Hospital- and community-based interventions enhancing (re)employment for people with spinal cord injury: a systematic review

Abstract

Study design: Systematic Review. Objectives: To investigate the effect of interventions enhancing (re)employment following spinal cord injury (SCI). Setting: Studies from multiple countries were included. Methods: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, PsycINFO and SPORTDISCUS databases were searched. Randomized controlled trials (RCTs) and non-randomized studies (NRSs) describing a hospital-or a community-based intervention aiming at employment in a SCI population were selected. Quality appraisal was done using the SIGN methodology, and the quality of evidence was graded using the Grade approach. Data extraction was performed according to the Cochrane Handbook. Employment rate and duration were primary outcomes. Results: Only one RCT, including 201 patients describing an intervention over 1 and 2 years, was of sufficient quality. In this study, the employment rate was 26% after 1 and 31% after 2 years for competitive work, compared with 10% in the treatment as usual-intervention site (TAU-IS) control group and 2% in the treatment as usual observational site (TAU-OS) after 1 and 2 years. Other studies were of low quality and describe higher employment rates from 36 to 100%. Conclusions: Only one RCT was of sufficient quality and showed evidence that a vocational rehabilitation programme based on the principles of supported employment integrated in a multidisciplinary team enhances employment for SCI people. As the vast majority of studies included in this review are of low methodological quality, further research is needed.

Labor Market Integration of People with Disabilities: Results from the Swiss Spinal Cord Injury Cohort Study

“…Most importantly, other factors than demographics and injury-related variables, such as differences in the environment or psychological resources that have not been accounted for in this study, may explain variation in LMP. In order to identify suitable intervention targets for an enhanced LMP of persons with SCI, future empirical and experimental research needs to address modifiable environmental and personal factors in relation to bodily capacity [15, 17, 46–49]. In the comparison of the amount of work performed by employed people from the SCI and the general population, stratification by gender, age group and lesion level yielded small sample sizes in some cases precluding meaningful interpretation.…”

Employment Of People With Disabilities In Romania

“…A multidisciplinary team approach with medical supervision [15,17,18] juridical assistance and social support to surpass obstacles during work reintegration, represent important aspects to overcome the environmental and psychological barriers at the company level [19,20].…”

Mapping Out One’s Own Paths Toward Work: Focus on Experiences of Return to Work After Spinal Cord Injury

“…Evidence for interventions to facilitate RTW after SCI is still scarce (123,124). The interventions given vary in being, for example, vocational, educational, multidisciplinary, and being based at hospital or in community settings.…”

“…The interventions given vary in being, for example, vocational, educational, multidisciplinary, and being based at hospital or in community settings. They also vary in, for example, start, duration, and frequency of intervention (124). Currently, research on RTW after SCI is dominated by two large, western countries.…”

“…Research to facilitate interventions for RTW internationally, as well as development of the RTW process in Sweden (84,85) mainly focuses on the leading causes of sick leave. There is a lack of evidence about how to support RTW after SCI (123,124), and research within this field is dominated by publications generated from a few countries (125,127,128). Because many persons with SCI remain outside the labour market after injury (20)(21)(22), it is important to expand the evidence base for RTW after SCI.…”