Employment trajectories after spinal cord injury: results from a 5-year prospective cohort study.
OBJECTIVE
To identify different employment trajectories in individuals with spinal cord injury (SCI) after discharge from initial rehabilitation and to determine predictors of different trajectories from demographic, injury, functional, and psychological characteristics.


METHODS
Prospective cohort study with baseline measurement at the start of active rehabilitation, a measurement at discharge, and follow-up measurements at 1, 2, and 5 years after discharge.


METHODS
Eight rehabilitation centers with SCI units in The Netherlands.


METHODS
People with acute SCI (N=176), aged between 18 and 60 years at baseline, who completed at least 2 follow-up measurements.


METHODS
Not applicable.


METHODS
Employment was defined as having paid work for ≥ 12 h/wk.


RESULTS
Using latent class growth mixture modeling, 3 distinct employment trajectories were identified: (1) no employment group (22.2%), that is, participants without employment pre-SCI and during 5-year follow-up; (2) low employment group (56.3%), that is, participants with pre-SCI employment and a low, slightly increasing probability of employment during 5-year follow-up; and (3) steady employment group (21.6%), that is, participants with continuous employment pre-SCI and within 5-year follow-up. Predictors of steady employment versus low employment were having secondary education (odds ratio, 4.32; 95% confidence interval, 1.69-11.02) and a higher FIM motor score (odds ratio, 1.04; 95% confidence interval, 1.01-1.06) at discharge.


CONCLUSIONS
Distinct employment trajectories after SCI were identified. More than half of the individuals with SCI had a low employment trajectory, and only one-fifth of the individuals with SCI had a steady employment trajectory. Secondary education and higher functional independence level predicted steady employment.
Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: astriferdiana@gmail.com.
Astri
A
Ferdiana
Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat, Utrecht, The Netherlands; Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, The Netherlands.
Marcel W
MW
Post
Department of Health Sciences and the EMGO+ Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
Trynke
T
Hoekstra
Center for Human Movement Sciences, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Luccas H
LH
van der Woude
Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Jac J
JJ
van der Klink
Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Ute
U
Bültmann
D000328:Adult; D004522:Educational Status; D004651:Employment; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010264:Paraplegia / Q000209:etiology; D011446:Prospective Studies; D011782:Quadriplegia / Q000209:etiology; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation; D013997:Time Factors
Disabled persons; Employment; Prospective/Observational; Rehabilitation; Spinal cord injuries