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
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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.
KeywordsVeterans Quality of life Supported employment Spinal cord injury
Health-related quality of life
Individualized placement and support
Institutional review board
Spinal cord injury
Spinal Cord Injury-Vocational Integration Program
Treatment as usual
Treatment as usual–interventional site
Treatment as usual–observational site
Traumatic brain injury
Veterans Affairs Medical Center
Veterans Health Administration
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.
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