This review confirmed low employment rates after SCI. Future research should explore interventions aimed at helping people with SCI to obtain and sustain productive work.

Objectives: To study mortality, cause of death and risk indicators for death in Norwegian patients with spinal cord injury. Design: A cross-sectional study with retrospective data. Subjects: All patients (n=387) with traumatic spinal cord injury admitted to Sunnaas Rehabilitation Hospital, Norway, during the period 1961-82. Methods: Medical records were reviewed retrospectively. Causes of death were collected from Statistics Norway and death certificates. Standardized mortality ratios (SMRs) were calculated for the entire sample and for causes of death. To explore risk indicators for death, a Cox regression model was used. Results: During the observation period, 1961-2002, 142 patients died. The main causes of death were pneumonia/influenza (16%), ischaemic heart diseases (13%) and urogenital diseases (13%). SMR was 1.8 for men and 4.9 for women. Cause-specific SMRs were markedly elevated for urogenital diseases, suicide, pneumonia/influenza, urogenital cancer, and diseases of the digestive system. Risk indicators for death were: higher age at injury, tetraplegia, functionally complete spinal cord injury, pre-injury cardiovascular disease, alcohol or substance abuse and psychiatric diagnosis. Conclusion: The SMRs show that life expectancy is reduced in chronic spinal cord injury in Norway, more for women than for men. Cause-specific SMRs and risk indicators suggest that the high mortality rates after spinal cord injury to a certain degree are related to preventable aetiologies. To maximize longevity in chronic spinal cord injury, more attention must be paid to co-morbidity.

Study design: A cross-sectional study of all patients with traumatic SCI admitted to Sunnaas Rehabilitation Hospital, Norway between 1961 and 1982. Objectives: To assess health-related quality of life (HRQOL) in persons with long-standing traumatic spinal cord injury (SCI) in Norway. Setting: Sunnaas Rehabilitation Hospital, Norway. Methods: Survey data and clinical examination of 165 persons with traumatic SCI of more than 20 years duration. HRQOL was assessed with the Norwegian 36-item short-form social functioning (SF-36) Health Survey. The SF-36 results were compared with Norwegian norm data adjusted to age and gender. Differences in HRQOL between subgroups were studied. Results: The persons with SCI exhibited significantly decreased HRQOL in the subscales for Physical Functioning, Bodily Pain, General Health and Vitality compared to the normal population. There were relatively small differences in HRQOL when comparing persons with paraplegia versus tetraplegia and persons with AIS (ASIA Impairment Scale; ASIA, American Spinal Injury Association) A-C versus D-E. Employed persons reported higher HRQOL compared to unemployed persons. HRQOL of individuals reporting health problems or symptoms was worse than those of individuals reporting no health problems at all. Conclusion: HRQOL is decreased in persons with long-standing SCI and especially in persons with comorbidity conditions.