title: Barriers and facilitators to employment after spinal cord injury: underlying dimensions and their relationship to labor force participation.
abstract: METHODS
  Cross-sectional survey.
  
  
  OBJECTIVE
  To identify barriers and facilitators to employment after spinal cord injury (SCI) and their relationship with labor force participation.
  
  
  METHODS
  Participants were initially identified through specialty hospitals in the Midwest and Southeastern United States of America. 781 adults with traumatic SCI, at least 1 year post-injury, and between the ages of 18-64, participated. A 30-item instrument on barriers and facilitators to employment was administered. Analyses included exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and comparisons of scores as a function of employment status.
  
  
  RESULTS
  EFA indicated six primary themes (root mean square error of approximation (RMSEA)=0.040), including: (a) resources, (b) health status, (c) disability considerations, (d) lack of importance, (e) disincentives and (f) motivation. CFA indicated an acceptable fit (RMSEA=0.078). Univariate analyses indicated each item and factor was significantly different as a function of labor force participation. After controlling for biographical and injury factors, multinomial logistic regression indicated three factors significantly differentiated those never employed, those currently unemployed but had worked since injury and those currently employed. Those employed reported higher scores for resources and motivation and lower scores for lack of importance.
  
  
  CONCLUSIONS
  Barriers and facilitators were consistently related to labor force participation, with facilitators more highly related to labor force participation than barriers. Although loss of financial and medical benefits (disincentives) as well as health status have been reported as barriers to employment, they were not as highly correlated with labor force participation as were other factors.
authors.affiliation: Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA. krause@musc.edu
authors.forename: J S
authors.initials: JS
authors.lastname: Krause
authors.forename: K S
authors.initials: KS
authors.lastname: Reed
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology / Q000534:rehabilitation*; D004651:Employment / Q000523:psychology / Q000639:trends; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000523:psychology / Q000534:rehabilitation*; D013119:Spinal Cord Injuries / Q000523:psychology / Q000534:rehabilitation*