Personal Factors
Several personal characteristics have been identified as factors which may interfere with the ability to return to the labor market (Anderson et al. 2007; Lidal et al. 2007, Ottomanelli & Lind 2009). Some of these characteristics cannot be modified (e.g. level of injury) while others such as level of education, health status, and work skills can be modified with appropriate and targeted interventions. Tables 2 and 3 identify the non-modifiable personal factors and the modifiable personal and activity/participation factors, respectively, which influence employment after SCI. All of these studies are Level 5 evidence.
Discussion
Several personal characteristics cannot be modified but must be taken into consideration in the assessment of potential (re-)employment after SCI as summarized in table 2. These factors can be divided into 4 categories: 1) demographics, 2) time-related, 3) injury-related, and 4) work/education factors. The evidence of the influence of these factors (level 5) is based on observational studies. Being Caucasian is a demographic factor that favors employment. Male gender has been a strong demographic predictor of employment, but a number of recent studies have shown no significant difference between males and females. However, 3 of the 6 studies showing no significant difference come from the same data source. The interaction between age, age at injury and the duration of injury is very complex making it difficult to determine their individual influence on employment. While the proportion of employed people tends to increase with age (increases up to about 30 years of age and is maintained up to 40 years), younger age at injury and longer duration of injury (up to 20 years post-injury) are better predictors of being employed than age alone. Due to a non-linear effect of age on labor market participation, it is likely that work participation may decrease with increasing age at some point after 40. Hirsch et al. (2009) reports that individuals aged 45-54 were significantly more likely to be employed than those aged 55-64. A more severe injury tends to decrease the probability of employment. A higher level of education seems to be a factor in increasing the probability of employment. Factors related to pre-injury work such as being employed at injury, returning to pre-injury job or holding a job requiring a lower physical intensity tend to positively influence employment.
Conclusion
There is level 5 evidence (see Table 2) that being male, Caucasian, and younger at time of injury; having a longer duration of injury, higher education pre-injury, and 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.
Discussion
Several factors can be modified in the post-injury period to prevent deleterious effects or to increase the likelihood of employment after SCI. These factors are categorized as: 1) education / training, 2) health status, 3) functional independence, 4) psychological issues, 5) wheelchair skills and 6) participation. Secondary health conditions such as pain, depression, spasticity, pressure ulcers, severe urinary tract infections and respiratory problems are likely to limit employment opportunities but this finding should be considered in conjunction with the severity of injury. For example having tetraplegia leads to a higher occurrence of secondary health complications due to larger extent of affectation than paraplegia. The level of education or pursuit of training after SCI remains a key factor that can offset other factors such as the severity of injury. Specifically, a professional degree and work that is not physically demanding increases the likelihood of employment. Some psychological attributes such as an internal locus of control, positive values and expectations regarding work including internalization of positive work outcomes are likely to favor employment. Participation in organized sports may facilitate employment through the building of mentorship/relationships, socialization and self-confidence (Blauwet et al. 2013). Reducing environmental barriers may enhance social participation and facilitate employment status.
Conclusion
There is level 5 evidence (see Table 3) 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.
