A prospective examination of the impact of a supported employment program and employment on health-related quality of life, handicap, and disability among Veterans with SCI.
OBJECTIVE
To investigate impact of participation in a supported employment program and impact of employment itself on health-related quality of life (HRQOL), disability, and handicap among Veterans with spinal cord injury (SCI).


METHODS
We used a prospective, randomized, controlled, multi-site trial of supported employment (SE) versus treatment as usual (TAU) for vocational issues. Subjects were 157 Veterans with SCI who received either SE or TAU for vocational issues. Outcomes were examined in terms of type of vocational treatment received and whether competitive employment was obtained. Outcomes investigated were HRQOL as measured by the Veterans RAND 36-item health survey (VR-36), handicap as measured by the Craig Handicap Assessment and Reporting Technique (CHART), and disability as measured by the functional independence measure (FIM). Subjects were assessed at baseline and at 3, 6, 9, and 12 months.


RESULTS
There were no significant differences between Veterans who participated in SE compared to those who received TAU in study measures. Participants obtaining competitive employment demonstrated significantly higher scores on the Social Integration, Mobility, and Occupation dimensions of the CHART. There were no observed differences in VR-36 scores or FIM scores for those obtaining competitive employment.


CONCLUSIONS
This study suggests that employment has a positive effect on an individual's ability to participate in social relationships, move about their home and community, and spend time in productive and usual roles. Inability to detect differences across other domains of handicap or any changes in HRQOL may have been due to several factors including level and intensity of employment, insufficient follow-up period, or measurement limitations.
Health Services Research and Development Service (HSR&D) and Rehabilitation Research and Development Service (RR&D) Center of Excellence Maximizing Rehabilitation Outcomes, James A. Haley Veterans' Hospital, 8900 Grand Oak Circle (118M), Tampa, FL, 33637, USA, lisa.ottomanelli@va.gov.
Lisa
L
Ottomanelli
Scott D
SD
Barnett
Lance L
LL
Goetz
D000293:Adolescent; D000328:Adult; D000368:Aged; D006233:Persons with Disabilities / Q000523:psychology / Q000534:rehabilitation; D004651:Employment / Q000458:organization & administration / Q000523:psychology*; D016832:Employment, Supported / Q000458:organization & administration / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult