# Work and Employment Table 3 Modifiable personal / activity and participation factors influencing employment after SCI

Personal

Impact on employment

Study (N)

Study reference

Education / training post-injury

Positive influence on employment:

• higher level of education (high school or above)
• Vocational retraining
• attaining post-secondary education

114

167

152

169

259

1362

1398

1329

192

559

5925

459

20143

234

118

181

181

60

1323

176

353

Castle 1994

Conroy and McKenna 1999

Gunduz et al. 2010

Jang et al. 2005

Krause 2003

Krause and Reed 2009*

Krause et al. 2010*

Kurtaran et al. 2009

Marti et al. 2012

Murphy et al. 2003

Pflaum et al. 2006

Tomassen et al. 2000

van Velzen et al. 2009

Rowell and Connelly 2010

Hilton et al. 2017

Jetha et al. 2014

Ferdiana et al. 2014

Huang et al. 2017

Household Income

Higher household income group had higher vocational satisfaction. The lower income group had greater improvements in vocational satisfaction over the course of the 10-year study.

434

Cao et al. 2014

Secondary health conditions

In 10 papers, secondary health conditions are a barrier to employment (e.g., medical complications, bowel incontinence, pain, depression)

Exception:

Hirsch et al. 2009 (N=620; pain, fatigue, sleep)

Krause et al. 2011 (N=781; health status)

Meade et al. 2011 (N=5925; secondary health conditions)

Matthew et al. 2013 (N=108; pressure ulcers)

Ramakrishnan et al. 2011 (N=84; medical co-morbidities.)

195

1013

781

403

559

103

234

83

219

2986

Anderson and Vogel 2002

Botticello et al. 2012

Hirsch et al. 2009 (psych functioning)

Franceschini et al. 2012

Marti et al. 2012 (pain)

Mann et al. 2013 (pain)

Wehman et al. 2000

Burns et al. 2010 (depression)

Lin et al. 2009 (depression)

Tsai et al. 2014 (catheter indwelling in bladder, pain)

Functional independence

Functional independence increases the likelihood of being employed

Physical function was the most important  in relation to return to work in patients with SCI

195

1013

14620

169

72

109

234

2986

192

2986

167

Anderson and Vogel 2002

Botticello et al. 2012

Cohen et al. 2012

Jang et al. 2005

Ramakrishnan et al. 2011 (personal care)

Tomssen et al. 2000

Tsai et al. 2014

Kurtaran et al. 2009

Tsai et al. 2014

Jeong et al. 2015

Psychological component

(locus of control, values placed on work, expectations)

Positive influence on employment:

• endorsement of gender norms
• internal locus of control
• valuing work
• positive expectations toward work
• positive attributional style (the individual’s propensity to “internalize” positive employment outcomes to his/her own attributes, capabilities or functioning
• personal sense of motivation
• family and rehabilitation professionals serving as extrinsic motivators
• social participation is correlated with wellbeing, decreased anxiety and depression
• subjective wellbeing
• hope and sense of direction
• gaining self confidence
• self-efficacy and secure attachment

83

459

57

109

181

60

30

60

13

44

190

4

84

Burns et al. 2010

Murphy et al. 2003

Schonherr et al. 2004

Wehman et al. 2000

Rowell and Connelly 2010

Murphy et al. 2011

Boyle et al. 2014

Hilton et al. 2017

Ramakrishnan et al. 2016

Reed et al. 2016

Umucu et al. 2016

Willbanks et al. 2015

Blake et al. 2017

Relationship status

Positive influence on employment

• participants in a relationship at the time of injury were 3.5 times more likely to be employed at 2 years post discharge
• married participants

60

461

1323

Hilton et al. 2017

Hwang et al. 2015

Jetha et al. 2014

Social roles

Participating in more social roles had a positive influence on employment for young/middle aged, and older adults

1323

Jetha et al. 2014

Wheelchair skills

People with better wheelchair skills are more likely to return to work.

Manual wheelchair users have higher employment rates than power wheelchair users

118

30

2986

van Velzen et al. 2009

Hastings et al. 2011

Tsai et al. 2014

Activity / participation factor

Impact on employment

Study (N)

Study reference

Sport participation

Participation in organized sports was associated with increased likelihood of employment.

149

Blauwet et al. 2013**

Social participation

Decreased social participation reduces the odds of being employed

3162

Tsai et al. 2017
* These studies are based on data from the National Spinal Cord Injury Statistical Center (NSCISC) in the United States. Generally speaking, two different types of analyses are undertaken (1) retrospective analysis of data in the database (2) a cross-sectional survey that is sent out to individuals identified from the database. Given that the same eligibility criteria are often used for studies relating to work and employment, it is likely that the data from the same individuals are being used for multiple studies.

**The definition of employment varies among different studies. These studies consider full-time students to be unemployed while others include students within the definition of employment.

top