Roels Ellen H, Reneman Michiel F, New Peter W, Kiekens Carlotte, Van Roey Lot, Townson Andrea, Scivoletto Giorgio, Smith Eimear, Eriks-Hoogland Inge, Staubli Stefan, Post Marcel W M
University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, Groningen, the Netherlands.
Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Caulfield, Epworth-Monash Rehabilitation Medicine Unit, Monash University, Melbourne, and Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Victoria, Australia.
Top Spinal Cord Inj Rehabil. 2020 Winter;26(1):21-35. doi: 10.1310/sci2601-21.
Employment rates among people with spinal cord injury or spinal cord disease (SCI/D) show considerable variation across countries. One factor to explain this variation is differences in vocational rehabilitation (VR) systems. International comparative studies on VR however are nonexistent. To describe and compare VR systems and practices and barriers for return to work in the rehabilitation of persons with SCI/D in multiple countries. A survey including clinical case examples was developed and completed by medical and VR experts from SCI/D rehabilitation centers in seven countries between April and August 2017. Location (rehabilitation center vs community), timing (around admission, toward discharge, or after discharge from clinical rehabilitation), and funding (eg, insurance, rehabilitation center, employer, or community) of VR practices differ. Social security services vary greatly. The age and preinjury occupation of the patient influences the content of VR in some countries. Barriers encountered during VR were similar. No participant mentioned lack of interest in VR among team members as a barrier, but all mentioned lack of education of the team on VR as a barrier. Other frequently mentioned barriers were fatigue of the patient (86%), lack of confidence of the patient in his/her ability to work (86%), a gap in the team's knowledge of business/legal aspects (86%), and inadequate transportation/accessibility (86%). VR systems and practices, but not barriers, differ among centers. The variability in VR systems and social security services should be considered when comparing VR study results.
脊髓损伤或脊髓疾病（SCI/D）患者的就业率在不同国家存在很大差异。解释这种差异的一个因素是职业康复（VR）系统的不同。然而，目前尚无关于VR的国际比较研究。为了描述和比较多个国家中SCI/D患者康复过程中的VR系统、实践及重返工作岗位的障碍。2017年4月至8月期间，来自七个国家的SCI/D康复中心的医学和VR专家开展并完成了一项包含临床案例的调查。VR实践的地点（康复中心与社区）、时间（入院前后、出院时或临床康复出院后）和资金来源（如保险、康复中心、雇主或社区）各不相同。社会保障服务差异很大。在一些国家，患者的年龄和伤前职业会影响VR的内容。VR过程中遇到的障碍相似。没有参与者提到团队成员对VR缺乏兴趣是一个障碍，但所有人都提到团队对VR缺乏培训是一个障碍。其他经常提到的障碍包括患者疲劳（86%）、患者对自己工作能力缺乏信心（86%）、团队在商业/法律方面的知识差距（86%）以及交通不便/可达性不足（86%）。各中心的VR系统和实践存在差异，但障碍并无不同。在比较VR研究结果时，应考虑VR系统和社会保障服务的变异性。
