Employment after spinal cord injury in the United States: predictors and barriers.
Georgios Theotokatos, Cristina Sadowsky, Shannon Inches and 4 others
Among US adults with spinal cord injury, 67.7% were in paid work.
The unemployed most often cited transportation as the barrier (82.5%), and about 70% said they wanted to work. Not receiving disability benefits was the strongest factor associated with being employed.
Key findings
167.7% of participants were in paid work at the time of the survey. In the final regression model, not receiving a disability pension was the strongest factor associated with employment (OR 16.72, 95% CI 5.122 to 54.566, p < 0.001).
2Among the unemployed, 82.5% cited insufficient transportation as a barrier, 33.8% cited fear of losing disability benefits, and 11.3% cited lack of workplace accessibility. About 70% of the unemployed said they wanted to work.
3Those 0 to 4 years post-injury had substantially lower odds of employment compared to those injured 25 or more years ago (OR 0.044, p = 0.004).
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What it does not show
The study is a one-time snapshot, so it cannot show that any factor causes unemployment or that removing a barrier would increase employment. Participants were recruited through rehabilitation hospitals and similar settings, so they were more connected to services than the average person with SCI in the US, which likely inflates the 67.7% employment rate compared to the 20-40% range the authors cite from other US studies. The unemployed subgroup had only 41 people, and the model included many predictors for that number, which raises the risk of overfitting. The confidence intervals around some estimates, particularly the disability benefit association (5.122 to 54.566), are wide, so the precise size of the effect is uncertain.
Declared interests
The authors declared that no financial support was received for the research, authorship, or publication of this article.
The easy way to misread this
Do not read the 16-fold association with disability benefits as proof that benefits cause unemployment. This is a cross-sectional snapshot, so the direction of the relationship cannot be established. The 67.7% employment rate is also higher than the 20-40% range the authors cite from other US studies, likely because participants were recruited through rehabilitation hospitals and any paid work counted, not just full-time competitive employment.
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