Employment Trajectories After Spinal Cord Injury: Results From a 5-Year Prospective Cohort Study

Objectives

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.

Design

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.

Setting

Eight rehabilitation centers with SCI units in The Netherlands.

Participants

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

Interventions

Not applicable.

Main Outcome Measure

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