Predictors of return to work 5 years after discharge for wheelchair-dependent individuals with spinal cord injury

Objectives: To examine the employment situation and predictors of return to work for individuals with spinal cord injury 5 years after discharge from inpatient rehabilitation. Design: Prospective cohort study. Subjects: A total of 114 subjects who were employed before the injury and who completed a 5-year follow-up. Methods: Work was defined as having paid work ≥ 1 h/week or ≥ 12 h/week. Predictors of return to work were identified using logistic regression analysis. Demographic, injury-related, pre-injury work factors and self-efficacy were measured at the start of rehabilitation and at discharge. Results: Return to work rates for ≥ 1 and ≥ 12 h/week were 50.9% and 42.6%, respectively. Median time to return to work was 13 months. Compared with before injury, participants worked for fewer hours per week and had occupations of lower physical intensity. The majority had a supplementary income. Those who returned to work were financially better-off than those who did not. Only 40% of participants received return to work support. A high/middle level occupation was associated with higher odds of return to work ≥ 1 h/week (odds ratio (OR) = 2.39, 95% confidence interval (95% CI) = 1.07-5.30). Low physical intensity of pre-injury occupation was significantly associated with higher odds of return to work ≥ 1 h/week (OR = 3.01, 95% CI = 1.31-6.91) and ≥ 12 h/week (OR = 2.67, 95% CI = 1.18-5.96). After adjustment for potential confounders, these associations were no longer significant. Conclusion: Return to work after spinal cord injury was relatively high in this study, but entailed considerable changes in the employment situation, especially reduced working hours and less physically intense occupations. Rehabilitation interventions should enhance the skills and qualifications of individuals with physically-demanding pre-injury work in order to improve access to suitable jobs after spinal cord injury. Interventions should focus not only on return to work, but also on the quality of employment, including opportunities to pursue full-time work.