Vocational rehabilitation and return to work after spinal cord injury: a scoping review of policies in the U.S. and Canada.
Georgios Theotokatos, Patrick Reardon, Jiaqi Chen and 3 others
PMID 42339052WHAT IT FOUND
Supported employment (IPS) outperformed traditional vocational counseling for SCI return to work, with a 43.2% competitive employment rate.
The biggest barrier in both the U.S. and Canada is fear of losing disability benefits and healthcare coverage.
Key findings
01Supported employment (IPS) was associated with better employment outcomes than traditional vocational counseling. A 24-month IPS program for veterans achieved a 43.2% competitive employment rate, and job development and placement were linked to employment while general vocational counseling was linked to unemployment.
02Fear of losing disability benefits and healthcare coverage was a major barrier to return to work in both countries. SSDI/SSI beneficiaries were less likely to be rehabilitated (55.6%) than non-beneficiaries (71.4%), and in Canada, complex income support systems deter return to work because earnings above a threshold risk losing prescriptions and dental care.
03Only one of the ten included studies was from Canada, compared to nine U.S.-focused studies, which the authors identify as a major gap in peer-reviewed evidence on Canadian disability and employment policies.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Only 10 studies were included, with highly heterogeneous designs (RCTs, case studies, qualitative interviews, retrospective analyses) and sample sizes ranging from 3 to 619,859, making direct comparison difficult. Only one study was from Canada, so the cross-national comparison the title promises is severely limited. Grey literature was excluded, which the authors acknowledge is often important for policy-oriented reviews. The Google Scholar search was constrained by a 256-character query limit. The protocol was not pre-registered. Participants in the included studies were predominantly male (up to 97% in some studies), so findings may not generalize to women with SCI. The authors themselves note that the evidence base is small and heterogeneous and that policy implications should be interpreted with caution.
Declared interests
The authors declared that no financial support was received for the work or its publication.
The easy way to misread this
Do not read the 43.2% IPS employment rate as a generalizable effect of supported employment. It comes from a single longitudinal study of veterans, and the review as a whole rests on only 10 heterogeneous studies, 9 of them U.S.-based. The authors themselves call the evidence base small and preliminary, and the Canadian side of the comparison is based on a single study.
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 →