Advertisement
Archives of Physical Medicine and Rehabilitation
Advanced searchSave search
Original research| Volume 101, ISSUE 12, P2157-2166, December 2020

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
    Search for articles by this author
  • 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
    Search for articles by this author
  • 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
    Search for articles by this author
  • Reuben Escorpizo
    Affiliations
    Swiss Paraplegic Research, Nottwil, Switzerland

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

    Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
    Search for articles by this author
  • 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
    Search for articles by this author
  • 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.
Published:July 12, 2020DOI:https://doi.org/10.1016/j.apmr.2020.05.027
Employment Among People With Spinal Cord Injury in 22 Countries Across the World: Results From the International Spinal Cord Injury Community Survey
Previous ArticleEnvironmental Barriers Experienced by People With Spinal Cord Injury Across 22 Countries: Results From a Cross-Sectional Survey
Next ArticleQuality of Life and the Health System: A 22-Country Comparison of the Situation of People With Spinal Cord Injury

      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)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Meade M.A.
        • Reed K.S.
        • Saunders L.L.
        • Krause J.S.
        It's all of the above: benefits of working for individuals with spinal cord injury.
        Top Spinal Cord Inj Rehabil. 2015; 21: 1-9
        View in Article
        • Leiulfsrud A.S.
        • Ruoranen K.
        • Ostermann A.
        • Reinhardt J.
        The meaning of employment from the perspective of persons with spinal cord injuries in six European countries.
        Work. 2016; 5: 133-144
        View in Article
        • Ottomanelli L.
        • Lind L.
        Review of critical factors related to employment after spinal cord injury: implications for research and vocational services.
        J Spinal Cord Med. 2009; 32: 503-531
        View in Article
        • Organisation for Economic Co-operation and Development 2010
        Sickness, disability and work: breaking the barriers. A synthesis of findings across OECD countries.
        OECD Publications, Paris2010
        View in Article
        • Young A.E.
        • Murphy G.C.
        Employment status after spinal cord injury (1992-2005): a review with implications for interpretation, evaluation, further research, and clinical practice.
        Int J Rehabil Res. 2009; 32: 1-11
        View in Article
        • Bloom J.
        • Dorsett P.
        • McLennan V.
        Investigating employment following spinal cord injury: outcomes, methods, and population demographics.
        Disabil Rehabil. 2019; 41: 2359-2368
        View in Article
        • Anderson C.
        • Ballantine E.
        • Bickenbach J.
        • et al.
        Education and employment.
        in: Bickenbach J. Officer A. Shakespeare T. International perspectives on spinal cord injury. World Health Organization, Geneva2013: 167-194
        View in Article
        • Trenaman L.
        • Miller W.C.
        • Querée M.
        • Escorpizo R.
        • SCIRE Research Team
        Modifiable and non-modifiable factors associated with employment outcomes following spinal cord injury: A systematic review.
        J Spinal Cord Med. 2015; 38: 422-431
        View in Article
        • Leiulfsrud A.S.
        • Solheim E.F.
        • Reinhardt J.D.
        • Post M.W.M.
        • Horsewell J.
        • Biering-Sørensen F.
        • Leiulfsrud H.
        Gender, class, employment status and social mobility following spinal cord injury in Denmark, the Netherlands, Norway and Switzerland.
        Spinal Cord. 2019 Oct 1; ([Epub ahead of print])
        View in Article
        • Stucki G.
        • Bickenbach J.
        The International Spinal Cord Injury Survey and the learning health system for spinal cord injury.
        Am J Phys Med Rehabil. 2017; 96: S2-S4
        View in Article
        • Gross-Hemmi M.H.
        • Post M.W.
        • Ehrmann C.
        • et al.
        Study protocol of the International Spinal Cord Injury (InSCI) Community Survey.
        Am J Phys Med Rehabil. 2017; 96: S23-S34
        View in Article
        • Fekete C.
        • Brach M.
        • Ehrmann C.
        • Post M.W.M.
        • Stucki G.
        Cohort profile of the International Spinal Cord Injury (InSCI) Community Survey.
        Arch Phys Med Rehabil. 2020; (In this issue)
        View in Article
        • Fekete C.
        • Post M.W.
        • Bickenbach J.
        • Middleton J.
        • Prodinger B.
        • Selb M.
        • Stucki G.
        • International Spinal Cord Injury Community Survey (InSCI) Group
        A structured approach to capture the lived experience of spinal cord injury: data model and questionnaire of the International Spinal Cord Injury Community Survey.
        Am J Phys Med Rehabil. 2017; 96: S5-S16
        View in Article
        • International Labour Organization Department of Statistics
        Employment.
        (Available at:)
        https://ilostat.ilo.org/glossary/employment/
        Date accessed: October 23, 2019
        View in Article
        • United Nations Educational, Scientific and Cultural Organization
        International standard classification of education (ISCED).
        UNESCO, Paris1997
        View in Article
        • Lidal I.B.
        • Hjeltnes N.
        • Røislien J.
        • Stanghelle J.K.
        • Biering-Sørensen F.
        Employment of persons with spinal cord lesions injured more than 20 years ago.
        Disabil Rehabil. 2009; 31: 2174-2184
        View in Article
        • Solheim E.F.
        • Leiulfsrud A.S.
        Employment after spinal cord injury in Norway: a cross-sectional survey.
        Scand J Disabil Res. 2018; 20: 197-210
        View in Article
        • Schönherr M.C.
        • Groothoff J.W.
        • Mulder G.A.
        • Eisma W.H.
        Participation and satisfaction after spinal cord injury: results of a vocational and leisure outcome study.
        Spinal Cord. 2005; 43: 241-248
        View in Article
        • Ferdiana A.
        • Post M.W.
        • de Groot S.
        • Bültmann U.
        • van der Klink J.J.
        Predictors of return to work 5 years after discharge for wheelchair-dependent individuals with spinal cord injury.
        J Rehabil Med. 2014; 46: 984-990
        View in Article
        • Marti A.
        • Reinhardt J.D.
        • Graf S.
        • Escorpizo R.
        • Post M.W.
        To work or not to work: labour market participation of people with spinal cord injury living in Switzerland.
        Spinal Cord. 2012; 50: 521-526
        View in Article
        • Reinhardt J.D.
        • Post M.W.
        • Fekete C.
        • Trezzini B.
        • Brinkhof M.W.
        • SwiSCI Study Group
        Labor market integration of people with disabilities: results from the Swiss Spinal Cord Injury Cohort Study.
        PLoS One. 2016; 11e0166955
        View in Article
        • Benavente A.
        • Palazón R.
        • Tamayo R.
        • Morán E.
        • Alaejos J.
        • Alcaraz A.
        Assessment of disability in spinal cord injury.
        Disabil Rehabil. 2003; 25: 1065-1070
        View in Article
        • Franceschini M.
        • Pagliacci M.C.
        • Russo T.
        • Felzani G.
        • Aito S.
        • Marini C.
        Italian Group for the Epidemiological Study of Spinal Cord Injuries. Occurrence and predictors of employment after traumatic spinal cord injury: the GISEM Study.
        Spinal Cord. 2012; 50: 238-242
        View in Article
      24. SCI facts and figures.
        J Spinal Cord Med. 2017; 40: 126-127
        View in Article
        • Carr J.J.
        • Kendall M.B.
        • Amsters D.I.
        • Pershouse K.J.
        • Kuipers P.
        • Buettner P.
        • Barker R.N.
        Community participation for individuals with spinal cord injury living in Queensland, Australia.
        Spinal Cord. 2017; 55: 192-197
        View in Article
        • Rowell D.
        • Connelly L.
        Labour market outcomes for people with a spinal cord injury.
        Econ Hum Biol. 2010; 8: 223-232
        View in Article
        • Murphy G.C.
        • Middleton J.
        • Quirk R.
        • De Wolf A.
        • Cameron I.D.
        Predicting employment status at 2 years' postdischarge from spinal cord injury rehabilitation.
        Rehabil Psychol. 2011; 56: 251-256
        View in Article
        • Bhattarai M.
        • Maneewat K.
        • Sae-Sia W.
        Psychosocial factors affecting resilience in Nepalese individuals with earthquake-related spinal cord injury: a cross-sectional study.
        BMC Psychiatry. 2018; 18: 60
        View in Article
        • Kovindha A.
        People with spinal cord injury in Thailand.
        Am J Phys Med Rehabil. 2017; 96: S120-S123
        View in Article
        • Ramakrishnan K.
        • Chung T.Y.
        • Hasnan N.
        • Abdullah S.J.
        Return to work after spinal cord injury in Malaysia.
        Spinal Cord. 2011; 49: 812-816
        View in Article
        • Xu Y.W.
        • Lam C.S.
        • Tang D.
        Contributors of return to work for a cohort of spinal cord injured workers.
        Chin J Rehabil Theory Pract. 2010; 16: 678-682
        View in Article
        • Kang E.N.
        • Shin H.I.
        • Kim H.R.
        Factors that influence employment after spinal cord injury in South Korea.
        Ann Rehabil Med. 2014; 38: 38-45
        View in Article
        • Nakajima A.
        • Honda S.
        Physical and social condition of rehabilitated spinal cord injury patients in Japan: a long-term review.
        Paraplegia. 1988; 26: 165-176
        View in Article
        • Tomassen P.C.
        • Post M.W.
        • van Asbeck F.W.
        Return to work after spinal cord injury.
        Spinal Cord. 2000; 38: 51-55
        View in Article
        • Roels E.H.
        • Reneman M.F.
        • New P.W.
        • et al.
        International comparison of vocational rehabilitation for persons with spinal cord injury: systems, practices, and barriers.
        Top Spinal Cord Inj Rehabil. 2020; 26: 21-35
        View in Article
        • Berghammer A.
        • Gramm M.
        • Vogler L.
        • Schmitt-Dannert H.H.
        Investigation of the social status of paraplegic individuals after medical rehabilitation.
        Spinal Cord. 1997; 35: 493-497
        View in Article
        • Ville I.
        • Ravaud J.F.
        Work, non-work and consequent satisfaction after spinal cord injury.
        Int J Rehabil Res. 1996; 19: 241-252
        View in Article

      Article info

      Publication history

      Published online: July 12, 2020

      Footnotes

      Disclosures: none.

      Identification

      DOI: https://doi.org/10.1016/j.apmr.2020.05.027

      Copyright

      © 2020 by the American Congress of Rehabilitation Medicine

      ScienceDirect

      Access this article on ScienceDirect

      Linked Article

      • Correction
        Archives of Physical Medicine and RehabilitationVol. 102Issue 11
        • Preview
          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.
        • Full-Text
        • PDF
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX