The literature review identified a number of limitations in the existing research including the lack of standardized reporting of employment outcomes and a need for increased consistency in reporting sample characteristics. In addition, there are gaps in the research about people with newly acquired spinal cord injury, particularly regarding the timing of interventions. Implications for Rehabilitation Spinal cord injury has the potential to disrupt a person's career across their lifespan. Employment rate is the gold standard for evaluating employment outcomes. Broader measures of employment, including job retention and hours worked, have potential in evaluating and improving the quality of employment outcomes for this population. Further research with people with newly acquired spinal cord injuries would better support the provision of vocational rehabilitation services earlier in a person's rehabilitation, potentially preserving jobs.

INTRODUCTION:The design was a narrative review. The objective of the study was to investigate the potential for early vocational rehabilitation (VR) interventions for people with spinal cord injury (SCI) in overcoming barriers in returning to work, and to pinpoint factors contributing to effectiveness in early VR intervention for this population. The setting was at Queensland, Australia. MATERIALS AND METHODS: Synthesis of the findings of a literature search of online databases ProQuest and CINAHL, using keywords relating to the employment situation and VR of people with SCI. Themes were identified and analysed in accordance with the research objectives. RESULTS: Despite increasing government commitment to the workforce and social participation of people with disabilities, Australians living with SCI have significantly diminished employment outcomes compared with the general population. Current VR approaches usually do not commence until some months post discharge, potentially missing a window of opportunity to preserve pre-existing employment or assist in vocational decision making. The review found that there are opportunities for enhancing VR service provision following SCI, namely integrating the VR programme within the primary rehabilitation team thus facilitating early VR intervention. DISCUSSION: Emerging evidence shows promising results for early intervention in VR; however, questions remain regarding ideal intervention approaches, and it is clear that further empirical investigation is required to support the use of early intervention models post SCI. The study was sponsored by Motor Accident Insurance Commission (MAIC).

BACKGROUND: Emerging vocational rehabilitation services for people with spinal cord injury seek to fill the gap between hospital and community services, and preserve jobs before they are lost. This is consistent with the longstanding notion within disability management and workers' compensation of 'occupational bonding', or the relationship between the person and their employer. Despite the importance of this factor, there is little research underpinning the concept of occupational bonding specifically. OBJECTIVE: To analyse the extant literature about vocational rehabilitation after spinal cord injury to summarise the evidence for the concept of occupational bonding after SCI. METHODS: A systematic review combined with a narrative synthesis of the literature. RESULTS: Evidence supported workplace-based social support, particularly from the employer, as being a key facilitator of return to work. There was also evidence of an intrinsic, values-based component describing the person's bond to the world of work in general. CONCLUSION: Reinforcing the employer and co-workers during return to work after a lengthy absence could facilitate employment outcomes. The person's intrinsic bond to the world of work may also be reinforced by the vocational rehabilitation professional during the often lengthy rehabilitation period following a spinal cord injury.