Real-world participation after spinal cord injury: longitudinal associations with return to work and long-term social integration.
Andrea Calderone, Loredana Raciti, Rosaria DE Luca and 4 others
PMID 42517167WHAT IT FOUND
In this US spinal cord injury registry, better mobility, more education and greater life satisfaction went with both working and better social integration, while non-private housing and greater care needs went with worse.
Depressive symptoms tracked with social integration, not employment.
Key findings
01Every 10-point higher CHART mobility score was associated with 56% higher odds of competitive employment (OR 1.56) and a 2.67-point higher social integration score.
02People with a bachelor's degree or higher at injury had almost sixfold the odds of employment compared with those who had not finished high school (OR 5.82) and scored 8.38 points higher on social integration.
03The two outcomes had different correlates: depressive symptoms were associated with lower social integration but not with employment, and pain severity was not associated with social integration once other factors were accounted for.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Observational secondary analysis of registry data. It cannot show cause and effect, and some predictors were recorded at the same interview as the outcome. Complete-case analysis: anyone missing a variable in a model was left out, and missing data were substantial for social integration, mobility, depressive symptoms, life satisfaction and pain, so the analysed samples may differ from the full group in ways the study could not measure. The public-use file removes centre and state identifiers, so results cannot be broken down by site or local policy, and employment after injury depends heavily on local benefit rules, vocational services and labour market conditions that could not be examined. Employment was recorded only as competitive paid work or not. Hours, wages, job quality, workplace accommodations, and unpaid productive roles such as caregiving, homemaking and volunteering are not captured. The CHART Social Integration score overlaps conceptually with marital and contact items and is prone to a ceiling effect, although a separate ceiling analysis kept the same direction. Registry participants come from specialised rehabilitation systems and may not represent everyone living with spinal cord injury, particularly people outside established follow-up networks. The findings apply to the United States rehabilitation, disability benefit and labour market context.
Declared interests
The authors state that they have no conflict of interest with any financial organisation regarding the material discussed. Funding came from the Current Research Funds 2026 of the Italian Ministry of Health.
The easy way to misread this
Do not read this as proof that improving mobility, mood or housing will get someone back to work or reconnect them socially. The data are observational and several predictors were measured at the same interview as the outcome, so the study can only show these things go together. Nor should the lower participation figures for Non-Hispanic Black participants be read as a patient characteristic, since the study cannot separate them from environment, socioeconomic position and access to services.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →