Study design: Cross-sectional survey. Objectives: To establish labour market participation figures of persons with spinal cord injury (SCI) living in Switzerland and to investigate determinants and consequences of having paid work. Setting: Community. Methods: A survey among members of the Swiss Paraplegic Association was performed in 2008. Inclusion criteria were: SCI of traumatic or non-traumatic origin, minimum age of 18 years, and living in the community for at least 1 year. A total of 559 persons with SCI returned the questionnaire (response rate 27%), of which 495 (24%) fulfilled the eligibility criteria. Bivariate and logistic regression analyses were performed based on theoretical considerations and relevant determinants found in the literature. Results: Of the respondents of working age, 63.8% were involved in gainful employment. No significant difference between persons with para-and tetraplegia was observed. Logistic regression showed that employment was associated with age, time since onset of SCI, having worked at 2 years after initial rehabilitation, having received vocational counselling, having less pain, more years of education and more perceived importance of work. Working persons achieved a significantly higher total income. The most important reasons to work were not financial, but rather of social nature. Barriers to work were primarily health-related. Conclusions: We found a relatively high employment rate among the studied persons with SCI living in Switzerland. However, because of the low response, it is difficult to generalise this finding.

The understanding and measurement of participation and environmental context in spinal cord injury (SCI) is critically important. However, there is limited understanding of the environment-participation relationship in SCI research. There is little consensus on what is and on how to measure participation and its environmental determinants in the SCI. The objective of this article is to develop a set of International Classification of Functioning, Disability and Health (ICF)-based SCI Participation and Environment Domain Set and measurement instruments that intend to measure those domains. ICF categories from the ICF components of activities and participation and environmental factors based on the comprehensive ICF Core Set for SCI and the ICF Core Set for vocational rehabilitation were merged. Measurement instruments were selected based on published systematic reviews of measurement instruments in SCI. There were 128 ICF categories or domains in total (38 for environmental factors and 90 for activities and participation). There were six measurement instruments on environmental factors and six for participation based on existing systematic reviews. This article presents a domain set that is relevant to conducting research on the social and environmental perspectives, in an effort to understand and measure functioning in SCI (i.e., "SCI participation domain set" and "SCI environment domain set," respectively). The sample of SCI Participation and Environment Measurement Instruments gathered indicate the comprehensiveness and depth of the different domains. Guiding principles on the utilization of these measurement instruments depending on the purpose and design of a research study are highly recommended to investigators.

Study design: Cross-sectional observational study with data from the 2012 community-based survey of the Swiss Spinal Cord Injury Cohort Study. Objectives: To examine the relationships between chronological age, age at injury, secondary health conditions (SHCs) and paid employment. Setting: Community setting in Switzerland. Methods: A total of 1159 individuals of working age (16-63 years for women and 64 years for men) with traumatic or non-traumatic spinal cord injury (SCI) were included in the study. Direct and indirect (via SHCs) effects of chronological age and age at injury on paid employment were tested using a decomposition method for logistic regression models. Results: Both chronological age groups (age 35-49 and 50-63/64 years) and the group with age at injury beyond 40 years showed negative direct effects on employment status. A partial indirect effect (mediation) via chronic pain was found in the group with the highest chronological age (450 years). Furthermore, pressure ulcer, pain and urinary tract infection were negatively related with employment in both models, that is, chronological age and employment and age at injury and employment. Conclusion: Being older and having a higher age at injury directly affects whether an individual is employed. Pain is mediating the relation between chronological age and employment. Furthermore, pressure ulcer, chronic pain and urinary tract infection directly reduce the likelihood to be employed and, therefore, represent important intervention targets in efforts to maintain or engage in employment of individuals with SCI.

Study design: Secondary data analysis of a questionnaire-based, cross-sectional survey in persons with spinal cord injury (SCI) in Switzerland. Objective: To describe the frequency of participation in sport (PiS) and to identify correlates for PiS in persons with SCI in Switzerland. Setting: Community sample Methods: Frequency of PiS was assessed retrospectively for the time before the onset of SCI and the time of the survey using a single-item question. A comprehensive set of independent variables was selected from the original questionnaire. Descriptive statistics, bivariate analyses and ordinal regressions were carried out. Results: Data from 505 participants were analyzed. Twenty independent variables were selected for analyses. PiS decreased significantly from the time before the onset of SCI to the time of the survey (Po0.001). Sport levels were significantly lower in women than men for the time of the survey (Po0.001), whereas no difference was observed before onset of SCI (P ¼ 0.446). Persons with tetraplegia participated significantly less often in sport than persons with paraplegia (Po0.001). Lesion level, active membership in a club, frequency of PiS before the onset of SCI and the subjective evaluation of the importance of sport correlate with PiS. When controlling for gender differences, only the subjective importance of sport for persons with SCI determines PiS, particularly among women. Conclusions: Persons with tetraplegia and women need special attention when planning interventions to improve PiS. Furthermore, the subjective importance of sport is important for PiS, particularly among women, whereas most other factors were only weakly associated with PiS. INTRODUCTIONPersons with spinal cord injury (SCI) are at high risk of developing secondary conditions. The decreased physical capacity caused by the loss of physical functions leads to lower energy expenditure and metabolic changes 1 that contribute to the development of cardiovascular diseases. 2 Furthermore, people with SCI have more psychological disorders than the general population. 3 In this population, a healthy lifestyle, including regular physical activity (PA), plays an important role.In general, the concept of PA comprises work-and householdrelated, as well as leisure-time PAs (LTPAs). The latter includes recreational activities, sport and exercise. Sport in SCI is an effective means to reduce health risks 4 when performed regularly, to improve quality of life and life satisfaction 5 and to increase social integration. 6 To date, only few studies have investigated participation in sport (PiS) and its determinants and correlates. Those existing investigated either LTPA or sport using different assessment instruments. Findings showed that the respective participation levels were low in that sense that 37-50% of persons with SCI did not engage in any LTPA 7,8

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Apart from three pathways leading towards paid employment, our results revealed one pathway that was characterized by permanent unemployment. Individuals facing a pathway of no paid work may benefit from more custom-made vocational follow-up solutions and prolonged job coaching after initial VR.

BackgroundThe high prevalence of rheumatic and musculoskeletal diseases (Ref 1) along with the limited resources allocated to the specialty of rheumatology, has made us think about new models of care. A mixed virtual and face-to-face rheumatology consultation, working together Lo Morant's Health Center (HC) and the Rheumatology Section of Alicante Hospital, began to work in May-2014. (Ref 2).ObjectivesTo analyse the causes of consultation from primary care to rheumatology, the distribution of the pathologies and the way they were resolved.MethodsThe primary care physician (PCP) made a virtual consultation (VC) to the rheumatologist within the electronic record system “Abucasis”. Once a month, the rheumatologist and one of the PCP attended a face-to-face consultation (F2F) in the HC. The same day, a formative-informative session took place in the HC with rheumatologist and PCPs attendance. Variables recorded: Number of patients, VC, F2F, technics performed, diagnosis and attitude. STATISTICAL ANALYSIS: Descriptive variables.ResultsThe period between May-2014 to December-2015 was analysed. 806 consultations (607 VC, 199 F2F, 537 patients), were performed. After VC, 75 patients (13,9%) were referred to specialised rheumatology consultation (SRC), but 280 were resolved (52,1%, 132 mechanical problems (47,1%), 51 osteoporosis (18,2%), 40 tendinitis (14,2%), 12 fibromyalgia (4,3%), 8 microcrystal diseases (2,8%), 5 inflammatory/autoimmune (1,7%), 5 no disease (1,7%), 21 were referred to other speciality (7,5%)). In F2F, 181 patients were attended (33,7%), 21 joint aspiration with microscopic synovial fluid exam, and 104 local injections were performed, 13 patients were referred to other speciality, and 31 were referred to SRC. The final diagnostics of the 106 patients referred to SRC were: 24 mechanical and tendinosus problems (22,8%), 22 chronic arthritis (20,9%), 21 microcrystal diseases (20%), 12 autoimmune diseases (11,4%), 9 severe osteoporosis (8,5%), 2 cancers, 2 no disease, 1 Sudeck atrophy, 1 neuropathy.Comments:VC avoided displacement of 301 patients (280 resolved, 21 referred to appropriate speciality), reducing the lost of working days and displacement costs, and diminishing SRC load. Minor problems (soft tissue and mechanic problems) were usually resolved in F2F of HC, while severe and inflammatory pathologies were mainly referred to SRC, where chronic patients are managed.ConclusionsMixed rheumatology consultation is very effective, avoids unnecessary patients displacements, and makes easier the appropriate level of attendance of pathology. Continuing education in primary care and tight relationship with rheumatologist allowed a better referral of patients, reserving SRC for more severe and complicated situations that required it.ReferencesWHO. The burden of muskuloskeletal conditions at the start of the new millenium. 2003.Vela P et al. Resultados preliminares de un modelo mixto virtual-presencial de consulta de reumatología: una propuesta de cambio de modelo asistencial. XLI Congreso Nacional de la Socie...