Article Text


325 5-year trajectories of employment in people with spinal cord injury
  1. A Ferdiana1,
  2. Post2,
  3. Hoekstra3,
  4. van der Klink1,
  5. Bultmann1
  1. 1Groningen, The Netherlands
  2. 2De Hoogstraat, Utrecht, The Netherlands
  3. 3Department of Epidemiology and Biostatistics Vrije University, Amsterdam, The Netherlands


Objectives To identify the employment rate over time, to examine employment trajectories and to determine the predictors of distinct employment trajectories in a cohort of people with spinal cord injury (SCI) in The Netherlands.

Methods The study population consisted of 179 participants from eight rehabilitation centres who had acute SCI, were 18–65 years old, wheelchair dependent, and able to understand Dutch. At the start of rehabilitation, socio-demographics (age, gender, education), pre-injury occupation (level and physical intensity), injury-related factors (age at onset, neurological level and motor completeness), and functional status were measured. Employment status was defined as “≥1 hour of paid work/week”. Follow-up measurements were conducted 1, 2 and 5 years after discharge. Employment trajectories were modelled with longitudinal latent class analysis. Determinants of distinct trajectories were identified using multivariable logistic regressions.

Results The employment rate was 79.5% before injury, 28.2% 1 year, 35.1% 2 year and 44.8% 5 year after discharge. Three distinct employment trajectories were identified: 1) never-worked (N = 35; 20%), those who did not work pre- and post-injury, 2) slow return to work (RTW) (N = 56; 30.9%), those who worked pre-injury and had a slow RTW, and 3) fast RTW (N = 88: 49.1%), those who worked pre-injury and had a fast and sustained RTW. Compared to participants with slow RTW, those with fast RTW had a higher functional status (OR = 1.07, 95% CI = 1.02–1.12) and a pre-injury occupation with low physical intensity (OR = 9.83, 95% CI = 2.27–42.57). The model explained 43% of the variance in RTW trajectory.

Conclusion The employment rate increased over time after discharge. Three distinct employment trajectories were identified. Predictors of fast RTW were higher functional status and pre-injury occupation with low physical intensity. Future research should focus on identifying environmental factors that may contribute to a favourable RTW trajectory.

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