Effective work reintegration for individuals with SCI is essential because despite their disability, many of these individuals possess the potential to remain or become productive members of society while deriving positive psychosocial benefits at the same time.Many factors that could facilitate return to work are at a level that is beyond the realm of health care. These include changing employer and societal perceptions and attitudes, and lobbying for social change that would include improved transportation (Conroy and McKenna 1999). Eliminating policies to reduce financial disincentives are key to eliminating barriers for those who return to work. Policy change requires a strong lobbying voice and a social will to overcome attitudes and arguments from opponents who may otherwise see provision of funding for personal care attendants and/or worksite modification as a poor investment of resources.
There is level 5 evidence (see Table 1) that being male, Caucasian, and younger at time of injury; having a longer duration of injury, higher education pre-injury; and having a low-intensity pre-injury job are non-modifiable personal factors that positively influence employment opportunities after SCI.
There is level 5 evidence (Hirsch et al. 2009) that the severity of injury is a non-modifiable personal factor that negatively influences employment opportunities after SCI.
There is level 5 evidence (see Table 2) that being married, having education post-injury, having fewer secondary health conditions and higher functional independence, having better work related values and a higher internal locus of control, and better wheelchair skills are modifiable personal factors that positively influence employment opportunities after SCI.
There is level 5 evidence (see Table 4) that financial disincentives has a negative effect on employment post-SCI but financial incentives has a positive effect on employment except for when receiving social security benefits.
There is level 5 evidence (see Table 4) that health insurance, ‘disability discrimination’ and inaccessibility of the workplace are environmental barriers negatively influencing employment after SCI.
There is level 5 evidence (see Table 3) that ability to use transportation independently, ability to use technological devices, and having access to job accommodations positively influencing employment after SCI.
There is level 1b evidence (Allen and Blascovich 1996) that suggests a service dog improves integration and participation in school and employment and decrease the number of hours of paid assistance after the first year.
There is level 2 evidence from two studies (Ottomanelli et al. 2012; Ottomanelli et al. 2013) that suggests that a supported employment intervention improves employment rates compared with treatment as usual over a one-year period, increases the number of hours worked per week and decreases the number of missed hours of work.
There is level 5 (Jellinek and Harvey 1982) and level 4 evidence (Marini et al. 2008) that on-site vocational rehabilitation counselling during inpatient rehabilitation can increase employment rates.
There is level 4 evidence (Marini et al. 2008) that use of job placement services may help individuals with SCI find employment.
There is level 4 evidence (Inge et al. 1998) suggesting that person-centred planning tools facilitate employment.
There is level 4 evidence (King et al. 2004) that case management programs increase return to educational training, but not to work.
There is level 5 evidence (Rowell and Connelly 2010) that an individual’s propensity to internalize positive employment outcomes in relation to his or her capabilities may contribute to returning to work.