Hilton G, Unsworth C A, Murphy G C, Browne M, Olver J
Occupational Therapy Department, Central Queensland University, Melbourne, Victoria, Australia.
Victorian Spinal Cord Service, Austin Health, Melbourne, Victoria, Australia.
Spinal Cord. 2017 Aug;55(8):743-752. doi: 10.1038/sc.2017.24. Epub 2017 Mar 14.
Longitudinal cohort design.
First, to explore the longitudinal outcomes for people who received early intervention vocational rehabilitation (EIVR); second, to examine the nature and extent of relationships between contextual factors and employment outcomes over time.
Both inpatient and community-based clients of a Spinal Community Integration Service (SCIS).
People of workforce age undergoing inpatient rehabilitation for traumatic spinal cord injury were invited to participate in EIVR as part of SCIS. Data were collected at the following three time points: discharge and at 1 year and 2+ years post discharge. Measures included the spinal cord independence measure, hospital anxiety and depression scale, impact on participation and autonomy scale, numerical pain-rating scale and personal wellbeing index. A range of chi square, correlation and regression tests were undertaken to look for relationships between employment outcomes and demographic, emotional and physical characteristics.
Ninety-seven participants were recruited and 60 were available at the final time point where 33% (95% confidence interval (CI): 24-42%) had achieved an employment outcome. Greater social participation was strongly correlated with wellbeing (ρ=0.692), and reduced anxiety (ρ=-0.522), depression (ρ=-0.643) and pain (ρ=-0.427) at the final time point. In a generalised linear mixed effect model, education status, relationship status and subjective wellbeing increased significantly the odds of being employed at the final time point. Tertiary education prior to injury was associated with eight times increased odds of being in employment at the final time point; being in a relationship at the time of injury was associated with increased odds of being in employment of more than 3.5; subjective wellbeing, while being the least powerful predictor was still associated with increased odds (1.8 times) of being employed at the final time point.
EIVR shows promise in delivering similar return-to-work rates as those traditionally reported, but sooner. The dynamics around relationships, subjective wellbeing, social participation and employment outcomes require further exploration.
纵向队列研究设计。
第一，探究接受早期干预职业康复（EIVR）的人群的纵向结果；第二，研究背景因素与就业结果随时间变化的关系的性质和程度。
脊髓社区融合服务（SCIS）的住院患者和社区患者。
因创伤性脊髓损伤而接受住院康复治疗的劳动年龄人群被邀请参加作为SCIS一部分的EIVR。在以下三个时间点收集数据：出院时、出院后1年和2年以上。测量指标包括脊髓独立性测量、医院焦虑抑郁量表、对参与和自主的影响量表、数字疼痛评分量表和个人幸福感指数。进行了一系列卡方检验、相关性检验和回归检验，以寻找就业结果与人口统计学、情绪和身体特征之间的关系。
招募了97名参与者，在最后一个时间点有60名可用，其中33%（95%置信区间（CI）：24 - 42%）实现了就业结果。在最后一个时间点，更高的社会参与度与幸福感（ρ = 0.692）、焦虑减轻（ρ = -0.522）、抑郁减轻（ρ = -0.643）和疼痛减轻（ρ = -0.427）密切相关。在广义线性混合效应模型中，教育程度、恋爱状况和主观幸福感在最后一个时间点显著增加了就业几率。受伤前接受高等教育与最后一个时间点就业几率增加8倍相关；受伤时处于恋爱关系与就业几率增加超过3.5倍相关；主观幸福感虽然是最不显著的预测因素，但仍与最后一个时间点就业几率增加（1.8倍）相关。
EIVR有望实现与传统报告相似的重返工作率，但时间更早。恋爱关系、主观幸福感、社会参与和就业结果之间的动态关系需要进一步探索。
