title: Hospital- and community-based interventions enhancing (re)employment for people with spinal cord injury: a systematic review.
abstract: METHODS
  Systematic Review.
  
  
  OBJECTIVE
  To investigate the effect of interventions enhancing (re)employment following spinal cord injury (SCI).
  
  
  METHODS
  Studies from multiple countries were included.
  
  
  METHODS
  MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, PsycINFO and SPORTDISCUS databases were searched. Randomized controlled trials (RCTs) and non-randomized studies (NRSs) describing a hospital- or a community-based intervention aiming at employment in a SCI population were selected. Quality appraisal was done using the SIGN methodology, and the quality of evidence was graded using the Grade approach. Data extraction was performed according to the Cochrane Handbook. Employment rate and duration were primary outcomes.
  
  
  RESULTS
  Only one RCT, including 201 patients describing an intervention over 1 and 2 years, was of sufficient quality. In this study, the employment rate was 26% after 1 and 31% after 2 years for competitive work, compared with 10% in the treatment as usual-intervention site (TAU-IS) control group and 2% in the treatment as usual observational site (TAU-OS) after 1 and 2 years. Other studies were of low quality and describe higher employment rates from 36 to 100%.
  
  
  CONCLUSIONS
  Only one RCT was of sufficient quality and showed evidence that a vocational rehabilitation programme based on the principles of supported employment integrated in a multidisciplinary team enhances employment for SCI people. As the vast majority of studies included in this review are of low methodological quality, further research is needed.
authors: Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium.|Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: E H
authors: EH
authors: Roels
authors: Department of Public Health and Primary Care, Academic Center of General Practice, KU Leuven, Belgium.
authors: B
authors: B
authors: Aertgeerts
authors: Department of Public Health and Primary Care, Center for Health Services and Nursing Research, KU Leuven, Belgium.
authors: D
authors: D
authors: Ramaekers
authors: Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium.|Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Belgium.
authors: K
authors: K
authors: Peers
mesh_terms: D004651:Employment; D006761:Hospitals; D006801:Humans; D012050:Rehabilitation, Vocational / Q000379:methods*; D012111:Residence Characteristics; D013119:Spinal Cord Injuries / Q000523:psychology / Q000534:rehabilitation*