title: Contextual influences on employment of people with dual diagnosis: spinal cord injury and traumatic brain injury.
abstract: OBJECTIVE
  Research into the paid employment of people with spinal cord injury or traumatic brain injury is prevalent; however, little research has examined the factors that may support employment for adults with a concomitant spinal cord injury and traumatic brain injury (dual diagnosis). This study aimed to determine the level of paid employment reported by people with dual diagnosis and to explore contextual factors that supported paid employment.
  
  
  METHODS
  This cross-sectional cohort study recruited 30 participants with dual diagnosis from a specialist spinal rehabilitation unit. Interviews were conducted during the first five years post-rehabilitation discharge to determine level of paid employment and contextual factors that supported employment.
  
  
  RESULTS
  At interview, 47% of participants were in paid employment. Employment type at interview indicated a shift away from more physically intensive jobs. Employed and unemployed participants reported a high level of social support and reported experiencing few physical or attitudinal barriers in their day to day lives. These environmental factors did not differentiate between employed and unemployed participants (z range = -0.98 to -0.17; P value range = 0.33-0.86). The most common facilitator of employment identified by participants was the personal factor - motivation (93% of employed participants).
  
  
  CONCLUSIONS
  When considering the impact of contextual factors on paid employment for people with a dual diagnosis of spinal cord injury/traumatic brain injury, personal factors may be of greater influence than environmental factors. Study participants experienced few physical or attitudinal barriers and reported highly supportive interpersonal relationships.
authors.affiliation: Brain Injury Rehabilitation Service, Westmead Hospital, Sydney, New South Wales, Australia; Moorong Spinal Unit, Royal Rehabilitation Centre Sydney, Albury, New South Wales, Australia.
authors.forename: Claire L
authors.initials: CL
authors.lastname: Boyle
authors.forename: Melissa T
authors.initials: MT
authors.lastname: Nott
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Baguley
authors.forename: Judy L
authors.initials: JL
authors.lastname: Ranka
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000453:epidemiology* / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D004651:Employment; D004777:Environment; D005260:Female; D006801:Humans; D008297:Male; D009788:Occupational Therapy; D012944:Social Support; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000534:rehabilitation*
keywords: ICF; spinal cord injury; traumatic brain injury; work