Trenaman Logan, Miller William C, Querée Matthew, Escorpizo Reuben
J Spinal Cord Med. 2015 Jul;38(4):422-31. doi: 10.1179/2045772315Y.0000000031. Epub 2015 May 20.
Employment rates in individuals with spinal cord injury (SCI) are approximately 35%, which is considerably lower than that of the general population. In order to improve employment outcomes a clear understanding of what factors influence employment outcomes is needed.
To systematically review factors that are consistently and independently associated with employment outcomes in individuals with SCI, and to understand the magnitude of their influence.
Through an electronic search of MEDLINE/PubMed, EMBASE, CINAHL, PsycINFO, Social Science Abstracts and Social Work databases, we identified studies published between 1952-2014 that investigated factors associated with employment outcomes following SCI. Exclusion criteria included: (1) reviews (2) studies not published in English (3) studies not controlling for potential confounders through a regression analysis, or (4) studies not providing an effect measure in the form of OR, RR, or HR. Data were categorized based on the International Classification of Functioning, Disability and Health framework, with each domain sub-categorized by modifiability. First author, year of publication, sample size, explanatory and outcome variables, and effect measures were extracted.
Thirty-nine studies met the inclusion criteria. Twenty modifiable and twelve non-modifiable factors have been investigated in the context of employment following SCI. Education, vocational rehabilitation, functional independence, social support, and financial disincentives were modifiable factors that have been consistently and independently associated with employment outcomes.
A number of key modifiable factors have been identified and can inform interventions aimed at improving employment outcomes for individuals with SCI. Future research should focus on determining which factors have the greatest effect on employment outcomes, in addition to developing and evaluating interventions targeted at these factors.
脊髓损伤（SCI）患者的就业率约为35%，远低于普通人群。为了改善就业成果，需要清楚了解哪些因素会影响就业成果。
系统回顾与脊髓损伤患者就业成果持续且独立相关的因素，并了解其影响程度。
通过对MEDLINE/PubMed、EMBASE、CINAHL、PsycINFO、社会科学文摘和社会工作数据库进行电子检索，我们确定了1952年至2014年期间发表的研究，这些研究调查了脊髓损伤后与就业成果相关的因素。排除标准包括：（1）综述；（2）非英文发表的研究；（3）未通过回归分析控制潜在混杂因素的研究；或（4）未以OR、RR或HR形式提供效应量的研究。数据根据国际功能、残疾和健康分类框架进行分类，每个领域再根据可修改性进行细分。提取第一作者、发表年份、样本量、解释变量和结果变量以及效应量。
39项研究符合纳入标准。在脊髓损伤后的就业背景下，已对20个可修改因素和12个不可修改因素进行了调查。教育、职业康复、功能独立性、社会支持和经济抑制因素是与就业成果持续且独立相关的可修改因素。
已确定了一些关键的可修改因素，这些因素可为旨在改善脊髓损伤患者就业成果的干预措施提供参考。未来的研究除了开发和评估针对这些因素的干预措施外，还应侧重于确定哪些因素对就业成果影响最大。
