Factors Associated with Return to Work after a Spinal Cord Injury: a Systematic Review and Meta-analysis
Creators: Gyawali, Bina
Publisher: name: University of Alberta Library
Year: 2023

<p>Background: Individuals with a Spinal Cord Injury (SCI) experience challenges in obtaining and maintaining employment. The overall Return-To-Work (RTW) rate after SCI is lower than the employment rate of the general population. Some factors have been reported in the literature as being associated with RTW after SCI, but there is a need to synthesize results to estimate the strength of association of each significant factor.<br>
Objectives: 1) To identify factors associated with RTW after a SCI, 2) To assess the strength of each factor’s association with RTW, and 3) To explore how factors associated with RTW after a SCI vary among High Income Countries (HIC) and Low/Middle Income Countries (LMIC). <br>
Methods: Systematic review and meta-analysis. A comprehensive literature search was conducted in MEDLINE, Embase, CINAHL, PsycINFO and Scopus databases. Search terms included two constructs, 1) “spinal cord injury” and 2) “return to work”. All articles discussing RTW after SCI as a key concept were included. Articles were then excluded if the descriptive data were not disaggregated in “employed” and “unemployed” categories or if data were not presented for SCI-only groups. Factors that were reported in three or more articles were included in meta-analyses and subgroup analysis were completed by country&#39;s economic status, as determined by the World Bank Classification (i.e. HIC vs. LMIC). A random effect model was used to estimate: 1) Odd ratios for nominal/ordinal factors, and 2) Mean differences for continuous factors with respective corresponding 95% confidence intervals (CI).<br>
Results: We screened 3,834 articles and 52 were included for analysis. Forty-seven studies were from HIC and five from LMIC. We identified 12 factors significantly associated with RTW: A) “body structures and functions” - 1) Being paraplegic (OR: 0.73, 95 % CI: 0.63 to 0.85, medium quality of evidence), B) “activity limitations”- 2) Ability to live alone (OR: 2.59, 95 % CI: 1.30 to 5.10, low quality of evidence), 3) Ability to drive (OR: 4.76, 95 % CI: 2.94 to 7.61, low quality of evidence), 4) No wheelchair use (OR: 0.44, 95 % CI: 0.20 to 0.96, low quality of evidence), and 5) Higher Functional Independence Measure scores (Mean difference: 0.67, 95 % CI: 0.49 to 0.85, medium quality of evidence) , and C)  “personal factors”- 6) Being married (OR: 1.54, 95 % CI: 1.06 to 2.23, medium quality of evidence), 7) Being white (OR: 2.16, 95 % CI: 1.54 to 3.03, low quality of evidence), 8) Being younger at the time of data collection (mean difference: -0.24, 95 % CI: -0.38 to -0.11, low quality of evidence), 9) Being younger at the time of injury (mean difference: -0.30, 95 % CI: -0.46 to -0.14, low quality of evidence), 10) More time since injury (mean difference: 0.31, 95 % CI: 0.12 to 0.49, low quality of evidence), 11) ≥ high school education (OR: 0.45, 95 % CI: 0.36 to 0.57, low quality of evidence), and 12) ≥ $20,000 annual income (OR: 0.15, 95 % CI: 0.06 to 0.34, low quality of evidence). No “environmental” factors qualified for meta-analysis. Five factors were included in the subgroup analyses and the following 3 factors were significantly associated with RTW only in HIC: 1) Being paraplegic, 2) Being able to live alone, and 3) Being married.<br>
Conclusions: Being able to drive, Being able to live alone, Being White, Being paraplegic, Having ≥ high school education, Having ≥$20,000 annual income were the most important factors associated with RTW after SCI. All factors identified as significantly associated with RTW were explored in HIC. There is a paucity of evidence on factors associated with RTW in LMIC so more research is needed in this area. Personal, impairment and activity limitation factors appear to be emphasized over environmental factors in the available literature, and there is a lack of high quality prospective studies in this area.<br>
Keywords: Meta-analysis, return to work, spinal cord injury, systematic review</p>