title: The experience of attempting to return to work following spinal cord injury: a systematic review of the qualitative literature.
abstract: OBJECTIVE
  This review sought to answer the question "What are the barriers and facilitators influencing people's experience of return to work following spinal cord injury?"
  
  
  METHODS
  Studies that met the selection criteria were identified, presented and critically appraised using National Institute for Health and Care Excellence guidelines. Thematic synthesis was completed with studies possessing strong methodological rigor. Synthesis and interpretation involved three stages; coding of primary data; development of descriptive themes reflective of the primary data; and establishment of analytical themes to answer the review question.
  
  
  RESULTS
  Data from nine papers were included in the thematic synthesis. Several descriptive themes and three analytical themes were drawn from the data to answer the research question. Analytical themes included: a matrix of personal and environmental factors exists requiring complex navigation in order to create possibilities and opportunities for postinjury employment; the process of seeking or gaining employment shares a reciprocal relationship with the temporal nature of adjustment to spinal cord injury; and there is an intrinsic need for occupational engagement through paid employment.
  
  
  CONCLUSIONS
  Returning to or gaining employment after spinal cord injury is a fundamentally difficult experience for people. Multiple strategies are required to support the navigation of the process. There is, however, a need in people with spinal cord injury, to be a worker, and with that comes the inherent benefits of being employed. Implications for rehabilitation Returning to work should be a significant focus of spinal cord injury rehabilitation. Employment is both possible and health promoting following spinal cord injury. Multiple strategies are required to support people to navigate the return to work process. It is important to be cognizant of the individual motivations for being a worker and the complexity of the adjustment process. Spinal cord injury centers can provide a consistent and supportive framework and culture of positivity about employment after spinal cord injury.
authors.affiliation: a Department of Occupational Therapy , Central Queensland University , Melbourne , Australia.|b Victorian Spinal Cord Service , Austin Health , Melbourne , Australia.
authors.forename: Gillean
authors.identifier: http://orcid.org/0000-0002-1551-0914
authors.initials: G
authors.lastname: Hilton
authors.affiliation: a Department of Occupational Therapy , Central Queensland University , Melbourne , Australia.|c School of Health and Welfare , Jönköping University , Jönköping , Sweden.|d School of Occupational Therapy , Curtin University , Perth , Australia.|e School of Public Health La Trobe University , Melbourne , Australia.
authors.forename: Carolyn
authors.identifier: http://orcid.org/0000-0001-6430-2823
authors.initials: C
authors.lastname: Unsworth
authors.affiliation: e School of Public Health La Trobe University , Melbourne , Australia.
authors.forename: Gregory
authors.initials: G
authors.lastname: Murphy
mesh_terms: D004651:Employment / Q000523:psychology*; D006801:Humans; D010549:Personal Satisfaction; D062707:Return to Work; D013119:Spinal Cord Injuries / Q000523:psychology*
keywords: Employment; return to work; spinal cord injury; systematic review