Abstract
Purpose of Review
This review focuses on employment after spinal cord injury (SCI) and highlights recent evidence-based models of vocational rehabilitation.
Recent Findings
Employment rates among people with SCI remain much lower than the general population. Benefits of employment for persons with SCI include improved quality of life, enhanced independence, reduced depression, improved social integration, greater life satisfaction, better health, and longevity. When striving to work after SCI, there are facilitators to be exploited (e.g., education, transportation, assistive technology) and barriers that need management (e.g., secondary medical complications).
Summary
Individualized placement and support (IPS) and vocational resource facilitation (VRF) are examples of new evidence-based models of vocational rehabilitation that integrate vocational services with clinical care in order to better help persons with SCI find competitive employment in the community. If people with SCI do not return to work soon after their injury, then it may take more time for them to reach their full vocational potential.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Houtenville A. 2018 annual compendium of disability statistics. Durham: NH Institute on Disability, University of New Hampshire; 2018.
Pflaum C, McCollister G, Strauss DJ, Shavelle RM, DeVivo MJ. Worklife after traumatic spinal cord injury. J Spinal Cord Med. 2006;29(4):377–86.
Krause JS, Sternberg M, Maides J, Lottes S. Employment after spinal cord injury: differences related to geographic region, gender, and race. Arch Phys Med Rehabil. 1998;79(6):615–24.
Krause JS, Kewman D, DeVivo MJ, Maynard F, Coker J, Roach MJ, et al. Employment after spinal cord injury: an analysis of cases from the model spinal cord injury systems. Arch Phys Med Rehabil. 1999;80(11):1492–500.
Lidal IB, Huynh TK, Biering-Sorensen F. Return to work following spinal cord injury: a review. Disabil Rehabil. 2007;29(17):1341–75.
Ottomanelli L, Lind L. Review of critical factors related to employment after spinal cord injury: implications for research and vocational services. J Spinal Cord Med. 2009;32(5):503–31.
Young AE, Murphy GC. Employment status after spinal cord injury (1992-2005): a review with implications for interpretation, evaluation, further research, and clinical practice. Int J Rehabil Res. 2009;32(1):1–11.
Krause JS, Saunders L. D. S. Race-ethnicity, education, and employment after spinal dcord injury. Rehabil Couns Bull. 2010;53(2):78–86.
Ottomanelli L, Sippel JL, Cipher DJ, Goetz LL. Factors associated with employment among veterans with spinal cord injury. J Voc Rehabil. 2011;34(3):141–50.
Krause JS. Years to employment after spinal cord injury. Arch Phys Med Rehabil. 2003;84(9):1282–9.
Hay-Smith EJ, Dickson B, Nunnerley J, Anne SK. “The final piece of the puzzle to fit in”: an interpretative phenomenological analysis of the return to employment in New Zealand after spinal cord injury. Disabil Rehabil. 2013;35(17):1436–46.
Leiulfsrud A, Reinhardt JD, Ostermann A, Ruoranen K, Post MWM. The value of employment for people living with spinal cord injury in Norway. Disabil Soc. 2014;29(8):1177–91.
Leiulfsrud AS, Ruoranen K, Ostermann A, Reinhardt JD. The meaning of employment from the perspective of persons with spinal cord injuries in six European countries. Work. 2016;55(1):133–44.
Meade MA, Reed KS, Saunders LL, Krause JS. It’s all of the above: benefits of working for individuals with spinal cord injury. Top Spinal Cord Inj Rehabil. 2015;21(1):1–9.
Nunnerley JL, Hay-Smith EJC, Dean SG. Leaving a spinal unit and returning to the wider community: an interpretative phenomenological analysis. Disabil Rehabil. 2013;35(14):1164–73.
Leduc BE, Lepage Y. Health-related quality of life after spinal cord injury. Disabil Rehabil. 2002;24(4):196–202.
McColl MA, Stirling P, Walker J, Corey P, Wilkins R. Expectations of independence and life satisfaction among ageing spinal cord injured adults. Disabil Rehabil. 1999;21(5–6):231–40.
Chapin MH, Holbert D. Employment at closure is associated with enhanced quality of life and subjective well-being for persons with spinal cord injuries. Rehabil Couns Bull. 2010;54(1):6–14.
Krause JS, Saunders LL, Acuna J. Gainful employment and risk of mortality after spinal cord injury: effects beyond that of demographic, injury and socioeconomic factors. Spinal Cord. 2012;50(10):784–8.
Gorzkowski JA, Kelly EH, Klaas SJ, Vogel LC. Girls with spinal cord injury: social and job-related participation and psychosocial outcomes. Rehabil Psychol. 2010;55(1):58–67.
Ottomanelli L, Barnett SD, Goetz LL. 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. 2013;22(8):2133–41.
Krause JS, Pickelsimer E. Relationship of perceived barriers to employment and return to work five years later: a pilot study among 343 participants with spinal cord injury. Rehabil Couns Bull. 2008;51(2):118–21.
Thomas FP, Goetz LL, Dixon T, Ho C, Holmes SA, Sandford P, et al. Optimizing medical care to facilitate and sustain employment after spinal cord injury. J Rehabil Res Dev. 2014;51(6):xi–xxii.
Anderson CJ, Vogel LC. Employment outcomes of adults who sustained spinal cord injuries as children or adolescents. Arch Phys Med Rehabil. 2002;83(6):791–801.
Botticello AL, Chen Y, Tulsky DS. Geographic variation in participation for physically disabled adults: the contribution of area economic factors to employment after spinal cord injury. Soc Sci Med. 2012;75(8):1505–13.
Goetz LL, Ottomanelli L, Barnett SD, Sutton B, Njoh E. Relationship between comorbidities and employment among veterans with spinal cord injury. Top Spinal Cord Inj Rehabil. 2018;24(1):44–53.
Burnham RS, Warren SA, Saboe LA, Davis LA, Russell GG, Reid DC. Factors predicting employment 1 year after traumatic spine fracture. Spine. 1996;21(9):1066–71.
Meade MA, Forchheimer MB, Krause JS, Charlifue S. The influence of secondary conditions on job acquisition and retention in adults with spinal cord injury. Arch Phys Med Rehabil. 2011;92(3):425–32.
Rivers CS, Fallah N, Noonan VK, Whitehurst DG, Schwartz CE, Finkelstein JA, et al. Health conditions: effect on function, health-related quality of life, and life satisfaction after traumatic spinal cord injury. a prospective observational registry cohort study. Arch Phys Med Rehabil. 2018;99(3):443–51.
Blackwell TL, Leierer SJ, Haupt S, Kampitsis A. Predictors of vocational rehabilitation return-to-work outcomes in workers’ compensation. Rehabil Couns Bull. 2003;46(2):108–14.
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.
Krause JS, Anson CA. Employment after spinal cord injury: relation to selected participant characteristics. Arch Phys Med Rehabil. 1996;77(8):737–43.
Yasuda S, Wehman P, Targett P, Cifu DX, West M. Return to work after spinal cord injury: a review of recent research. NeuroRehabil. 2002;17(3):177–86.
Krause JS, Reed KS. Obtaining employment after spinal cord injury: relationship with pre-and post-injury education. Rehabil Couns Bull. 2009;53(1):27–33.
Hedrick B, Pape TL, Heinemann AW, Ruddell JL, Reis J. Employment issues and assistive technology use for persons with spinal cord injury. J Rehabil Res Dev. 2006;43(2):185–98.
Driscoll MP, Rodger SA, Jonge DM. Factors that prevent or assist the integration of assistive technology into the workplace for people with spinal cord injuries: perspectives of the users and their employers and co-workers. J Voc Rehabil. 2001;16(1):53–66.
Whiteneck G, Meade MA, Dijkers M, Tate DG, Bushnik T, Forchheimer MB. Environmental factors and their role in participation and life satisfaction after spinal cord injury. Arch Phys Med Rehabil. 2004;85(11):1793–803.
Murphy GC, Middleton J, Quirk R, De Wolf A, Cameron ID. Predicting employment status at 2 years postdischarge from spinal cord injury rehabilitation. Rehabil Psychol. 2011;56(3):251–6.
Lin MR, Hwang HF, Yu WY, Chen CY. A prospective study of factors influencing return to work after traumatic spinal cord injury in Taiwan. Arch Phys Med Rehabil. 2009;90(10):1716–22.
Norweg A, Jette AM, Houlihan B, Ni P, Boninger ML. Patterns, predictors, and associated benefits of driving a modified vehicle after spinal cord injury: findings from the National Spinal Cord Injury Model Systems. Arch Phys Med Rehabil. 2011;92(3):477–83.
Schonherr MC, Groothoff JW, Mulder GA, Schoppen T, Eisma WH. Vocational reintegration following spinal cord injury: expectations, participation and interventions. Spinal Cord. 2004;42(3):177–84.
Berry K, Drake R. Attachment theory in psychiatric rehabilitation: informing clinical practice. Adv Psychiatr Treat. 2010;16(4):308–15.
Kowal J, McWilliams LA, Péloquin K, Wilson KG, Henderson PR, Fergusson DA. Attachment insecurity predicts responses to an interdisciplinary chronic pain rehabilitation program. J Behav Med. 2015;38(3):518–26.
Blake J, Brooks J, Greenbaum H, Chan F. Attachment and employment outcomes for people with spinal cord injury: the intermediary role of hope. Rehabil Couns Bull. 2017;60(2):77–87.
Bergmark L, Westgren N, Asaba E. Returning to work after spinal cord injury: exploring young adults’ early expectations and experience. Disabil Rehabil. 2011;33(25–26):2553–8.
Hilton G, Unsworth C, Murphy G. The experience of attempting to return to work following spinal cord injury: a systematic review of the qualitative literature. Disabil Rehabil. 2018;40(15):1745–53.
Krause JS. Adjustment to life after spinal cord injury: a comparison among three participant groups based on employment status. Rehabil Couns Bull. 1992;35:218–29.
Krause JS, Newman JC, Clark JMR, Dunn M. The natural course of spinal cord injury: changes over 40 years among those with exceptional survival. Spinal Cord. 2017;55(5):502–8.
Ottomanelli L, Barnett SD, Goetz LL, Toscano R. Vocational rehabilitation in spinal cord injury: what vocational service activities are associated with employment program outcome? Top Spinal Cord Inj Rehabil. 2015;21(1):31–9.
O’Neill J, Ottomanelli L. Vocational rehabilitation for individuals with spinal cord injury. In: Kirshblum S, Lin VW, editors. Spinal cord medicine. 3rd ed. New York, NY: Demos Medical Publishing; 2019. p. 776–88.
Trenaman LM, Miller WC, Escorpizo R. Interventions for improving employment outcomes among individuals with spinal cord injury: a systematic review. Spinal Cord. 2014;52(11):788–94.
Roels EH, Aertgeerts B, Ramaekers D, Peers K. Hospital- and community-based interventions enhancing (re)employment for people with spinal cord injury: a systematic review. Spinal Cord. 2016;54(1):2–7.
•• Ottomanelli L, Goetz LL, Suris A, McGeough C, Sinnott PL, Toscano R, et al. Effectiveness of supported employment for veterans with spinal cord injuries: results from a randomized multisite study. Arch Phys Med Rehabil. 2012;93(5):740–7 Only evidenced-based study on employment demonstrating effectiveness of individual placement support (IPS) model in SCI.
Ottomanelli L, Goetz LL, Barnett SD, Njoh E, Dixon TM, Holmes SA, et al. Individual placement and support in spinal cord injury: a longitudinal observational study of employment outcomes. Arch Phys Med Rehabil. 2017;98(8):1567–75.e1.
Cotner BA, Ottomanelli L, O'Connor DR, Njoh EN, Barnett SD, Miech EJ. Quality of life outcomes for veterans with spinal cord injury receiving individual placement and support (IPS). Top Spinal Cord Inj Rehabil. 2018;24(4):325–35.
Cotner BA, Njoh EN, Trainor JK, O'Connor DR, Barnett SD, Ottomanelli L. Facilitators and barriers to employment among veterans with spinal cord injury receiving 12 months of evidence-based supported employment services. Top Spinal Cord Inj Rehabil. 2015;21(1):20–30.
Cotner BA, Ottomanelli L, O'Connor DR, Trainor JK. Provider-identified barriers and facilitators to implementing a supported employment program in spinal cord injury. Disabil Rehabil. 2018;40(11):1273–9.
Trexler LE, Trexler LC, Malec JF, Klyce D, Parrott D. Prospective randomized controlled trial of resource facilitation on community participation and vocational outcome following brain injury. J Head Trauma Rehabil. 2010;25(6):440–6.
Buffington A, Malec J. The vocational rehabilitation continuum: maximizing outcomes through bridging the gap from hospital to community-based services. J Head Trauma Rehabil. 1997;12:1–13.
Malec JF, Moessner AM. 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.
• Malec JF, Buffington AL, Moessner AM, Degiorgio L. A medical/vocational case coordination system for persons with brain injury: an evaluation of employment outcomes. Arch Phys Med Rehabil. 2000;81(8):1007–15 Provides evidence on effectiveness of early employment intervention in sub-acute neurotama (traumatic brain injury) rehabilitation setting.
O’Neill J, Dyson-Hudson T, West M, Kirshblum SC. Resource facilitation: early inpatient/assertive outpatient vocational rehabilitation services in SCI [abstract]. J Spinal Cord Med. 2017;40(5):599–600.
Ferdiana A, Post MW, Hoekstra T, van der Woude LH, van der Klink JJ, Bultmann U. Employment trajectories after spinal cord injury: results from a 5-year prospective cohort study. Arch Phys Med Rehabil. 2014;95(11):2040–6.
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John O’Neill and Trevor A. Dyson-Hudson declare that they have no conflicts of interest.
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O’Neill, J., Dyson-Hudson, T.A. Employment After Spinal Cord Injury. Curr Phys Med Rehabil Rep 8, 141–148 (2020). https://doi.org/10.1007/s40141-020-00266-4
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DOI: https://doi.org/10.1007/s40141-020-00266-4
Keywords
- Spinal cord injuries
- Employment
- Supported employment
- Return-to-work
- Vocational rehabilitation
- Rehabilitation