Systematic Reviews and Meta-Analyses
Discussion
We found three systematic reviews and one meta-analysis looking at employment after SCI. The first of two systematic reviews performed by Trenaman et al. (2014) looked at employment outcomes for people after SCI. The strongest evidence finds that supported employment (Ottomanelli et al. 2012, 2013, 2015) and the use of service dogs (Allen & Blascovich 1996) can improve employment outcomes among people with SCI. The majority of research found in the reviews was observational and predominantly focused on vocational rehabilitation programs. Conclusions drawn from vocational rehabilitation programs may be confounded, as individuals could be self-selecting for these programs (Trenaman et al. 2014). Trenaman et al. (2014) recommend that future studies should aim to identify which components of vocational programs in particular have the greatest influence on employment outcomes.
A systematic review conducted by the same authors (Trenaman et al. 2015) found 20 modifiable and 12 non-modifiable factors that had been investigated in the context of employment following SCI. Education, vocational rehabilitation, functional independence, social support, and financial disincentives were modifiable factors that have been consistently and independently associated with employment outcomes. Researchers recommend that future research should focus on determining which factors have the greatest effect on employment outcomes, so that better intervention research with controls could be conducted (Trenaman et al. 2015).
*Modifiable and non-modifiable factors for employment after SCI are described in more detail in Tables 2 and 3.
Kent and Dorstyn (2014) conducted a meta-analysis to determine if any psychological constructs have effects on employment after SCI. They found moderate to large positive effects across three broad psychological constructs (that could be considered clinically important to employment): affective experience or feelings (weighted effect size – dw=3.16), quality of life (dw=1.06) and life satisfaction (dw=0.70) (Generally, d=0.2, 0.5 and 0.8 are considered to be small, medium and large effects, respectively).
Conclusion
There is level 1 evidence (Trenaman et al. 2014) suggesting that supported employment shows the strongest evidence that it can improve employment outcomes amongst individuals with SCI. Service dogs have also been shown to increase employment.
There is level 1 evidence (Kent & Dorstyn et al. 2014) that 3 psychological constructs: affective experiences, quality of life, and life satisfaction could be considered clinically important in their effects on employment.
