Return to work after traumatic spinal fractures and spinal cord injuries: a retrospective cohort study

Abstract

This study aimed to determine the factors associated with return to work (RTW) after traumatic spinal fracture and spinal cord injury. It provided a predictive model for RTW among patients with spinal fractures and spinal cord injury and determined important factors influencing the time to RTW after injury. A retrospective cohort study was conducted in Poursina Tertiary Hospital, Guilan, Iran between May 2017 and May 2020. Patients aged 18 to 65 who were hospitalized with traumatic spinal fractures and spinal cord injuries were included. Demographic and clinical data were collected from the National Spinal Column/Cord Injury Registry of Iran (NSCIR-IR). A researcher-administered questionnaire was used through a telephone interview to obtain complementary data on social and occupational variables. Kaplan–Meier survival analysis was used to estimate the average time to RTW and the predictors of RTW were determined by multivariate Cox regression model. Of the 300 patients included, 78.6% returned to work and the average time to RTW was about 7 months. The mean age of the participants was 45.63 ± 14.76 years old. Among the study variables, having a Bachelor’s degree (HR 2.59; 95% CI 1.16–5.77; P = 0.019), complications after injury (HR 0.47; 95% CI 0.35–0.62; P = 0.0001), full coverage health insurance (HR 1.73; 95% CI 1.10–2.72; P = 0.016), opium use (HR 0.48; 95% CI 0.26–0.90; P = 0.023), number of vertebral fractures (HR 0.82; 95% CI 0.67–0.99; P = 0.046), and length of hospital stay (HR 0.95; 95% CI 0.93–0.98; P = 0.001) were found to be significant in predicting RTW in Cox regression analysis. Our analysis showed that wealthier people and those with high job mobility returned to work later.