Vocational reintegration following spinal cord injury:expectations, participation and interventions

Study design: Survey.Objectives: To explore the process of reintegration in paid work following a traumatic spinal cord injury (SCI), including the role of early expectations of individual patients regarding return to work, indicators of success of job reintegration and a description of reintegration interventions and barriers.Setting: Dutch rehabilitation centre with special department for patients with spinal cord injuries.Methods: Descriptive analysis of data gathered by a mailed questionnaire, which was returned by 57 persons ( response 83%) with traumatic SCI, aged 18 - 60 years, and data of earlier expectations reported by the individual patients during the rehabilitation admission following SCI from 1990 to 1998.Results: Of 49 respondents who were employed at the moment of the SCI, 45% expected to be able to resume work. These positive expectations were associated with a higher educational level. In 67%, return to work was successful. The chance to reintegrate successfully was better if the patient expected to resume work. Logistic regression analysis did not reveal other significant indicators. About one-third of the 49 respondents working preinjury followed vocational retraining, which was successful for most of them so far. In the majority of work situations modi. cations have been made, such as job adaptations and reduction of working hours. Several unmet needs regarding reintegration interventions were also reported.Conclusions: Positive expectations regarding resumption of work after a SCI are an important indicator of successful reintegration in work. An active role of the rehabilitation team is recommended in drawing up a vocational reintegration plan to prepare the patient, the employer and professionals involved in the reintegration process.