Vocational Rehabilitation Intervention Research Articles

Lupus: Vocational aspects and the best rehabilitation practices

BACKGROUND: Lupus (systemic lupus erythematosus; SLE) is a chronic autoimmune disorder, and is usually diagnosed initially in early to middle adulthood, which is the prime career-building phase of individual’s life. Persons with lupus report considerable financial burden not only because of healthcare costs but also because of compromised ability to engage in paid work due to illness as lupus can have a significantly negative impact on a person’s work participation, including loss of employment and reduced working hours. Rehabilitation counselors must be knowledgeable about the critical physical and psychosocial impacts of the illness and potential employment problems that the illness may cause. With this knowledge base, rehabilitation counselors can better assist individuals with lupus with obtaining and maintaining employment, economic independence, and balancing their life demands with their changing health care needs. OBJECTIVE: This paper first provides an overview of lupus and functional limitations that it may impose, followed by relevant vocational rehabilitation interventions, including workplace accommodations and education. CONCLUSIONS: We emphasize consumer advocacy, anticipatory coping and illness management, accommodations on the job, and need of active involvement of employers in problem solving as key elements of successful vocational rehabilitation for people with lupus.

Effect of college or university training on earnings of people with disabilities: A case control study

OBJECTIVE: To examine the effect of college or university training on earnings of individuals with disabilities receiving services through the public vocational rehabilitation system. METHODS: A non-experimental case-control study design. Data for 178,290 individuals closed as successfully rehabilitation in fiscal year 2011 were extracted from the Rehabilitation Services Administration Case Service Report (RSA-911) database. RESULTS: Propensity scores were estimated based on demographic variables using the classification and regression tree (CART) method, which yielded six homogeneous subgroups, ranging from high propensity to received college or university training as a vocational rehabilitation intervention to low propensity to receive such service. Individuals who received college/university training had higher weekly earnings than those who did not, and had the greatest benefit for young adults; White, Asian, or Native American women with physical impairments; and people with mental impairments. CONCLUSION: College or university training should be considered as a viable and beneficial option to improve employment outcomes and job quality for individuals with disabilities.

Evaluation of the implementation of the protocol of an early vocational rehabilitation intervention for people with acquired brain injury

Purpose: The purpose of this study was to evaluate (1) the feasibility of an early vocational rehabilitation (EVR) protocol in the standard rehabilitation process, (2) promoting factors and barriers encountered with the EVR protocol, and (3) perceived effectiveness of the protocol in facilitating return to work (RTW) following acquired brain injury (ABI). Method: A pre- and post-process evaluation was performed in a Dutch rehabilitation center. Dependent variables were feasibility (defined by the usability on process level and fulfillment of usability expectations), promoting factors and barriers, and perceived effectiveness of the protocol. Usability (defined by 13 performance and timing goals) was evaluated with existing forms and registrations. Fulfillment of usability expectations, perceived promoting factors and barriers, and perceived effectiveness were investigated with questionnaires. Data of 23 patients were available for process evaluation. Nine rehabilitation professionals, 10 patients with ABI, nine employers, and six occupational physicians completed the questionnaires. Results: Two-thirds of the performance goals and one-fourth of the timing goals were reached. All respondents cited the structured protocol as a promoting factor. Thirty-two of the thirty-four participants perceived the protocol as being suitable facilitating RTW after ABI. Conclusions: The EVR protocol provides a structured strategy to focus on RTW during standard rehabilitation. It is now possible to implement and test the protocol in other rehabilitation settings.Implications for RehabilitationThe early vocational rehabilitation (EVR) facilitates an interdisciplinary and systematic focus on return to work during rehabilitation of people with acquired brain injury.The feasibility of the EVR protocol has been tested.The EVR protocol is ready for implementation and wider testing in other rehabilitation settings.

The importance of work or productive activity in life care planning and case management.

INTRODUCTION: The importance of work or productive activity for the well-being, community integration, and quality of life of people living with disabilities is addressed, with implications for life care planning and case management.BACKGROUND: The role of work or productive activity in our society, and consequences of deprivation if rehabilitation services do not address vocational effects of disabilities, is explored. A continuum of productivity options is introduced; types of vocational rehabilitation assessment processes and interventions are described.PURPOSE: The role of vocational rehabilitation services in life care planning and case management is discussed, focusing on quality of life for people living with disabilities.CONCLUSION: Rehabilitation and health care professionals should understand the importance of work or other productive activity, and support the development of appropriate plans to address those needs among people who have disabilities.

Return to Work after Stroke: Recording, Measuring, and Describing Occupational Therapy Intervention

Introduction: Existing research on vocational rehabilitation following stroke has been criticised for not describing intervention in sufficient detail for replication or clinical implementation. The purpose of this study was to test the feasibility of recording and measuring the content of an early stroke-specific vocational rehabilitation intervention delivered to participants in a feasibility randomized controlled trial, using a proforma previously developed for a study of vocational rehabilitation following traumatic brain injury. Method: The proforma was adapted for use in stroke with input from an expert panel and was used to record intervention content, in 10-minute units, following each intervention session. Findings: Twenty-five people, working or in education at the time of stroke, participated in the study. Two thirds of the therapists' time was spent in face-to-face contact (43%) and liaison with the patient and others (20%). Intervention mainly focused on work preparation (21%) and the return to work process (24%). The remaining time was consumed by administration (19%) and travel (18%). Conclusion: The proforma was quick and easy to use and captured the main focus of intervention. This study suggests that it can be used to record stroke-specific vocational rehabilitation intervention content and has potential for wider use in research and clinical practice.

Development of a new tool to evaluate work support needs and guide vocational rehabilitation: the Work-ability Support Scale (WSS)

Purpose: This article outlines our overall approach, qualitative work, and pilot testing to develop a tool to facilitate identification of level of support needs and assist in planning for vocational rehabilitation interventions. Methods: A set of foundation principles drawn from literature and previous critiques of work-ability assessment tools were used to guide a set of studies to develop a new tool. A review of the literature regarding factors that influence work-ability, qualitative interviews and focus groups with a range of stakeholders in the return-to-work process, and pilot testing in different settings were used to develop the Work-ability Support Scale (WSS) to a stage where it had face validity, usability and acceptability for a range of key stakeholders and was ready for further testing. Results: Qualitative work and pilot testing enhanced the proposed tool with a series of changes and refinements to the content, structure and scoring framework. The current version of the tool is presented. Inter-rater reliability is presented elsewhere. Conclusion: Core principles and stakeholders’ views (injured or sick workers, employers, case managers and health professionals) support current tool design. Although further testing is required, the WSS appears to hold potential for use in the assessment of vocational rehabilitation needs.Implications for RehabilitationBeing unable to work due to injury or illness often negatively affects a person’s well-being.Vocational rehabilitation planning from the early stages of recovery assists people to make informed decisions about work choices, supports and rehabilitation.Responding to a lack of standardised tools to support vocational rehabilitation planning, the Work-ability Support Scale (WSS) was developed using a robust, multi-stage process.The WSS appears to hold good potential for use in the assessment of vocational rehabilitation needs, and as a vocational rehabilitation planning tool.

165. Rheumatoid Arthritis Patients’ Views of a Vocational Rehabilitation Intervention Provided by Rheumatology Occupational Therapists

Background: Work disability in rheumatoid arthritis (RA) is common and many are unlikely to return to work once they cease working. This study, nested within a randomised controlled trial (RCT) of a vocational rehabilitation (VR) programme, aimed to explore employed RA patients’ perceptions of the impact of VR or work advice received. Method: The VR intervention was modified for use in the UK from an American study and provided by Rheumatology OTs, who had received training in VR. Both the intervention and control group received a work advice pack. The intervention group also received on average 3 (SD1.08) hours of VR. At six month follow-up, semi-structured telephone interviews with participants (n=32) were conducted to investigate their views of VR and advice received. These were recorded, transcribed and thematically analysed by three researchers to ensure validity. Results: Two different and overarching themes emerged within each group: (i) the intervention group: valued the work advice they received (e.g. pacing, looking after self, changes to work routines, advice on equipment/aids) and highlighted the therapeutic benefit of seeing an OT (ii) the control group: perceived their condition as more debilitating than those in the intervention group, and lacked future aspirations about staying employed. They were unaware of their rights at work, refrained from disclosing their condition to their employers and expressed concerns about taking frequent sick leave, anticipating this might result in job loss. Participants from both groups admitted not having read the information booklet. Conclusions: Working people with RA receiving VR in this trial found it helped them learn how to manage their condition at work, and understand their employment rights. A relatively short intervention provided by rheumatology OTs may help them to stay in work for longer, potentially improving work disability.

Staying at work and living with MS: a qualitative study of the impact of a vocational rehabilitation intervention

Objective: This study examines the impact of a patient designed occupational therapy led vocational rehabilitation (VR) intervention on the experiences of people with multiple sclerosis (MS) who were experiencing work instability. We used qualitative in-depth interviews to gain insight into participants’ experiences of the intervention and identify the aspects that were most helpful from the participants’ perspectives. Design: We conducted interviews with 19 participants 2–8 weeks after the completion of their VR intervention. In these interviews, the participants were asked to describe the processes of the intervention and the influence of these on their work and MS. The interviews were transcribed verbatim and data analysis involved coding and the use of the constant comparative method to develop themes. Results: We identified five major themes related to the impact of the intervention on “understanding my symptoms and their management in the workplace”, “removing my anxieties”, “understanding and influencing my employer”, “managing my loss of confidence” and “having professional support”. Conclusions: The VR intervention was valued by people with MS who felt that after the intervention they had a greater understanding of disease related, work related and personal factors that impacted on their ability to work and they were supported to manage these by a skilled professional. The themes identified in this study help gain insight into the participants’ experience of the intervention and identify aspects that were most helpful from the participants’ perspectives. This information could be used to inform further research and service development.Implication for RehabilitationVocational rehabilitation can be effective in maintaining people with MS in their employment and help to remove some of the physical and emotional barriers that can develop.Employers and employees with MS must work together to effectively manage the MS in the workplace; a health professional can facilitate, support and encourage this dynamic process.

Function, health and psychosocial needs in job-seekers with anxiety, mood, and psychotic disorders who access disability employment services

Labour force participation of people with mental disorders varies according to the nature of their disorder. Research that compares function and psychosocial need in job-seekers with different mental disorders, however, is scant especially in the Australian setting. Identifying rehabilitation needs of job-seekers with mental disorders receiving employment services is of interest to providers of disability employment services in Australia. This study sought to identify differences in health, social needs and function in people with anxiety, mood, or psychotic disorders accessing disability employment services to inform disability service providers of vocational rehabilitation interventions. 106 adult job-seekers with anxiety (29%), mood (51%), and psychotic (20%) disorders receiving job placement services from a disability employment service provider consented to participate in this study. Self-report measures and the Executive Interview (EXIT) were used to document function. Differences between disorders were determined using one-way analysis of variance. Significantly better estimates of social functioning as measured by the Behaviour and Symptom Identification Scale (BASIS-32) were reported by job-seekers with psychotic disorders compared to those with anxiety or mood disorders. However, job-seekers with psychotic disorders reported longer periods of unemployment compared to those with mood disorders and longer estimates of the time it would take to obtain work compared to both the other groups. Perceived psychosocial problems, such as poor social function in job-seekers with anxiety and mood disorders and perceptions of poor employability in those with psychotic disorders, should be considered when developing vocational rehabilitation interventions, or where additional support may be required once employment is obtained.

Vocational Rehabilitation after Acquired Brain Injury: A Swedish Study of Benefits and Costs

Purpose: To examine the benefits from a vocational rehabilitation program for patients suffering from Acquired Brain Injury (ABI) in terms of quality of life, and overall health. In addition, to examine the direct societal costs of healthcare interventions related to vocational rehabilitation and indirect societal costs related to production loss. Method: Identified interventions in 45 patients with ABI who were discharged from a vocational rehabilitation program between 2010 and 2011 were documented, classified and translated into costs. Expenses associated with production loss were calculated by comparing sick leave production loss at first contact with the team, with sick leave production loss at discharge. Health related QoL and overall health, was measured at first contact and at discharge by using the EQ5D. Results: For vocational rehabilitation interventions, mean costs were €6303/individual/month. At first contact with the team, mean production loss was estimated to be €4409/individual/month compared; at discharge to be €2446. QoL ratings increased from first contact to discharge, although estimated health did not change. At discharge, significant correlations were found between QoL ratings and estimated health and the extent of production loss (p

Developing stroke-specific vocational rehabilitation: a soft systems analysis of current service provision

Purpose: This study aimed to clarify the existing service provision of stroke-specific vocational rehabilitation (VR) in one English county, in order to facilitate future service development. Method: Using soft systems methodology, services in Health, Social Care, Department of Work and Pensions, the voluntary and private sectors, which were identified as supporting return to work after stroke, were mapped using a mixed-methodology approach. Results: A lack of a sanctioned VR pathway meant access to support relied on brokered provision and tacit knowledge. The timing of an intervention was complex and there was a substantial degree of unmet need for mild stroke patients. VR was seen as “non-essential” due to competing commissioning priorities. Service providers from all sectors lacked training and cross-sector partnerships were tenuous and provider roles unclear. Conclusions: Stroke-specific VR should be delivered by an integrated, cross-sector multi-disciplinary team and integrated commissioning between health and other sectors is necessary. Although early intervention is important, support later on in the recovery process is also necessary. Service providers need adequate training to meet the needs of stroke survivors wishing to return to work and better awareness of best practice guidelines. Business cases which demonstrate the efficacy and cost-effectiveness of VR are vital.Implications for RehabilitationThe timeliness of a vocational rehabilitation (VR) intervention is complex; services need to be responsive to the changing needs of the stroke survivor throughout their recovery process and have better mechanisms to ensure re-entry into the stroke pathway is possible.Return to work is a recognised health outcome; health services need to develop better mechanisms for interagency/cross sector working and liaison with employers and not assume that VR is beyond their remit. Therapists and non-health service providers should receive sufficient training to meet the needs of stroke survivors wishing to return to work. Rehabilitation teams must decide how to implement national guidance within existing resources and what training is needed to deploy SSVR.The lack of a sanctioned pathway results in disorganised and patchy provision of VR for stroke survivors; mild stroke patients can fall through the net and receive little or no support. The journey back to work commences at the point of stroke. Mechanisms for identifying acute stroke survivors who were working at onset and for assessing the impact of the stroke on their work need to be put in place. The entire MDT has a role to play. In the absence of a VR specialist, even patients without obvious disability should be referred for ongoing rehabilitation with detailed work assessment and signposted to employment specialists e.g. disability employment advisors EARLY after stroke.Health-based VR interventions can influence work return and job retention. However, therapists must routinely measure work outcomes to inform their business case and be encouraged to demonstrate these outcomes to local commissioners. Commissioners should consider emerging evidence of early VR interventions on reduced length of stay, health and social care resource use and the wider health benefits of maintaining employment.

A new intervention to improve work participation of young adults with physical disabilities: a feasibility study

The aim of the study was to evaluate the feasibility of a new intervention to improve work participation of young adults with physical disabilities, addressing (1) implementation and costs and (2) preliminary effectiveness. Twelve young adults with physical disabilities (six males, six females; age 19-28 y, median age 21 y 6 mo) participated in a 1-year multidisciplinary vocational rehabilitation intervention. In a pre-post intervention design, we assessed implementation and costs as well as preliminary effectiveness in terms of employment and occupational performance using questionnaires and interviews. We tested pre-post differences with the McNemar test for proportions and the Wilcoxon signed-rank test for scores on occupational performance; p-values less than 0.05 were considered statistically significant. Additionally, we assessed work participation at follow-up after 2 years and 3 years. The intervention was implemented in an outpatient rehabilitation clinic for young adults. The median cost per participant for 1 year was €3128, which is an equivalent to the cost of 72 contact hours per participant. Post intervention, and at 2 years and 3 years follow-up, a significantly higher proportion of participants were employed (8/12 post vs 2/12 pre-intervention; p<0.05), with the ratio of those in paid to unpaid employment being 4:4, 5:3, and 7:1 respectively. Participants showed improved occupational performance in work, self-care, and leisure. Feasibility and preliminary effectiveness of the intervention are promising. Employed participants seemed to have achieved suitable and continuous employment.

Improved Occupational Performance of Young Adults with a Physical Disability After a Vocational Rehabilitation Intervention

The purpose of this study was to investigate into more detail how occupational performance of participants of a 1-year multidisciplinary vocational rehabilitation intervention changed over time, using a broad focus on three areas of occupational performance, addressing work, as well as self-care and leisure. In addition, we explored differences between employed and unemployed persons. In a pre-post-intervention design, changes in occupational performance, addressing work, self-care and leisure, were evaluated using the Canadian Occupational Performance Measure (COPM) and the Occupational Performance History Interview (OPHI-II). Eleven young adults (median 22 years) with physical disabilities participated. Post-intervention, participants experienced fewer problems and showed improved occupational performance in work, as well as self-care and leisure, and improved satisfaction with performance. Participants also showed improved occupational identity and occupational competence, and total scores on OPHI-II. Participants who did not achieve employment did not differ in demographic characteristics. They experienced problems in all three areas of occupational performance at pre-intervention, and more difficulty in interacting in occupational settings (environment). Post-intervention, their levels of occupational identity, competence and settings were similar to those of employed persons. Participants showed improved occupational performance after the intervention. The goal of employment and the broad integrated approach of the intervention seemed to motivate participants to resolve problems in work, as well as self-care and leisure. Unemployed persons faced problems in all three areas of occupational performance at start. Although they seemed to catch up during the intervention, they did not achieve employment within 1 year.

Return to work after traumatic brain injury: Cohort comparison and economic evaluation

Background: Returning to work (RTW) in the UK is problematic following TBI. Vocational rehabilitation (VR) is limited and efficacy or costs seldom reported. This study aimed to determine whether a TBI specialist VR intervention (TBI VR) was more effective at work return and retention 12 months after injury than usual care (UC). Secondary aims were to explore the feasibility of collecting economic data to inform a definitive trial.Method: Work outcomes of TBI-VR were compared to UC. Ninety-four participants (40 TBI-VR) with TBI resulting in hospitalization ≥48 hours, who were working at injury were followed up by postal questionnaire at 3, 6 and 12 months post-hospital discharge. Primary outcome was RTW. Secondary outcomes were functional ability, mood and quality-of-life. Health resource use was measured by self-report.Results: At 12 months, 15% more TBI-VR participants (27% more with moderate/severe TBI) were working than UC (27/36, 75% vs. 27/45, 60%). Mean TBI-VR health costs per person (consultant, GP, therapy, medication) were only £75 greater at 1 year. Secondary outcomes showed no significant baseline differences between groups.Discussion: More TBI-VR participants returned to work than UC. People with moderate/severe TBI benefitted most. This positive trend was achieved without greatly increased health costs, suggesting cost-effectiveness. This study justifies the need for and can inform a definitive Randomized Controlled Trial (RCT).

Examination of Veterans Affairs Disability Compensation as a Disincentive for Employment in a Population-Based Sample of Veterans Under Age 65

Concerns that disability benefits may create disincentives for employment may be especially relevant for young American military veterans, particularly veterans of the recent wars in Iraq and Afghanistan who are facing a current economic recession and turning in large numbers to the Department of Veterans Affairs (VA) for disability compensation. This study describes the rate of employment and VA disability compensation among a nationally representative sample of veterans under the age of 65 and examines the association between levels of VA disability compensation and employment, adjusting for sociodemographics and health status. Data on a total of 4,787 veterans from the 2010 National Survey of Veterans were analyzed using multinomial logistic regressions to compare employed veterans with two groups that were not employed. Two-thirds of veterans under the age of 65 were employed, although only 36 % of veterans with a VA service-connected disability rating of 50 % or higher were employed. Veterans who received no VA disability compensation or who were service-connected 50 % or more were more likely to be unemployed and not looking for employment than veterans who were not service-connected or were service-connected less than 50 %, suggesting high but not all levels of VA disability compensation create disincentives for employment. Results were similar when analyses were limited to veterans who served in Iraq and Afghanistan. Education and vocational rehabilitation interventions, as well as economic work incentives, may be needed to maximize employment among veterans with disabilities.

Case management vocational rehabilitation for women with breast cancer after surgery: a feasibility study incorporating a pilot randomised controlled trial

BackgroundThere is a paucity of methodologically robust vocational rehabilitation (VR) intervention trials. This study assessed the feasibility and acceptability of a VR trial of women with breast cancer to inform the development of a larger interventional study.MethodsWomen were recruited in Scotland and randomised to either a case management VR service or to usual care. Data were collected on eligibility, recruitment and attrition rates to assess trial feasibility, and interviews conducted to determine trial acceptability. Sick leave days (primary outcome) were self-reported via postal questionnaire every 4 weeks during the first 6 months post-surgery and at 12 months. Secondary outcome measures were change in employment pattern, quality of life and fatigue.ResultsOf the 1,114 women assessed for eligibility, 163 (15%) were eligible. The main reason for ineligibility was age (>65 years, n = 637, 67%). Of those eligible, 111 (68%) received study information, of which 23 (21%) consented to participate in the study. Data for 18 (78%) women were analysed (intervention: n = 7; control: n = 11). Participants in the intervention group reported, on average, 53 fewer days of sick leave over the first 6 months post-surgery than those in the control group; however, this difference was not statistically significant (p = 0.122; 95% confidence interval −15.8, 122.0). No statistically significant differences were found for secondary outcomes. Interviews with trial participants indicated that trial procedures, including recruitment, randomisation and research instruments, were acceptable.ConclusionsConducting a pragmatic trial of effectiveness of a VR intervention among cancer survivors is both feasible and acceptable, but more research about the exact components of a VR intervention and choice of outcomes to measure effectiveness is required. VR to assist breast cancer patients in the return to work process is an important component of cancer survivorship plans.Trial registrationISRCTN29666484

Employment outcomes of adults with cerebral palsy in Taiwan

Purpose: To examine the employment status and determinants of employability for adults with cerebral palsy (CP) in Taiwan. Method: A cross-sectional survey was conducted. Participants were recruited from five main branches of the Cerebral Palsy Association. Two hundred and seventy-nine persons over the age of 18 (M = 26.4, SD = 7.7) with a diagnosis of cerebral palsy participated in the current study. Results: Sixty-four of the 279 participants were employed with an employment rate of 22.9%. Of the 64 employed individuals, 67% worked in an integrated setting, 14% in supported employment, and 19% in sheltered employment. Hierarchical logistic regression analyses indicated that having an older age (odds ratio [OR] = 1.05; 95% confidence intervals [CI]: 1.01–1.10), a diagnosis of ataxia (OR = 3.44; 95% CI: 1.29–9.13), a higher educational attainment (OR = 1.86; 95% CI: 1.09–3.18), a higher mobility function in the community (OR = 1.48; 95% CI: 1.04–2.10), and a higher level of independence in daily activities (OR = 1.60; 95% CI: 1.23–2.09) were associated with an increased odds for employment. Conclusions: The employment rate for adults with CP in Taiwan is low. Age, CP diagnosis, educational attainment, and functional performance are important determinants related to employment outcomes for this group. Further research to validate effective medical and vocational rehabilitation interventions to improve the employability of people with CP in Taiwan is warranted.Implications for RehabilitationWith advances in medical care, the number of adults with CP continues to grow but information about their employment outcomes is often lacking.A low employment rate for adults with CP in Taiwan is found in the current study.Age, CP diagnosis, educational attainment, mobility in the community, and level of independence in daily activities are important determinants related to employment outcomes for this group.

Associations between disability and employment 1 year after traumatic brain injury in a working age population

Objective: To investigate associations between disability and employment 1 year after traumatic brain injury (TBI) using the International Classification of Functioning, Disability and Health (ICF) as a conceptual model.Design and methods: A prospective study including 93 patients with moderate-to-severe TBI (aged 16–55 year). Disability components of the ICF model (impairments, activity limitations and participation restrictions) and personal factors (age, gender, pre-injury employment status) were used as independent variables. The outcome measure was employment at 1 year post-injury categorized into unemployed and employed groups.Results: Personal factors, impairments (brain injury severity, overall trauma severity and number of impaired body functions) and activity limitations (motor and cognitive abilities) accounted for 57% of the variance in employment outcome. Multivariate analyses showed that the probabilities of being employed 1 year post-injury were 95% lower for patients who were unemployed pre-injury (OR = 0.05), 74% lower for those with more severe brain injury (OR = 0.26) and 82% lower for those with more cognitive limitations (OR = 0.18).Conclusion: Rehabilitation professionals should take into account the importance of the ICF model when planning vocational rehabilitation interventions for individuals with TBI and focus on targeting modifiable aspects related to employment outcome, such as the individual's cognitive ability.

Factors associated with the success of a vocational rehabilitation programme for incapacity benefit claimants

ObjectivesImproving fitness for employment in workless individuals with health problems requires effective vocational rehabilitation programmes. This study evaluates the effectiveness of a Condition Management Programme (CMP) in improving the health...

Factors associated with employment among veterans with spinal cord injury

The purpose of the present study was to investigate predictors of competitive employment after a spinal cord injury (SCI) among veterans. This study retrospectively examined return to work after SCI, types of jobs held, and variables that were associated with return to work. The present sample included 238 veterans receiving healthcare at one of several Veteran Affairs Medical Centers. Data were obtained through subject interviews and chart extraction. Subjects were also administered the Veterans RAND 36-Item Health Survey (VR-36), Quick Inventory for Depressive Symptomatology - Self Report (QIDS-SR), and Craig Handicap Assessment Reporting Technique (CHART). Results revealed that 34.5% of our study sample was employed at some point after SCI. Employed subjects had significantly higher scores on two of the CHART subscales (Mobility and Occupation) than unemployed subjects, but there were no significant differences among subjects on the QIDS or the VR-36. Receipt of social security benefits was a significant disincentive for employment, but receipt of Veterans disability benefits was not. Education, gender, ethnicity, level and severity of injury were not significant predictors of employment status after SCI, after controlling for demographic variables. Clinical implications of these findings may be that vocational rehabilitation interventions that focus on rapid re-entry to the workforce using existing skill sets may maximize post-SCI employment.