Socioeconomic outcomes following spinal cord injury and the role of no-fault compensation: longitudinal study

Abstract

Study design: Longitudinal cohort study. Objectives: To estimate socioeconomic and work outcomes over 2 and a half years following spinal cord injury (SCI), and to compare those in receipt of compensation (Accident Compensation Corporation, ACC) and those not. Setting: People admitted to the two spinal units in [2007][2008][2009] in New Zealand, where there is a unique no-fault compensation scheme for injury. Methods: Interviews were conducted at B6, 18 and 30 months after SCI and data collected on pre-SCI and post-SCI health and socioeconomic characteristics. Poisson regression, quantile regression and a linear mixed model regression were used to compare differences in outcomes. Results: Of the 162 eligible people, 118 (73%) participated and 91(77%) were followed to 30 months; 79% received ACC. Median personal income, self-reported standard of living and household income adequacy all fell slightly to 18 months and then stabilized at 30 months. At that time, 49% had returned to paid work. Among those not eligible for ACC, income fell to less than half the ACC group (Po0.006 after adjustment), and return to work was lower (29% versus 54%). Conclusion: The findings that most people retained their economic status and that return to work was relatively high appear to be due to the proportion entitled to the ACC no-fault compensation scheme for injury; with earnings-related compensation, a focus on rehabilitation to work and non-means-tested support services. This situation should mitigate against the downward spiral into poverty and further ill-health.

Integrated services and early intervention in the vocational rehabilitation of people with spinal cord injuries

“…6,18,35 However, comparison of these measures is difficult due to pervasive methodological, sampling and definitional differences throughout the literature. Specific early intervention studies tend to utilise employment rate as the primary outcome measure due to its establishment as the 'gold standard' measure of rehabilitation success.…”

Characterizing the Interrelationships of Prescription Opioid and Benzodiazepine Drugs With Worker Health and Workplace Hazards

“…Some studies show up to 75% lost productivity immediately following injury. 154 This model is supported by four prospective cohort studies (score = II) and 14 other studies (score = III) (Table 2). …”

“…150 Low income has also been found to be associated with PD use. 142,151–154 For example, after filing a claim, progression to long-term use of opioids was more likely to occur among Australian workers in the lower two deciles of socioeconomic index for area (SEIFA) (OR adjusted for injury type and type of opioid = 1.78; 95% CI: 1.51 to 2.10). 142 Among a Norwegian group, persistent opioid use was associated with a number of factors, including receiving a disability pension, not working, being in the lower quartile of income, and having only compulsory education (no more than 10 years).…”

New Zealand’s universal no‑fault accident compensation scheme: Embedding community responsibility

“…The relative disadvantage to people with disabilities that happen not to be covered by the ACC remains a source of grievance for the disability community, and there is no sign at the time of writing that it will be resolved. Cost has always been the sticking point, even though significant costs of sickness are already being paid for through healthcare subsidies and welfare benefits, and in spite of evidence that the ACC rehabilitation model may return to work people with functionally equivalent incapacity more promptly than the social security system (McAllister et al 2013;Paul et al 2013).…”