsibilities or pressures that compete with work; (3) access to a suitable job; and (4) whether work was of enough benefit to the individual to be worth pursuing. Conclusions Findings illustrate the complexity of decisions about working after SCI, and provide a framework that health and vocational professionals may find useful to inform discussions with their clients. Findings also provide a basis for further research into interventions to support people to make informed decisions about employment after SCI.


Spinal cord injury Vocational rehabilitation Return to work Decision 



Appreciation is extended to participants for contributing their time and sharing their experiences; to AUT University for funding the research; to Arron Perriam and Sridhar Atresh for their support and facilitation of recruitment efforts; to Marta Leete for her input as an external reader during analysis; and to the NRC-SANN writing clinic for feedback on a draft of the paper.


  1. 1.
    Grint K. The sociology of work: introduction. 3rd ed. Cambridge: Polity Press; 2005.Google Scholar
  2. 2.
    Krause JS. Adjustment to life after spinal cord injury: a comparison among three participant groups based on employment status. Rehabil Couns Bull. 1992;35(4):218–29.Google Scholar
  3. 3.
    Hammell K. Quality of life after spinal cord injury: a meta-synthesis of qualitative findings. Spinal Cord. 2007;45(2):124–39.CrossRefGoogle Scholar
  4. 4.
    Murphy GC, Young AE, Brown DJ, King NJ. Explaining labor force status following spinal cord injury: the contribution of psychological variables. J Rehabil Med. 2003;35(6):276–83.CrossRefPubMedGoogle Scholar
  5. 5.
    Yasuda S, Wehman P, Targett P, Cifu DX, West M, Yasuda S, et al. Return to work after spinal cord injury: a review of recent research. Neurorehabilitation. 2002;17(3):177–86.PubMedGoogle Scholar
  6. 6.
    Hess DW, Ripley DL, McKinley WO, Tewksbury M. Predictors for return to work after spinal cord injury: a 3-year multicenter analysis. Arch Phys Med Rehabil. 2000;81(3):359–63.CrossRefPubMedGoogle Scholar
  7. 7.
    Crisp R. Return to work after spinal cord injury. J Rehabil. 1990;56(1):28–35.Google Scholar
  8. 8.
    Murphy GC, Brown DJ, Athanasou J, Foreman P, Young AE. Labour force participation and employment among a sample of Australian patients with a spinal cord injury. Spinal Cord. 1997;35(4):238–44.CrossRefPubMedGoogle Scholar
  9. 9.
    Tomassen PC, Post MW, van Asbeck FW. Return to work after spinal cord injury. Spinal Cord. 2000;38(1):51–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Krause JS. Years to employment after spinal cord injury. Arch Phys Med Rehabil. 2003;84(9):1282–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Krause N, Frank JW, Dasinger LK, Sullivan TJ, Sinclair SJ. Determinants of duration of disability and return-to-work after work related injury and illness: challenges for future research. Am J Ind Med. 2001;40:464–84.CrossRefPubMedGoogle Scholar
  12. 12.
    McKee-Ryan FM, Song Z, Wanberg CR, Kinicki AJ. Psychological and physical well-being during unemployment: a meta-analytic study. J Appl Psychol. 2005;90(1):53–76.CrossRefPubMedGoogle Scholar
  13. 13.
    Young A, Murphy G. Vocationally orientated rehabilitation service requests: the case of employed persons experiencing a spinal cord injury. Aust J Career Dev. 2003;12(1):17–24.Google Scholar
  14. 14.
    Chapin MH, Kewman DG. Factors affecting employment following spinal cord injury: a qualitative study. Rehabil Psychol. 2001;46(4):400–16.CrossRefGoogle Scholar
  15. 15.
    Ville I, Winance M. To work or not to work? The occupational trajectories of wheelchair users. Disabil Rehabil. 2006;28(7):423–36.CrossRefPubMedGoogle Scholar
  16. 16.
    Cheek J, Shoebridge J, Willis E, Zadoroznyi M. Society and health: social theory for health workers. Melbourne: Addison Wesley Longman; 1996.Google Scholar
  17. 17.
    Strauss A, Corbin J. Basics of qualitative research: techniques and procedures for developing grounded theory. 2nd ed. California: SAGE; 1998.Google Scholar
  18. 18.
    World Health Organisation. International classification of functioning, disability and health: ICF. Geneva: World Health Organisation; 2001.Google Scholar
  19. 19.
    Polkinghorne DE. Language and meaning: data collection in qualitative research. J Couns Psychol. 2005;52(2):137–45.CrossRefGoogle Scholar
  20. 20.
    Mays N, Pope C. Qualitative research: rigour and qualitative research. BMJ. 1995;311:109–12.PubMedGoogle Scholar
  21. 21.
    Patton MQ. Qualitative research and evaluation methods. 3rd ed. California: Sage; 2002.Google Scholar
  22. 22.
    Patel S, Greasley K, Watson P. Barriers to rehabilitation and return to work for unemployed chronic pain patients: a qualitative study. Eur J Pain. 2007;11:831–40.CrossRefPubMedGoogle Scholar
  23. 23.
    Maticka-Tyndale E, Adam BD, Cohen JJ. To work or not to work: combination therapies and HIV. Qual Health Res. 2002;12(10):1353–72.CrossRefPubMedGoogle Scholar
  24. 24.
    Kennedy F, Haslam C, Munir F, Pryce J. Returning to work following cancer: a qualitative exploratory study into the experience of returning to work following cancer. Eur J Cancer Care. 2007;16:17–25.CrossRefGoogle Scholar
  25. 25.
    Main DS, Nowels CT, Cavender TA, Etschmaier M, Steiner JF. A qualitative study of work and work return in cancer survivors. Psychooncology. 2005;14:992–1004.CrossRefPubMedGoogle Scholar
  26. 26.
    Alaszewski A, Alaszewski H, Potter J, Penhale B. Working after stroke: survivors’ experiences and perceptions of barriers to and facilitators of the return to paid employment. Disabil Rehabil. 2007;29:1858–69.CrossRefPubMedGoogle Scholar
  27. 27.
    Lawthers AG, Pransky GS, Peterson LE, Himmelstein JH. Rethinking quality in the context of persons with disability. Int J Qual Health Care. 2003;15(4):287–99.CrossRefPubMedGoogle Scholar
  28. 28.
    Malec J, Moessner A. Replicated positive results for the VCC model of vocational intervention after ABI within the social model of disability. Brain Inj. 2006;20(3):227–36.CrossRefPubMedGoogle Scholar
  29. 29.
    Fadyl JK, McPherson KM. Approaches to vocational rehabilitation after traumatic brain injury—a review of the evidence. J Head Trauma Rehabil. 2009;24(3):195–212.CrossRefPubMedGoogle Scholar
  30. 30.
    Perriam A. Wheels in work. Australia New Zealand spinal cord society conference 2008. Christchurch: Australia New Zealand Spinal Cord Society; 2008.Google Scholar
  31. 31.
    Malec J, Buffington A, Moessner A, Degiorgio L. A medical/vocational case coordination system for persons with brain injury: an evaluation of employment outcomes. Arch Phys Med Rehabil. 2000;81:1007–15.CrossRefPubMedGoogle Scholar
  32. 32.
    Statistics New Zealand Te Tari Tatau. Household economic survey (income): year ended June 2008. Wellington: Statistics New Zealand Te Tari Tatau; 2008.Google Scholar
  33. 33.
    Work and Income New Zealand Te Hiranga Tangata. Sickness benefit information. 2009 [Internet; cited 2009 01 July]; available from:

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Health and Rehabilitation Research CentreAUT UniversityNorthcote, AucklandNew Zealand

Personalised recommendations