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      Labour market participation after spinal cord injury. A register-based cohort study

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          Abstract

          Study design

          A register based cohort study.

          Objectives

          To investigate labour market participation following spinal cord injury (SCI) and to describe the impact of personal and SCI characteristics.

          Setting

          Norway.

          Methods

          Persons registered with SCI in the Norwegian SCI registry 2011–2017, and matched reference individuals without SCI from the general population (named controls) were followed for up to six years after injury using national registry data on employment, education, income, and social security benefits. Main measures of labour market participation were: (1) Receiving any amount of pay for work, and (2) Receiving sickness and disability benefits.

          Results

          Among the 451 persons with SCI (aged 16–66 years and working before injury), the estimated percentages receiving pay for work and sickness and disability benefits in the sixth years after injury were 63% (95% CI 57–69) and 67% (95% CI 61–72).

          Corresponding percentages for the controls ( n = 1791) were 91% (95% CI 90–93) for receiving pay for work and 13% (95% CI 12–15) for receiving sickness and disability benefits. Among persons with SCI, less severe neurological outcome, higher level of education, younger age at injury, and a stronger pre-injury attachment to employment (higher employment income, having an employer, less receipt of benefits), were associated with higher labour market participation.

          Conclusion

          SCI substantially decreased labour market participation up to six years after injury compared to matched controls. Even if a relatively large proportion of persons with SCI remained in some degree of work activity, more than half did so in combination with receiving benefits.

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          Most cited references19

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          International standards for neurological classification of spinal cord injury (revised 2011).

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            Register-based follow-up of social benefits and other transfer payments: accuracy and degree of completeness in a Danish interdepartmental administrative database compared with a population-based survey.

            Social consequences of disease may be subject to register based follow-up. A Danish database, DREAM, allows weekly follow-up of any public transfer payment. This study aimed to evaluate the feasibility of the register for use in public health research. The DREAM database includes information on all public transfer payments administered by Danish ministries, municipalities, and Statistics Denmark for all Danish citizens on a weekly basis since 1991. The DREAM database was compared with self-reported information on sources of income in a population survey from 2001 with about 5000 participants. According to DREAM, 80.2% of respondents had received some kind of transfer income since 1991. For the week they filled in the questionnaire, 9.0% had a record of labour-market-related benefit (unemployment benefit, social assistance, wage subsidy), 6.4% a health-related benefit (sickness benefit, vocational rehabilitation allowance, salary from subsidized jobs for persons with limited work capacity, anticipatory pension), 10.1% a voluntary retirement pension, while 74.4% had no record of transfer payment for that week. The predictive value of DREAM was 74.8% for health-related transfer payment and 98.2% for self-support. Among persons with a record of sickness benefit, 52.4% reported no transfer payment. The DREAM database is feasible for follow-up of social and economic consequences of disease. Respondents may be unaware of payments transferred by the public authorities to the employer, and in such cases DREAM may be the best source of information. The database is useful for public health research, but may also be useful for socioeconomic analyses of selection bias and dropout from other studies.
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              Return to work following spinal cord injury: a review.

              To review literature on return to work (RTW) and employment in persons with spinal cord injury (SCI), and present employment rates, factors influencing employment, and interventions aimed at helping people with SCI to obtain and sustain productive work. A systematic review for 2000 - 2006 was carried out in PubMed/Medline, AMED, (ISI) Web of Science, EMBASE, CINAHL, PsycInfo and Sociological abstracts database. The keywords 'spinal cord injuries', 'spinal cord disorder', 'spinal cord lesion' or 'spinal cord disease' were cross-indexed with 'employment', 'return to work', 'occupation' or 'vocational'. Out of approximately 270 hits, 110 references were used, plus 13 more found elsewhere. Among individuals with SCI working at the time of injury 21 - 67% returned to work after injury. RTW was higher in persons injured at a younger age, had less severe injuries and higher functional independence. Employment rate improved with time after SCI. Persons with SCI employed ranged from 11.5% to 74%. Individuals who sustained SCI during childhood or adolescence had higher adult employment rates. Most common reported barriers to employment were problems with transportation, health and physical limitations, lack of work experience, education or training, physical or architectural barriers, discrimination by employers, and loss of benefits. Individuals with SCI discontinue working at younger age. This review confirmed low employment rates after SCI. Future research should explore interventions aimed at helping people with SCI to obtain and sustain productive work.
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                Author and article information

                Contributors
                Annette.Halvorsen@stolav.no
                Journal
                Spinal Cord
                Spinal Cord
                Spinal Cord
                Nature Publishing Group UK (London )
                1362-4393
                1476-5624
                30 January 2023
                30 January 2023
                2023
                : 61
                : 4
                : 244-252
                Affiliations
                [1 ]GRID grid.52522.32, ISNI 0000 0004 0627 3560, Clinic of Physical Medicine and Rehabilitation, Department of Spinal Cord Injuries, St. Olavs hospital, , Trondheim University Hospital, ; Trondheim, Norway
                [2 ]GRID grid.52522.32, ISNI 0000 0004 0627 3560, Department of Medical Quality Registries, St. Olavs hospital, , Trondheim University Hospital, ; Trondheim, Norway
                [3 ]GRID grid.5947.f, ISNI 0000 0001 1516 2393, Department of Public Health and Nursing, , Norwegian University of Science and Technology, ; Trondheim, Norway
                [4 ]GRID grid.5947.f, ISNI 0000 0001 1516 2393, Department of Neuro Medicine and Movement Science, Faculty of Medicine and Health Sciences, , NTNU-Norwegian University of Science and Technology, ; Trondheim, Norway
                [5 ]GRID grid.7692.a, ISNI 0000000090126352, Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, , University Medical Centre Utrecht, University Utrecht and De Hoogstraat Rehabilitation, ; Utrecht, The Netherlands
                [6 ]GRID grid.4830.f, ISNI 0000 0004 0407 1981, University of Groningen, University Medical Centre Groningen, Centre for Rehabilitation, ; Groningen, The Netherlands
                [7 ]GRID grid.475435.4, Section for Spinal Cord Injuries, Department for Brain and Spinal Cord Injuries, , Copenhagen University Hospital, Rigshospitalet, and Department for Clinical Medicine, University of Copenhagen, ; Copenhagen, Denmark
                Author information
                http://orcid.org/0000-0002-4974-1366
                http://orcid.org/0000-0002-9086-6670
                http://orcid.org/0000-0002-2205-9404
                http://orcid.org/0000-0002-2186-0144
                Article
                876
                10.1038/s41393-023-00876-4
                10070183
                36717734
                9afaa36f-dbb6-4289-a9cb-0800ff211bad
                © The Author(s) 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 7 April 2022
                : 6 January 2023
                : 11 January 2023
                Funding
                Funded by: Dam foundation Grant number 2018/FO 198620 The Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and Technology (NTNU) Grant number 18/420 The joint research committee between St. Olavs hospital HF and the Faculty of Medicine and Health Sciences at NTNU. Grant number 2018/42795.
                Categories
                Article
                Custom metadata
                © International Spinal Cord Society 2023

                Neurology
                epidemiology,spinal cord diseases
                Neurology
                epidemiology, spinal cord diseases

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