Employment trajectories after spinal cord injury: results from a 5-year prospective cohort study

Abstract

Objectives: To identify different employment trajectories in individuals with spinal cord injury (SCI) after discharge from initial rehabilitation and to determine predictors of different trajectories from demographic, injury, functional, and psychological characteristics.

Design: Prospective cohort study with baseline measurement at the start of active rehabilitation, a measurement at discharge, and follow-up measurements at 1, 2, and 5 years after discharge.

Setting: Eight rehabilitation centers with SCI units in The Netherlands.

Participants: People with acute SCI (N=176), aged between 18 and 60 years at baseline, who completed at least 2 follow-up measurements.

Interventions: Not applicable.

Main outcome measure: Employment was defined as having paid work for ≥ 12 h/wk.

Results: Using latent class growth mixture modeling, 3 distinct employment trajectories were identified: (1) no employment group (22.2%), that is, participants without employment pre-SCI and during 5-year follow-up; (2) low employment group (56.3%), that is, participants with pre-SCI employment and a low, slightly increasing probability of employment during 5-year follow-up; and (3) steady employment group (21.6%), that is, participants with continuous employment pre-SCI and within 5-year follow-up. Predictors of steady employment versus low employment were having secondary education (odds ratio, 4.32; 95% confidence interval, 1.69-11.02) and a higher FIM motor score (odds ratio, 1.04; 95% confidence interval, 1.01-1.06) at discharge.

Conclusions: Distinct employment trajectories after SCI were identified. More than half of the individuals with SCI had a low employment trajectory, and only one-fifth of the individuals with SCI had a steady employment trajectory. Secondary education and higher functional independence level predicted steady employment.

Keywords: Disabled persons; Employment; Prospective/Observational; Rehabilitation; Spinal cord injuries.