Key Factors Related to Vocational Outcome: Trends for Six Disability Groups

This revie! w examined the key factors related to vocational outcome (that is, commencement of, or return to, work after onset of disability) reported in the research literature for six disability groups. Previous reviews of vocational outcome found that most studies differed with respect to sampling procedures, participant characteristics, methodology and variables associated with vocational outcome in, for example, disability groups such as SCI (Crisp, 1990; Trieschmann, 1988), TBI (Crisp, 1992; Sherer, Novack et al., 2002), CP (Crook, Milner, Schultz & Stringer, 2002) and severe mental illness (Tsang, Lain, Ng & Leung, 2000). Since they evaluated the methodological quality of much of the research literature and analyzed the return to work rates for these disability groups, these two aspects will not be the primary interest of this review. Instead, this paper focused upon the dominant themes emerging from those studies that analyzed a range of medical, socio-demographic and psychosocial factors that were related to vocational outcome. It was intended to draw attention to the need for a broader perspective than can be provided by smaller sets of variables to explain or predict vocational outcome. Most attention was paid to the more recent studies with larger samples and sets of predictor variables; and mostly upon the implications for vocational rehabilitation service providers than for researchers. The goal of this review was to identify the important factors that impact upon the employment of people in six disability groups. It was not assumed that the issues common to persons with particular disabilities could be generalized to persons with other disabilities. These groups were selected because of the likelihood that they would provide different perspectives on vocational outcome, and included persons with: spinal cord injuries (SCI), traumatic brain injuries (TBI), amputations, chronic pain (CP), myocardial infarction/coronary artery bypass grafting (MI/CABG), and severe mental illness, that is, psychosis, bi-polar disorder, long-term major depression or dysthymia. Method A selective rather than an exhaustive literature search was conducted to identify articles from prominent rehabilitation and disability journals, published since 1987, which would locate recurring themes. There were several inclusion criteria: 1. Exclusive focus was on one of the six abovementioned disability groups; 2. Research was well-designed, in so far as the authors clearly described the objectives of the research, sample selection, data collection and analysis; 3. Prospective and retrospective studies, utilizing multivariate statistical analyses, consisted of samples with high generalizability and reliability (e.g., 10 or more participants per predictor variable) as recommended by Crook et al. (2002) and Sherer, Novack et al. (2002); 4. Retrospective studies, utilizing univariate statistical analyses, had samples of 50 or more participants; 5. Predictor variables consisted of socio-demographic, psychosocial and clinical variables; 6. The outcome measure was return to work or employment status after onset of disability. Results Seventy-five studies were included for review. The number of studies selected for review in each of the six diagnostic groups are listed in Table 1. Although there were differences between and within disability groups, and between the methodologies adopted by researchers, it was possible to identify five key factors related to vocational outcome. The most commonly cited predictor variables are listed in Table 2. 1. Severity of disability Return to work was most likely to occur when individuals' residual abilities and pre-injury skills were utilized in relatively less physically demanding employment. This trend was evident in most SCI (e.g., DeVivo, Rutt, Stover & Fine, 1987; Hess, Ripley, McKinley & Tewksbury, 2000; Krause, 2003; Krause, Kewman et al. …