Spinal Cord Injury Vocational Integration Program (SCI-VIP)
Condition: Spinal Cord Injuries
MeSH terms: Spinal Cord Injuries; Wounds and Injuries
Study type: Interventional

Summary: 
      This study involves research about how to help Veterans with spinal cord injury (SCI) gain
      employment. During the first couple of years following SCI, many people are concentrating on
      their rehabilitation and are unable to afford the time for return to work. However, studies
      have shown people often regain the necessary strength and function about two years after SCI
      to resume activities of daily living very similar to what they experienced prior to the SCI.
      Even though many social and legal efforts have been made in the last decade to improve
      chances for people with disabilities to return to work, Veterans with SCI are sometimes
      hindered in finding employment because of age, past work history, and many other factors.
      Other Veterans with SCI are very successful at finding employment either working for
      themselves or working for a company. The investigators know very little about what issues
      Veterans with SCI face when they attempt to find employment after SCI. The study will analyze
      both quantitative and qualitative measures to maximize its findings.
    

Detailed description: 
      Legal mandates, such as the Rehabilitation Act of 1973 and the Americans with Disabilities
      Act, have been implemented to improve employment opportunities for disabled persons and yet
      the proportion of persons with spinal cord injury (SCI) who are employed remains about 9%.
      For the Veteran population with SCI, the return to work rate is most likely much lower. This
      study will be conducted to evaluate whether a vocational rehabilitation program patterned
      after the VA Community Employment and Support approach improves rehabilitation outcomes for
      the SCI Veteran population as compared with vocational rehabilitation practices currently
      used in most Veteran Affairs Medical Centers (VAMCs). The vocational rehabilitation program
      developed for the SCI Veterans is referred to as SCI-VIP and it will be implemented at the
      Dallas VA Medical Center (VAMC), Houston VAMC, San Diego VAMC, and Cleveland VAMC. A five
      year evaluative research will be conducted to test the following hypothesized outcomes (HO)
      from the subjects who participate in the SCI-VIP program and a control group of subjects who
      receive conventional methods of vocational rehabilitation:

      Primary HO: Veterans with SCI who participate in the SCI-VIP will demonstrate significantly
      greater changes in vocational rehabilitation after twelve months than those who do not
      receive this intervention. Vocational rehabilitation will be a measure of change from
      baseline to one-year in the subject's scores on instruments which measure employment indices,
      perceived barriers to employment, level of handicap, quality of life, depression, and
      sustaining care needs.

      Secondary HO 1: Veterans with SCI who participate in the SCI-VIP will exhibit lower VA and
      non-VA costs for medical, non-rehabilitation treatment, offsetting the higher SCI-VIP program
      costs.

      Secondary HO 2: The program fidelity will be equally adequate in terms of accomplishing
      program objectives relative to operations, cost-benefit balance, subject and stakeholder
      satisfaction, and outcomes when comparing the four SCI-VIP programs and when comparing
      conventional vocational rehabilitation approaches applied at six different VAMCs.

      Program evaluation and cost-benefit analysis will be conducted using a fidelity instrument
      developed by the researchers and patterned after fidelity instruments conventionally used to
      evaluate psychiatric rehabilitation programs. Veterans at each VAMC who express an interest
      in vocational rehabilitation and consent to participate in this study will be randomized to
      either the experimental or the control group. It is expected that at least 96 subjects will
      participate in the SCI-VIP approach to vocational rehabilitation and 144 Veterans who receive
      conventional vocational rehabilitation will form the control group.

      Data will be collected from subjects upon enrollment into either the experimental or control
      group and every three months for one year. Descriptive analysis will be used to compare
      differences between groups of subjects drawn from each VAMC and to compare participants in
      the experimental and control groups. Analysis of variance will be computed to determine
      degree of difference between experimental group and control group subjects' scores on each
      dependent variable. The study hypotheses will be tested using the Mann-Whitney U, Chi-square,
      and odds ratio statistical procedures. The Cochran-Mantel-Haenszel along with relative risk
      scores will indicate the likelihood that any change in performance between baseline and
      program completion for ether experimental or control group subjects could be attributed to
      the subjects' degree of participation in the SCI-VIP, which VAMC vocational rehabilitation
      services were received, SCI factors, and age.
    

Intervention name(s): Arm 1; Arm 2
Intervention type(s): Behavioral; Behavioral
Intervention description(s): SCI-VIP: Supported employment implemented for veterans with spinal cord injury.; Standard Care: varies slightly between participating VA SCI centers, however, usually involves referral outside SCI center
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Adult; Depression; Employment, supported; Health Service/ut; Humans; Outcomes; Quality of life; Veterans/rh (rehabilitation); Workplace; Spinal Cord Injuries