Work participation following spinal cord injury

Spinal cord injury (SCI) results in severe physical impairments and limitations. This has an impact on all aspects of life including work participation. Work participation is beneficial for people with SCI and society. Nevertheless, it remains underexposed in rehabilitation and work participation rates for people with SCI are low (approximately 38% worldwide). Vocational rehabilitation (VR) aims at optimizing work participation, however the ingredients of successful VR remain unclear. The overarching aim of this thesis was to contribute to optimal VR for people with SCI. This aim was achieved by performing different research studies. A systematic review looking into what VR programs have already been described in literature, concluded that a programme based on the principles of supported employment enhanced employment. An international survey concluded that VR systems and practices, but not barriers, differed among centers in multiple countries. A multicentre, cross-sectional study concluded that age, gender, relationship, education, time since injury and self-reported pain-related work limitations showed a relationship with work participation; different types of pain, however, were unrelated. To measure vocational functioning a comprehensive valid instrument is warranted. The measurement properties of the Work Rehabilitation Questionnaire (WORQ), were investigated in people with physical disabilities. Internal consistency and test–retest reliability were good. A mixed methods study, however, showed that the content validity of the WORQ without SCI-specific additional items is insufficient for people with SCI. The evidence and ideas that rose from this PhD provide a background for describing a possible best practice VR intervention and further research