Academic journal article The Journal of Rehabilitation

Return to Work after Spinal Cord Injury

Academic journal article The Journal of Rehabilitation

Return to Work after Spinal Cord Injury

Article excerpt

Introduction

Gainful employment may be an important rehabilitation goal for a person with spinal cord injury (SCI) both psychologically and financially. Unfortunately, most studies of vocational resettlement have reported relatively low rates of employment, usually below 40 percent (Trieschmann, 1980). However, the majority approximately 85 percent) of persons at the time of onset of their injury were relatively youthful and were employed or studying. An examination of the literature may provide an insight into the low rates of employment following the onset of injury.

There have been many studies regarding return to work after SCI, especially in the past 25 years. Yet, it is difficult to be definite about the factors related to vocational outcome after SCI. Most studies differ with respect to sampling procedures and sample characteristics (e.g., age, severity of injury, time of follow-up since onset of injury), methodology and variables associated with vocational outcome. It is also likely that some of these studies have become dated due to legislative, social and economic changes which have altered the conditions in which persons with SCI seek to obtain and maintain employment. Furthermore, earlier studies tended to explain vocational outcomes almost exclusively in terms of the characteristics of persons with SCI. Little attention was given to environmental variables such as employer attitudes, specific cultural biases, financial disincentives to employment and the procedures of rehabilitation agencies (Trieschmann, 1980). However, there has been a growing awareness of the importance of these issues in the SCI literature (De Jong, Branch & Corcoran, 1984; Trieschmann, 1980, 1987).

The purpose of this paper is to explore the available information from recent studies and from other related studies. This paper begins with the findings of studies of the past 10 years and concludes with a discussion of key factors related to vocational outcome. In following this approach, it is intended to draw attention to the need for a broader perspective than can be provided by focusing on a relatively small set of variables to explain or predict outcome. There is not likely to ever be a standard recipe for successful vocational outcome because the personal and environmental factors which determine return to work tend to differ among persons with SCI.

Selection of Evidence

Studies published in the past decade were selected on the basis that they were more likely than earlier studies to reflect topical issues related to vocational resettlement. As most studies were retrospective and were based upon non-random samples, it was decided to concentrate upon studies with a lower limit of 50 respondents who were followed-up for at least 12 months after onset of injury. This meant that some otherwise excellent studies were excluded due to the smallness of the sample (Alfred, Fuhrer & Rossi, 1987; Crisp, 1982; Goldberg & Freed, 1982; Jellinek & Harvey, 1982), brevity of follow-up period (Rohe & Athelstan, 1982) or absence of sufficient information (Ikata, 1987; Jenik, Kuhn & Zach, 1982; Lang, Duff, Hoffman & Koeth, 1980; Sposito, Casalis & Ferraretto, 1984; Sutton et al., 1982). In sum, 12 studies satisfied the essential criteria and are discussed below.

Analysis of Recent Studies

Cook, Bolton & Taparek (1981) obtained a sample of 144 respondents (a 79 percent response rate to a postal questionnaire), 27 percent of whom were women, and had been served by the Arkansas Rehabilitation Service. Women reported greater optimism about their employment prospects than men; spent more time in social activities than men; and were more likely to describe themselves as employed or as homemaker whereas men were more likely to say they were unemployed. Most of those who were employed were satisfied with their jobs. Regardless of their level of injury, most unemployed respondents were pessimistic about their employment prospects due, they felt, to their disabilities and associated medical problems. …

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