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Employment Among People With Spinal Cord Injury in 22 Countries Across the World: Results From the International Spinal Cord Injury Community Survey

  • Marcel W. Post
    Correspondence
    Corresponding author Marcel W. Post, PhD, Center of Excellence for Rehabilitation Medicine, De Hoogstraat Rehabilitation, Rembrandtkade 10, 3583TM Utrecht, The Netherlands.
    Affiliations
    University of Groningen, University Medical Center Groningen, Center for Rehabilitation Medicine, Groningen, The Netherlands

    Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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  • Jan D. Reinhardt
    Affiliations
    Institute for Disaster Management and Reconstruction, Sichuan University and Hong Kong Polytechnic University, Chengdu, China

    Swiss Paraplegic Research, Nottwil, Switzerland

    Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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  • Mercè Avellanet
    Affiliations
    Research Group in Health Sciences and Health Services, University of Andorra, Sant Julià Lòria, Andorra

    Rehabilitation Department, Hospital Nostra Sra de Meritxell, Escaldes-Engordany, Andorra
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  • Reuben Escorpizo
    Affiliations
    Swiss Paraplegic Research, Nottwil, Switzerland

    Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT
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  • Julia P. Engkasan
    Affiliations
    Department of Rehabilitation Medicine, University of Malaya, Kuala Lumpur, Malaysia
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  • Urban Schwegler
    Affiliations
    Swiss Paraplegic Research, Nottwil, Switzerland

    Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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  • Author Footnotes
    ∗ The members of the InSCI group are: James Middleton, John Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical School, The University of Sydney, Sydney, Australia; Linamara Battistella, School of Medicine, University of São Paulo, São Paulo, Brazil; Jianan Li, Department of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China; Brigitte Perrouin-Verbe, University Hospital of Nantes, St Jacques Hospital, Nantes, France; Christoph Gutenbrunner, Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany; Christina-Anastasia Rapidi, Department of Physical and Rehabilitation Medicine, General Hospital “G. Gennimatas,” Athens, Greece; Luh Karunia Wahyuni, Medicine and Rehabilitation Department, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Mauro Zampolini, Department of Rehabilitation, San Giovanni Battista Hospital, Foligno, Perugia, Italy; Eiichi Saitoh, Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan; Bum Suk Lee, Department of Rehabilitation Medicine, National Rehabilitation Center and Hospital, Seoul, Korea; Alvydas Juocevicius, Rehabilitation, Physical and Sport Medicine Center Department of Vilnius University Hospital Santariskiu Klinikos, Medical Faculty Vilnius University, Vilnius, Lithuania; Nazirah Hasnan, Department of Rehabilitation Medicine, University of Malaya, Kuala Lumpur, Malaysia; Abderrazak Hajjioui, Department of Rehabilitation Medicine, Clinical Neuroscience Laboratory, Faculty of Medicine, Sidi Mohammed Ben Abdallah University, Fez, Morocco; Johan K. Stanghelle, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Oslo, Oslo, Norway; Piotr Tederko, Department of Rehabilitation, First Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland; Daiana Popa, Clinical Rehabilitation Hospital Felix-Spa Bihor County, Oradea, Romania; Conran Joseph, Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa; Michael Baumberger, Swiss Paraplegic Center, Nottwil, Switzerland; Apichana Kovindha, Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
    InSCI
    Footnotes
    ∗ The members of the InSCI group are: James Middleton, John Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical School, The University of Sydney, Sydney, Australia; Linamara Battistella, School of Medicine, University of São Paulo, São Paulo, Brazil; Jianan Li, Department of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China; Brigitte Perrouin-Verbe, University Hospital of Nantes, St Jacques Hospital, Nantes, France; Christoph Gutenbrunner, Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany; Christina-Anastasia Rapidi, Department of Physical and Rehabilitation Medicine, General Hospital “G. Gennimatas,” Athens, Greece; Luh Karunia Wahyuni, Medicine and Rehabilitation Department, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Mauro Zampolini, Department of Rehabilitation, San Giovanni Battista Hospital, Foligno, Perugia, Italy; Eiichi Saitoh, Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan; Bum Suk Lee, Department of Rehabilitation Medicine, National Rehabilitation Center and Hospital, Seoul, Korea; Alvydas Juocevicius, Rehabilitation, Physical and Sport Medicine Center Department of Vilnius University Hospital Santariskiu Klinikos, Medical Faculty Vilnius University, Vilnius, Lithuania; Nazirah Hasnan, Department of Rehabilitation Medicine, University of Malaya, Kuala Lumpur, Malaysia; Abderrazak Hajjioui, Department of Rehabilitation Medicine, Clinical Neuroscience Laboratory, Faculty of Medicine, Sidi Mohammed Ben Abdallah University, Fez, Morocco; Johan K. Stanghelle, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Oslo, Oslo, Norway; Piotr Tederko, Department of Rehabilitation, First Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland; Daiana Popa, Clinical Rehabilitation Hospital Felix-Spa Bihor County, Oradea, Romania; Conran Joseph, Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa; Michael Baumberger, Swiss Paraplegic Center, Nottwil, Switzerland; Apichana Kovindha, Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
    Authors List
  • Annelie Schedin Leiulfsrud
    Affiliations
    Department of Neuro Medicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway

    Spinal Cord Unit, Department of Physical Medicine and Rehabilitation, St Olav’s University Hospital, Trondheim, Norway
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  • Author Footnotes
    ∗ The members of the InSCI group are: James Middleton, John Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical School, The University of Sydney, Sydney, Australia; Linamara Battistella, School of Medicine, University of São Paulo, São Paulo, Brazil; Jianan Li, Department of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China; Brigitte Perrouin-Verbe, University Hospital of Nantes, St Jacques Hospital, Nantes, France; Christoph Gutenbrunner, Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany; Christina-Anastasia Rapidi, Department of Physical and Rehabilitation Medicine, General Hospital “G. Gennimatas,” Athens, Greece; Luh Karunia Wahyuni, Medicine and Rehabilitation Department, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Mauro Zampolini, Department of Rehabilitation, San Giovanni Battista Hospital, Foligno, Perugia, Italy; Eiichi Saitoh, Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan; Bum Suk Lee, Department of Rehabilitation Medicine, National Rehabilitation Center and Hospital, Seoul, Korea; Alvydas Juocevicius, Rehabilitation, Physical and Sport Medicine Center Department of Vilnius University Hospital Santariskiu Klinikos, Medical Faculty Vilnius University, Vilnius, Lithuania; Nazirah Hasnan, Department of Rehabilitation Medicine, University of Malaya, Kuala Lumpur, Malaysia; Abderrazak Hajjioui, Department of Rehabilitation Medicine, Clinical Neuroscience Laboratory, Faculty of Medicine, Sidi Mohammed Ben Abdallah University, Fez, Morocco; Johan K. Stanghelle, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Oslo, Oslo, Norway; Piotr Tederko, Department of Rehabilitation, First Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland; Daiana Popa, Clinical Rehabilitation Hospital Felix-Spa Bihor County, Oradea, Romania; Conran Joseph, Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa; Michael Baumberger, Swiss Paraplegic Center, Nottwil, Switzerland; Apichana Kovindha, Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

      Abstract

      Objectives

      To describe the employment situation of individuals with spinal cord injury (SCI) in 22 countries participating in the International Spinal Cord Injury community survey, to compare observed and predicted employment rates, to estimate gaps in employment rates among people with SCI compared with the general population, and to study differences in employment between men and women.

      Design

      Cross-sectional survey.

      Setting

      Community.

      Participants

      People of employable age (N=9875; 18-64 y) with traumatic or non-traumatic SCI (including cauda equina syndrome) who were at least 18 years of age at the time of the survey, living in the community, and able to respond to one of the available language versions of the questionnaire.

      Interventions

      Not applicable

      Main Outcome Measures

      The observed employment rate was defined as performing paid work for at least 1 hour a week, and predicted employment rate was adjusted for sample composition from mixed logistic regression analysis.

      Results

      A total of 9875 participants were included (165-1174 per country). Considerable differences in sample composition were found. The observed worldwide employment rate was 38%. A wide variation was found across countries, ranging from 10.3% to 61.4%. Some countries showed substantially higher or lower employment rates than predicted based on the composition of their sample. Gaps between the observed employment rates among participants with SCI and the general population ranged from 14.8% to 54.8%. On average, employment rates were slightly higher among men compared with women, but with large variation across countries. Employment gaps, however, were smaller among women for most countries.

      Conclusions

      This first worldwide survey among people with SCI shows an average employment rate of 38%. Differences between observed and predicted employment rates across countries point at country-specific factors that warrant further investigation. Gaps with employment rates in the general population were considerable and call for actions for more inclusive labor market policies in most of the countries investigated.

      Keywords

      List of abbreviations:

      InSCI (International Spinal Cord Injury community survey), SCI (spinal cord injury), TSI (time since onset of injury)
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      • Correction
        Archives of Physical Medicine and RehabilitationVol. 102Issue 11
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          In the authorship listing for the InSCI group in “Describing functioning in people living with spinal cord injury across 22 countries: a graphic modeling approach” ( https://www.archives-pmr.org/article/S0003-9993 (20)30958-8/fulltext) Daniela Utiyama, PhD should be listed in that group in place of Prof. Liniamara Batistella.
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