Quality of Life Research

, Volume 22, Issue 8, pp 2133–2141 | Cite as

A prospective examination of the impact of a supported employment program and employment on health-related quality of life, handicap, and disability among Veterans with SCI

  • Lisa Ottomanelli
  • Scott D. Barnett
  • Lance L. Goetz



To investigate impact of participation in a supported employment program and impact of employment itself on health-related quality of life (HRQOL), disability, and handicap among Veterans with spinal cord injury (SCI).


We used a prospective, randomized, controlled, multi-site trial of supported employment (SE) versus treatment as usual (TAU) for vocational issues. Subjects were 157 Veterans with SCI who received either SE or TAU for vocational issues. Outcomes were examined in terms of type of vocational treatment received and whether competitive employment was obtained. Outcomes investigated were HRQOL as measured by the Veterans RAND 36-item health survey (VR-36), handicap as measured by the Craig Handicap Assessment and Reporting Technique (CHART), and disability as measured by the functional independence measure (FIM). Subjects were assessed at baseline and at 3, 6, 9, and 12 months.


There were no significant differences between Veterans who participated in SE compared to those who received TAU in study measures. Participants obtaining competitive employment demonstrated significantly higher scores on the Social Integration, Mobility, and Occupation dimensions of the CHART. There were no observed differences in VR-36 scores or FIM scores for those obtaining competitive employment.


This study suggests that employment has a positive effect on an individual’s ability to participate in social relationships, move about their home and community, and spend time in productive and usual roles. Inability to detect differences across other domains of handicap or any changes in HRQOL may have been due to several factors including level and intensity of employment, insufficient follow-up period, or measurement limitations.


Veterans Quality of life Supported employment Spinal cord injury 



Competitive employment


Health-related quality of life


Individualized placement and support


Institutional review board


Spinal cord injury


Spinal Cord Injury-Vocational Integration Program


Supported employment


Treatment as usual


Treatment as usual–interventional site


Treatment as usual–observational site


Traumatic brain injury


United States


Veterans Affairs Medical Center


Veterans Health Administration


Vocational rehabilitation


Vocational rehabilitation counselor



This material is based upon work supported by the Office of Research and Development, Rehabilitation Research and Development Service, Department of Veterans Affairs (#B3773R). Contents of this presentation do not represent the views of the Department of Veterans Affairs or the United States Government. The authors acknowledge the kind support of Compensated Work Therapy and Spinal Cord Injury and Disorders Services, Department of Veterans Affairs. We also acknowledge the contributions of our study coordinators, program and data managers, Compensated Work Therapy program managers, and vocational rehabilitation clinicians. We thank Lynn Dirk, MAMC, for editorial assistance. Finally, we greatly appreciate the Veterans who participated in this study.


  1. 1.
    Westgren, N., & Levi, R. (1998). Quality of life and traumatic spinal cord injury. Archives of Physical Medicine and Rehabilitation, 79(11), 1433–1439.PubMedCrossRefGoogle Scholar
  2. 2.
    Krause, J. S. (1990). The relationship between productivity and adjustment following spinal cord injury. Rehabilitation Counseling Bulletin, 33, 188–199.Google Scholar
  3. 3.
    Krause, J. S. (1992). Adjustment to life after spinal cord injury: A comparison among three participant groups based on employment status. Rehabilitation Counseling Bulletin, 35, 218–229.Google Scholar
  4. 4.
    Krause, J. S. (1992). Longitudinal changes in adjustment after spinal cord injury: A 15-year study. Archives of Physical Medicine and Rehabilitation, 73(6), 564–568.PubMedGoogle Scholar
  5. 5.
    Chapin, M. H., & Kewman, D. G. (2001). Factors affecting employment following spinal cord injury: A qualitative study. Rehabilitation Psychology, 46(4), 400–416.CrossRefGoogle Scholar
  6. 6.
    Clayton, K. S., & Chubon, R. A. (1994). Factors associated with the quality of life of long-term spinal cord injured persons. Archives of Physical Medicine and Rehabilitation, 75(6), 633–638.PubMedCrossRefGoogle Scholar
  7. 7.
    Leduc, B. E., & Lepage, Y. (2002). Health-related quality of life after spinal cord injury. Disability and Rehabilitation, 24(4), 196–202.PubMedCrossRefGoogle Scholar
  8. 8.
    Jain, N. B., Sullivan, M., Kazis, L. E., Tun, C. G., & Garshick, E. (2007). Factors associated with health-related quality of life in chronic spinal cord injury. American Journal of Physical Medicine and Rehabilitation, 86(5), 387–396.PubMedCrossRefGoogle Scholar
  9. 9.
    Ottomanelli, L., Goetz, L. L., Suris, A., McGeough, C., Sinnott, P. L., Toscano, R., et al. (2012). Effectiveness of supported employment for veterans with spinal cord injuries: Results from a randomized multisite study. Archives of Physical Medicine and Rehabilitation, 93(5), 740–747.PubMedCrossRefGoogle Scholar
  10. 10.
    Becker, D., & Drake, R. E. (2006). Supported employment interventions are effective for people with severe mental illness. Evidence-Based Mental Health, 9(1), 22.PubMedCrossRefGoogle Scholar
  11. 11.
    Bond, G. R., Becker, D. R., Drake, R. E., Rapp, C. A., Meisler, N., Lehman, A. F., et al. (2001). Implementing supported employment as an evidence-based practice. Psychiatric Services, 52(3), 313–322.PubMedCrossRefGoogle Scholar
  12. 12.
    Bond, G. R. (2004). Supported employment: Evidence for an evidence-based practice. Psychiatric Rehabilitation Journal, 27(4), 345–359.PubMedCrossRefGoogle Scholar
  13. 13.
    Murphy, G. C., Middleton, J., Quirk, R., De Wolf, A., & Cameron, I. D. (2011). Predicting employment status at 2 years’ postdischarge from spinal cord injury rehabilitation. Rehabilitation Psychology, 56(3), 251–256.PubMedCrossRefGoogle Scholar
  14. 14.
    Cohen, J. T., Marino, R. J., Sacco, P., & Terrin, N. (2012). Association between the functional independence measure following spinal cord injury and long-term outcomes. Spinal Cord, 50(10), 728–733.Google Scholar
  15. 15.
    Ottomanelli, L., Goetz, L., McGeough, C., Suris, A., Sippel, J., Sinnott, P., et al. (2009). Methods of a multisite randomized clinical trial of supported employment among veterans with spinal cord injury. Journal of Rehabilitation Research and Development, 46(7), 919–930.PubMedCrossRefGoogle Scholar
  16. 16.
    Kazis, L. E., Ren, X. S., Lee, A., Skinner, K., Rogers, W., Clark, J., et al. (1999). Health status in VA patients: results from the Veterans health study. American Journal of Medical Quality, 14(1), 28–38.PubMedCrossRefGoogle Scholar
  17. 17.
    Kazis, L. E., Lee, A., Spiro, A., Rogers, W., Ren, X. S., Miller, D. R., et al. (2004). Measurement comparisons of the medical outcomes study and veterans SF-36 health survey. Health Care Financing Review, 25(4), 43–58.PubMedGoogle Scholar
  18. 18.
    Kazis, L. E., Miller, D. R., Clark, J. A., Skinner, K. M., Lee, A., Ren, X. S., et al. (2004). Improving the response choices on the veterans SF-36 health survey role functioning scales: Results from the Veterans Health Study. The Journal of Ambulatory Care Management, 27(3), 263–280.PubMedCrossRefGoogle Scholar
  19. 19.
    Kazis, L. E., Miller, D. R., Skinner, K. M., Lee, A., Ren, X. S., Clark, J. A., et al. (2006). Applications of methodologies of the Veterans health study in the VA healthcare system: conclusions and summary. The Journal of Ambulatory Care Management, 29(2), 182–188.PubMedCrossRefGoogle Scholar
  20. 20.
    Whiteneck, G. G., Charlifue, S. W., Gerhart, K. A., Overholser, J. D., & Richardson, G. N. (1992). Quantifying handicap: A new measure of long-term rehabilitation outcomes. Archives of Physical Medicine and Rehabilitation, 73(6), 519–526.PubMedGoogle Scholar
  21. 21.
    Linacre, J. M., Heinemann, A. W., Wright, B. D., Granger, C. V., & Hamilton, B. B. (1994). The structure and stability of the functional independence measure. Archives of Physical Medicine and Rehabilitation, 75(2), 127–132.PubMedGoogle Scholar
  22. 22.
    Hamilton, B. B., Laughlin, J. A., Fiedler, R. C., & Granger, C. V. (1994). Interrater reliability of the 7-level functional independence measure (FIM). Scandinavian Journal of Rehabilitation Medicine, 26(3), 115–119.PubMedGoogle Scholar
  23. 23.
    Bond, G. R., Becker, D. R., Drake, R. E., & Vogler, K. M. (1997). A fidelity scale for the individual placement and support model of supported employment. Rehabilitation Counseling Bulletin, 40, 265–284.Google Scholar
  24. 24.
    Bond, G. R., Vogler, K. M., & Sandra. (2001). Dimensions of supported employment: Factor structure of the IPS fidelity scale. Journal of Mental Health, 10(4) 383–393.Google Scholar
  25. 25.
    Krause, J. S., & Anson, C. A. (1996). Employment after spinal cord injury: Relation to selected participant characteristics. Archives of Physical Medicine and Rehabilitation, 77(8), 737–743.PubMedCrossRefGoogle Scholar
  26. 26.
    Bush, M. B. A., Drake, M. D., Xie, P. D., McHugo, P. D., & Haslett, M. A. (2009). The long-term impact of employment on mental health service use and costs for persons with severe mental Illness. Psychiatric Services, 60(8), 1024–1031.PubMedCrossRefGoogle Scholar
  27. 27.
    Krause, J. S., & Coker, J. L. (2006). Aging after spinal cord injury: A 30-year longitudinal study. Journal of Spinal Cord Medicine, 29(4), 371–376.PubMedGoogle Scholar
  28. 28.
    Becker, D. R., Bond, G. R., McCarthy, D., Thompson, D., Xie, H., McHugo, G. J., et al. (2001). Converting day treatment centers to supported employment programs in Rhode Island. Psychiatric Services, 52(3), 351–357.PubMedCrossRefGoogle Scholar
  29. 29.
    Drake, R. E., McHugo, G. J., Becker, D. R., Anthony, W. A., & Clark, R. E. (1996). The New Hampshire study of supported employment for people with severe mental illness. Journal of Consulting and Clinical Psychology, 64(2), 391–399.PubMedCrossRefGoogle Scholar
  30. 30.
    Drake, R. E., Becker, D. R., Clark, R. E., & Mueser, K. T. (1999). Research on the individual placement and support model of supported employment. Psychiatric Quarterly, 70(4), 289–301.PubMedCrossRefGoogle Scholar
  31. 31.
    Burns, T., Catty, J., White, S., Becker, T., Koletsi, M., Fioritti, A., et al. (2009). The impact of supported employment and working on clinical and social functioning: Results of an international study of individual placement and support. Schizophrenia Bulletin, 35(5), 949–958.PubMedCrossRefGoogle Scholar
  32. 32.
    Mueser, K. T., Clark, R. E., Haines, M., Drake, R. E., McHugo, G. J., Bond, G. R., et al. (2004). The Hartford study of supported employment for persons with severe mental illness. Journal of Consulting and Clinical Psychology, 72(3), 479–490.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht (outside the USA) 2013

Authors and Affiliations

  • Lisa Ottomanelli
    • 1
    • 2
  • Scott D. Barnett
    • 1
  • Lance L. Goetz
    • 3
    • 4
  1. 1.Health Services Research and Development Service (HSR&D) and Rehabilitation Research and Development Service (RR&D) Center of Excellence Maximizing Rehabilitation OutcomesJames A. Haley Veterans’ HospitalTampaUSA
  2. 2.Department of Rehabilitation and Mental Health CounselingCollege of Behavioral and Community Sciences, University of South FloridaTampaUSA
  3. 3.Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire Veterans Affairs Medical CenterRichmondUSA
  4. 4.Department of Physical Medicine and RehabilitationVirginia Commonwealth UniversityRichmondUSA

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