Vocational reintegration following spinal cord injury: expectations, participation and interventions

Abstract

Study design: Survey. Objectives: To explore the process of reintegration in paid work following a traumatic spinal cord injury (SCI), including the role of early expectations of individual patients regarding return to work, indicators of success of job reintegration and a description of reintegration interventions and barriers. Setting: Dutch rehabilitation centre with special department for patients with spinal cord injuries. Methods: Descriptive analysis of data gathered by a mailed questionnaire, which was returned by 57 persons (response 83%) with traumatic SCI, aged 18-60 years, and data of earlier expectations reported by the individual patients during the rehabilitation admission following SCI from 1990 to 1998. Results: Of 49 respondents who were employed at the moment of the SCI, 45% expected to be able to resume work. These positive expectations were associated with a higher educational level. In 67%, return to work was successful. The chance to reintegrate successfully was better if the patient expected to resume work. Logistic regression analysis did not reveal other significant indicators. About one-third of the 49 respondents working preinjury followed vocational retraining, which was successful for most of them so far. In the majority of work situations modifications have been made, such as job adaptations and reduction of working hours. Several unmet needs regarding reintegration interventions were also reported. Conclusions: Positive expectations regarding resumption of work after a SCI are an important indicator of successful reintegration in work. An active role of the rehabilitation team is recommended in drawing up a vocational reintegration plan to prepare the patient, the employer and professionals involved in the reintegration process.

Participation and satisfaction after spinal cord injury: results of a vocational and leisure outcome study

“…[9][10][11][12][13] Factors related to the success of vocational reintegration are age, education level, realistic expectations, preinjury type of job, type of lesion and disease-specific problems and disabilities. 2,4,9,[14][15][16] For those people unable to reintegrate in work, participation in nonvocational activities must also be considered as a successful rehabilitation outcome. Very few studies have described the types of postinjury activities and roles other than traditional employment.…”

“…24 In our previous study on vocational reintegration, a reasonably good job satisfaction was found. 14 Information about the satisfaction with nonvocational activities is rare. 1,2 To improve rehabilitation interventions aimed at a satisfactory participation, it is important to know the perspectives of job reintegration, time use and satisfaction.…”

Prognostic Models for Physical Capacity at Discharge and 1 Year Postdischarge From Rehabilitation in Persons With Spinal Cord Injury

“…3,29 The promising outcomes for subjects with a habit of working indicates the importance of vocational rehabilitation, and clinicians must create and evaluate opportunities for patients to return to employment after discharge from rehabilitation. 45 Foreign subjects tended to have a lower level of different aspects of physical capacity. Not being Dutch negatively predicted strength and its recovery during the year after discharge.…”

“…Further prospective data are needed to establish these proposed explanations. 45 Although there was no significant colinearity between sex and hours of employment, and although both predictors contributed to the explained variance simultaneously, it is difficult to rule out that the predictive effect of employment was mediated through a covariate such as sex. 3,29 The promising outcomes for subjects with a habit of working indicates the importance of vocational rehabilitation, and clinicians must create and evaluate opportunities for patients to return to employment after discharge from rehabilitation.…”

Developing core sets for persons with spinal cord injuries based on the International Classification of Functioning, Disability and Health as a way to specify functioning

“…The typical spectrum of activity limitations and participation restriction relate to mobility such as transfers and locomotion, [15][16][17][18] self-care activities such as bathing, dressing and toileting, 19,20 difficulties in regaining work, maintaining social relationships, participating in leisure activities and being active members of the community. 11,21 Given the activity limitations resulting from SCI, participation restrictions that a person with SCI might experience are highly dependent on environmental factors. 22 For many persons with SCI, barriers in the community are particularly related to mobility equipment and transportation.…”