Occurrence and predictors of employment after traumatic spinal cord injury: the GISEM Study

• Published in: Spinal cord Vol. 50; no. 3; pp. 238 - 242
• Main Authors: Franceschini, M, Pagliacci, M C, Russo, T, Felzani, G, Aito, S, Marini, C
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-03-2012; Nature Publishing Group
• Subjects: Adult; Anatomy; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Cerebrospinal fluid. Meninges. Spinal cord; Employment - statistics & numerical data; Female; Follow-Up Studies; Forecasting; Human Physiology; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Italy; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurochemistry; Neurology; Neuropsychology; Neurosciences; original-article; Prospective Studies; Quality of Life; Residence Characteristics; Spinal Cord Injuries - economics; Spinal Cord Injuries - psychology; Spinal Cord Injuries - rehabilitation; Traumas. Diseases due to physical agents; Young Adult; Italy; spinal cord injury; rehabilitation; employment; Nervous system diseases; Vertebral canal; Spinal cord trauma; Central nervous system disease; Rehabilitation; Spinal cord disease
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/sc.2011.131

Study design:
Multicenter, prospective study.
Objectives:
To assess the occurrence and predictors of return to work after traumatic spinal cord injury (SCI).
Setting:
Italian rehabilitation centers.
Methods:
We evaluated patients previously included in the Italian Group for the Epidemiological Study of Spinal Cord Injuries study. A standardised telephone interview was used to collect data after a mean follow-up of 3.8 years. The main outcome measure was employment at the end of follow-up.
Results:
A total of 403 patients, 336 men and 67 women, with a mean age of 41.8±16.3 years, were included in the follow-up. In all, 42.1% of patients were employed at the moment of the interview, though 62% reported a worsening in their employment level. Predictors of employment were education (
P
<0.0001), bowel continence (
P
=0.02), independence in mobility (
P
=0.0004), ability to drive (
P
<0.0001), participating in the community (
P
=0.0001) and ability to live alone (
P
<0.0001) while age (
P
<0.0001), being married (
P
<0.0001), tetraplegia (
P
=0.03), occurrence of recent medical problems (
P
=0.002), re-hospitalization (
P
=0.02), presence of architectonic barriers (
P
=0.009) and having a public welfare subsidy (
P
<0.0001), predicted unemployment. On the basis of multivariate analysis, younger age, education, absence of tetraplegia, ability to drive, ability to live alone, previous employment were independent predictors of employment after SCI. Employment at follow-up was related to several indicators of quality of life.
Conclusion:
Employment after SCI was rather frequent and was related to several patient characteristics and social factors. Specific interventions on the patient and on the social environment may favor employment after SCI and improve quality of life.