title: State vocational rehabilitation services and employment in multiple sclerosis.
abstract: BACKGROUND
  Obtaining and maintaining suitable employment can be a significant challenge for people with multiple sclerosis (MS).
  
  
  OBJECTIVE
  The objective of this article is to identify what vocational rehabilitation (VR) services helped MS clients obtain and maintain employment, after controlling for the effect of demographic covariates and disability-related government benefits.
  
  
  METHODS
  We retrieved data from the Rehabilitation Services Administration (RSA) 911 database in the fiscal year (FY) 2009, and used VR services as predictors to predict employment outcomes of people with MS by hierarchical logistic regression.
  
  
  RESULTS
  A total of 924 out of 1920 MS clients (48.1%) were successfully employed after receiving VR services. Logistic regression analysis results indicated that cash benefits (OR =0.51, p < 0.001) and public medical benefits (OR =0.76, p < 0.01) were negatively associated with employment outcomes, whereas counseling and guidance (OR = 1.68, p < 0.001), job placement assistance (OR = 2.43, p < 0.001), on-the-job supports (OR = 1.62, p < 0.01), maintenance services (OR = 1.59, p < 0.01), and assistive technology services (OR =2.09, p < 0.001) were significant predictors of positive employment outcomes.
  
  
  CONCLUSIONS
  VR services were found to be associated with employment status. MS patients experiencing problems obtaining or maintaining employment should be encouraged to pursue services from state VR agencies.
authors.affiliation: Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, USA.
authors.forename: Chung-Yi
authors.initials: CY
authors.lastname: Chiu
authors.forename: Fong
authors.initials: F
authors.lastname: Chan
authors.forename: Malachy
authors.initials: M
authors.lastname: Bishop
authors.forename: Elizabeth
authors.initials: E
authors.lastname: da Silva Cardoso
authors.forename: John
authors.initials: J
authors.lastname: O'Neill
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015897:Comorbidity; D016208:Databases, Factual; D006233:Persons with Disabilities / Q000534:rehabilitation; D004522:Educational Status; D004651:Employment; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D018868:Insurance, Disability; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology / Q000534:rehabilitation*; D016017:Odds Ratio; D012050:Rehabilitation, Vocational / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: Multiple sclerosis; employment; logistic regression; service delivery; vocational rehabilitation; vocational services