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.
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.
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.