Quality of Life Outcomes for Veterans With Spinal Cord Injury Receiving Individual Placement and Support (IPS)

Abstract

Background: Individual Placement and Support (IPS) is an evidence-based practice that helps persons with mental and/or physical disabilities, including spinal cord injury, find meaningful employment in the community. While employment is associated with positive rehabilitation outcomes, more research is needed on the impact of IPS participation on non-vocational outcomes, particularly quality of life (QOL). Objective: To identity QOL outcomes experienced with (1) IPS participation and (2) IPS participation leading to employment. Methods: Using a mixed method design, data on quality of life outcomes were collected from 151 interviews and 213 surveys completed by veterans with SCI participating in IPS. Results: At 12 months, participants who obtained competitive employment (CE) and those who did not (no-CE) showed improvement on most measures. In months 12-24, the CE group showed improvements on all study measures while the no-CE group declined on many indices. Statistically significant changes were observed between participants who obtained CE versus no-CE on several measures. Themes were identified from interview data related to productivity and well-being. Productivity themes were (1) contributing to society, (2) earning an income, and (3) maintaining employment. Themes for well-being were (1) mental health/self-confidence, (2) physical health, and (3) goal setting. Themes were associated with IPS participation irrespective of employment outcomes. Conclusion: IPS participants who were competitively employed report consistent improvement in handicap, health-related QOL, and life satisfaction measures across time. Qualitative findings revealed improved QOL outcomes in productivity and well-being for veterans participating in IPS overall, regardless of employment outcomes.

Keywords: handicap; life satisfaction; non-vocational; spinal cord injury; supported employment; veterans; vocational rehabilitation.

Figure 1.

Changes in measures over time for the competitive employment (CE) group. Higher values for CHART, VR36, and SWLS indicate improvement; lower values for PHQ-9 indicate improvement. CHART = Craig Handicap and Reporting Technique; MCS = mental component scale; PCS = physical component scale; PHQ-9 = Patient Health Questionnaire; SWLS = Satisfaction with Life Scale; VR36 = Veterans RAND 36-item health survey. *p ≤ .05.

Figure 2.

Changes in measures over time in the no-competitive employment (no-CE) group. Higher values for CHART, VR36, and SWLS indicate improvement; lower values for PHQ-9 indicate improvement. CHART = Craig Handicap and Reporting Technique; MCS = mental component scale; PCS = physical component scale; PHQ-9 = Patient Health Questionnaire; SWLS = Satisfaction with Life Scale; VR36 = Veterans RAND 36-item health survey. *p ≤ .05.