Abstract
Longitudinal cohort design. First, to explore the longitudinal outcomes for people who received early intervention vocational rehabilitation (EIVR); second, to examine the nature and extent of relationships between contextual factors and employment outcomes over time. Both inpatient and community-based clients of a Spinal Community Integration Service (SCIS). People of workforce age undergoing inpatient rehabilitation for traumatic spinal cord injury were invited to participate in EIVR as part of SCIS. Data were collected at the following three time points: discharge and at 1 year and 2+ years post discharge. Measures included the spinal cord independence measure, hospital anxiety and depression scale, impact on participation and autonomy scale, numerical pain-rating scale and personal wellbeing index. A range of chi square, correlation and regression tests were undertaken to look for relationships between employment outcomes and demographic, emotional and physical characteristics. Ninety-seven participants were recruited and 60 were available at the final time point where 33% (95% confidence interval (CI): 24-42%) had achieved an employment outcome. Greater social participation was strongly correlated with wellbeing (ρ=0.692), and reduced anxiety (ρ=-0.522), depression (ρ=-0.643) and pain (ρ=-0.427) at the final time point. In a generalised linear mixed effect model, education status, relationship status and subjective wellbeing increased significantly the odds of being employed at the final time point. Tertiary education prior to injury was associated with eight times increased odds of being in employment at the final time point; being in a relationship at the time of injury was associated with increased odds of being in employment of more than 3.5; subjective wellbeing, while being the least powerful predictor was still associated with increased odds (1.8 times) of being employed at the final time point. EIVR shows promise in delivering similar return-to-work rates as those traditionally reported, but sooner. The dynamics around relationships, subjective wellbeing, social participation and employment outcomes require further exploration.
Highlights
For most people who experience a traumatic spinal cord injury (SCI), gaining or returning to durable employment is a significant achievement[1] and a measure of rehabilitation success.[2]
Chi-square test for independence to examine attrition bias indicated no significant differences between the demographic characteristics of study participants and non-respondents at
This paper described the development, implementation and results of early intervention vocational rehabilitation delivered as part of a hospital-led Spinal Community Integration Service (SCIS)
Summary
For most people who experience a traumatic spinal cord injury (SCI), gaining or returning to durable employment is a significant achievement[1] and a measure of rehabilitation success.[2] Reengagement in vocational roles has a positive influence on quality of life[3] and is held to be an important part of the adjustment process following injury.[4,5] Despite the health-promoting nature of work[6] and the vocational potential of this group,[2] employment rates after injury generally remain very low.[5] Where there has been no explicit vocational intervention, rates are typically quoted as being around 35–40% in developed nations,[1,2] but often are far less.[7] Previous literature reporting post-injury vocational achievement has focussed on calculating crude employment rates following SCI or exploring the relationship with physical function.[5,8] personal factors relating to employment outcomes such as the individual’s education, pre-injury worker role and psychological traits have been examined.[8,9,10] Relatively little, is known about how the passage of time may influence employment outcomes, as well as the nature and extent of influence of possible effects of environmental factors such as access to social support, funding and compensation arrangements, the geographical area where the individual lives including amenities and infrastructure, and the use of vocational services.[1]
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