Preventable Job Loss Following Return to Work Post Traumatic Spinal Cord Injury

Preventable Job Loss Following Return to Work Post Traumatic Spinal Cord Injury

Team leads: Associate Professor Gregory Murphy (Victoria)/ Dr Cheryl Cott (Ontario)

Lead Organisations: La Trobe University (Victoria); Toronto Rehabilitation Institute (Ontario)

TAC/ONF Joint Funding: $93,050

Start Date: 1 August 2010 – 7 September 2012

Background:

In Australia, approximately 43% of traumatic spinal cord injury (SCI) survivors report being employed at any point in time post-discharge. However, a clear majority (median of 62%) also report that they have worked at some time post-injury, which implies a relatively high incidence of job loss following the initial return-to-work (RTW). To date, most vocational rehabilitation research involving this population has focused on the influence of a limited number of demographic and injury factors on post-injury employment but with little attempt to identify the processes or factors involved in either the RTW or the withdrawal from work gained post-injury.

Aims:

The aims of the present three-phase research program were to (1) identify the reported factors that led to post-injury job withdrawal among those living with traumatic spinal cord injury (SCI) (2) identify potential interventions to minimize the impact of the reported job withdrawal factors and (3) evaluate the perceived benefits and drawbacks of the proposed interventions.

Methods:

Using a combined survey and focus group methodology, 30 traumatic SCI participants were interviewed about the details of their post-injury job withdrawal (Phase 1); next, 16 rehabilitation service providers (9 clinicians and 7 community rehabilitation professionals) brainstormed potential interventions designed to minimize the impact of the job withdrawal catalysts (Phase 2); finally, 35 SCI participants and 6 employers evaluated the potential benefits and drawbacks of the proposed interventions (Phase 3).

Results:

Phase 1: Three job-withdrawal factors were significantly related to lower levels of current employment: travel distance; lack of career progression and lack of workplace social support. Conversely, two job-withdrawal factors were significantly related to higher levels of current employment: a better job offer and negative societal attitudes. Phase 2: Rehabilitation service providers (clinicians and community rehabilitation professionals) brainstormed multiple potential interventions including: a hospital-led unit dedicated to return-to-work; supervisor/co-worker education; access to an expert pain management team; and workshops on interview techniques and accessing the hidden job market. Phase 3: Ratings of the perceived benefits of the proposed interventions by traumatic SCI participants were mostly positive ranging from 93% to 47%. Interestingly, traumatic SCI participants perceived the potential interventions as being more beneficial to others relative to themselves (i.e., subjective norms were higher). Although intervention preferences sometimes differed by injury type (e.g., paraplegias vs. quadriplegias), the two interventions perceived as the most beneficial overall were 'workshops on interview techniques and accessing the hidden job market' and 'a hospital-led unit dedicated to return-to-work'. Among employers, two interventions rated as conferring the greatest overall benefit were an 'assessment of workplace social environment and demands' and 'supervisor / co-worker education'. A cost-benefit analysis of implementing the latter intervention ('supervisor / co-worker education') conservatively estimated that savings of $1.2 million per annum would result.

Conclusions:

Most of the potential interventions were perceived as beneficial for the maintenance of durable employment by traumatic SCI participants, however, multiple analyses revealed four interventions were perceived as particularly beneficial. Furthermore, as perceived benefit differed according to injury type (paraplegias vs. quadriplegias) and residential area (metro vs. non-metro), targeted interventions may best meet the needs of each group. Finally, preliminary cost-benefit analyses revealed that implementation of at least one of the interventions would result in substantial monetary savings. These results are of practical (and economic) importance to all major stakeholders (SCI survivors, rehabilitation professionals and employers) as well as researchers.

Publications:

Murphy G, Cott C, O'Hare M. Reasons for job loss following return to work post traumatic spinal cord injury. Topics in Spinal Cord Injury Rehabilitation. 2011;16 (1):88-89.

Presentations:

Murphy G, O'Hare M. Spinal cord injury and durable employment: Potential interventions to prevent post-injury job loss. Annual scientific meeting of the International Spinal Cord injury Society ; 2012 September 3-5, London, United Kingdom.


Preventable Job Loss Following Return to Work Post Traumatic Spinal Cord Injury Preventable Job Loss Following Return to Work Post Traumatic Spinal Cord Injury Team leads: Associate Professor Gregory Murphy (Victoria)/ Dr Cheryl Cott (Ontario) Lead Organisations: La Trobe University (Victoria); Toronto Rehabilitation Institute (Ontario) TAC/ONF Joint Funding: $93,050 Start Date: 1 August 2010 – 7 September 2012 Background: In Australia, approximately 43% of traumatic spinal cord injury (SCI) survivors report being employed at any point in time post-discharge. However, a clear majority (median of 62%) also report that they have worked at some time post-injury, which implies a relatively high incidence of job loss following the initial return-to-work (RTW). To date, most vocational rehabilitation research involving this population has focused on the influence of a limited number of demographic and injury factors on post-injury employment but with little attempt to identify the processes or factors involved in either the RTW or the withdrawal from work gained post-injury. Aims: The aims of the present three-phase research program were to (1) identify the reported factors that led to post-injury job withdrawal among those living with traumatic spinal cord injury (SCI) (2) identify potential interventions to minimize the impact of the reported job withdrawal factors and (3) evaluate the perceived benefits and drawbacks of the proposed interventions. Methods: Using a combined survey and focus group methodology, 30 traumatic SCI participants were interviewed about the details of their post-injury job withdrawal (Phase 1); next, 16 rehabilitation service providers (9 clinicians and 7 community rehabilitation professionals) brainstormed potential interventions designed to minimize the impact of the job withdrawal catalysts (Phase 2); finally, 35 SCI participants and 6 employers evaluated the potential benefits and drawbacks of the proposed interventions (Phase 3). Results: Phase 1: Three job-withdrawal factors were significantly related to lower levels of current employment: travel distance; lack of career progression and lack of workplace social support. Conversely, two job-withdrawal factors were significantly related to higher levels of current employment: a better job offer and negative societal attitudes. Phase 2: Rehabilitation service providers (clinicians and community rehabilitation professionals) brainstormed multiple potential interventions including: a hospital-led unit dedicated to return-to-work; supervisor/co-worker education; access to an expert pain management team; and workshops on interview techniques and accessing the hidden job market. Phase 3: Ratings of the perceived benefits of the proposed interventions by traumatic SCI participants were mostly positive ranging from 93% to 47%. Interestingly, traumatic SCI participants perceived the potential interventions as being more beneficial to others relative to themselves (i.e., subjective norms were higher). Although intervention preferences sometimes differed by injury type (e.g., paraplegias vs. quadriplegias), the two interventions perceived as the most beneficial overall were 'workshops on interview techniques and accessing the hidden job market' and 'a hospital-led unit dedicated to return-to-work'. Among employers, two interventions rated as conferring the greatest overall benefit were an 'assessment of workplace social environment and demands' and 'supervisor / co-worker education'. A cost-benefit analysis of implementing the latter intervention ('supervisor / co-worker education') conservatively estimated that savings of $1.2 million per annum would result. Conclusions: Most of the potential interventions were perceived as beneficial for the maintenance of durable employment by traumatic SCI participants, however, multiple analyses revealed four interventions were perceived as particularly beneficial. Furthermore, as perceived benefit differed according to injury type (paraplegias vs. quadriplegias) and residential area (metro vs. non-metro), targeted interventions may best meet the needs of each group. Finally, preliminary cost-benefit analyses revealed that implementation of at least one of the interventions would result in substantial monetary savings. These results are of practical (and economic) importance to all major stakeholders (SCI survivors, rehabilitation professionals and employers) as well as researchers. Publications: Murphy G, Cott C, O'Hare M. Reasons for job loss following return to work post traumatic spinal cord injury. Topics in Spinal Cord Injury Rehabilitation. 2011;16 (1):88-89. Presentations: Murphy G, O'Hare M. Spinal cord injury and durable employment: Potential interventions to prevent post-injury job loss. Annual scientific meeting of the International Spinal Cord injury Society ; 2012 September 3-5, London, United Kingdom.