Multidisciplinary Model to Guide Employment Amongst PLWSCI

Study Overview
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Brief Summary
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Spinal cord injury often results in complete or partial loss of functioning of the upper and or lower limbs, leading to the affected individual experiencing difficulties in performing activities of daily living. This in turn results in reduced participation in social, religious, recreational and economic activities (employment). Globally, there is a low employment rate (11-67%) amongst PLWSCI. In South Africa, according to Statistics South Africa, the unemployment rate of people with disabilities is estimated to be 25.2%. However, there is no information available on employment amongst PLWSCI in South Africa. Furthermore, there is insufficient knowledge related to SCI in South Africa to enable a model to be developed and implemented. Data on the current SCI rehabilitation practices (with specific reference to vocational rehabilitation); employment status and factors (both personal and environmental); barriers and facilitators of employment amongst PLWSCI is limited. This information is needed to develop a return to work model for individuals with SCI in South Africa. In South Africa, a legal framework exists that promotes the employment as well as assistance of people with disabilities in the workplace, such as: the Constitution of Republic of South Africa, 1996; the Employment Equity Act (EEA), 1998; the Promotion of Equality and Prevention of Unfair Discrimination Act (PEPUDA), 2000; Labour Relations Act (LRA), 1995; Skills Development Act (SDA), 1998; Public Service Act (PSA), 1994; Basic Conditions of Employment Act (BCEA), 1997 and the Integrated National Disability Strategy (2000). However, rehabilitation interventions provided in rehabilitation institutions are mainly medical, with limited attempts to prepare those with SCI to return to gainful employment. There is therefore a need for a well-coordinated, multi-sectorial, multi-disciplinary and multi-factorial rehabilitation intervention that will promote the employment of PLWSCI in South Africa.

Detailed Description
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This is a cross-sectional study in which mixed methods will be used in various phases of the study. Mixed methods involve the collection and analysis of both quantitative and qualitative data in a single study. Data are collected concurrently or sequentially and integrated at one or more stages during the research process. This study will be divided into 3 phases with stages to answer the objectives. Phase one of this study will attempt to answer objectives 1-3 of the study. Stage 1 will include a systematic review of literature to identify the most effective vocational rehabilitation interventions amongst PLWSCI. Stage 2 will determine rehabilitation services rendered to individual who sustain SCI in South Africa with an intention of identifying gaps in vocational rehabilitation practices by retrospectively analysing medical files. This phase will be concluded by a focus group to further explore current vocational rehabilitation practices rendered to PLWSCI (Stage3). Phase two will answer objectives 4-5. Stage 1 of this phase will determine the employment status as well as factors that influence employment amongst PLWSCI. Stage 2 will determine the barriers and facilitators of employment amongst PLWSCI. Results obtained from phase 1 to 2, will be utilised to by the researcher to develop the proposed model. The final phase will aim to develop, validate and refine the model. Stage 1 of this phase will include the researcher using the information gained in previous phases to develop the proposed model. The second stage will include a focus group to validate the content of the proposed model. The last stage will included obtaining consensus amongst the stakeholders regarding the structure and the content of the proposed model and subsequently refine it.

Official Title
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Development of a Multidisciplinary Model to Guide Employment Outcomes in People Living With Spinal Cord Injuries in South Africa.

Conditions
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Spinal Cord Injury

Intervention / Treatment
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* Other: Focus groups, semistructured interviews and Delphi rounds


Participation Criteria
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Eligibility Criteria
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Phase One: Inclusion Criteria: • Rehabilitation professionals who are directly involved in the management of individuals who sustain SCI and have more than 1 year of working experience post community service. Exclusion Criteria: • Rehabilitation professionals who are not directly involved in the management of individuals who sustain SCI and have less than 1 year working experience post community service. Phase Two : Inclusion Criteria: • Person who sustained injury to the spine, resulting in permanent neurological damage (complete or incomplete) and must reside in a rural, peri-urban and urban. Exclusion Criteria • People living with spinal cord injuries who cannot verbally communicate Phase Three Inclusion Criteria PLWSCI Injury to who resides in a rural, peri-urban and urban. Rehabilitation professionals who are directly involved in the management of individuals who sustain SCI and have more than 2 years of experience post community service. An individual who is full time employed in a supervisory and managerial capacity in both private and public sector, currently have subordinates who are PLWSCI. A representative from the Disability Section of an insurance company that is the member of the LOA. Exclusion Criteria PLWSCI who cannot verbally communicate. Rehabilitation professionals who are not directly involved in the management of individuals who sustain SCI and have less than two years of experience post community service. An individual who is employed on a part-time basis and not in supervisory or managerial positions and have no subordinates who are PLWSCI.

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Rehabilitation Professionals<br>Focus group consisting of rehabilitation professionals that will inform the study on vocational rehabilitation interventions rendered during acute to in-patient rehabilitation in KwaZulu-Natal. | Other: Focus groups, semistructured interviews and Delphi rounds<br> <br> |
| People living with Spinal Cord Injuries (PLWSCI)<br>Focus group consisting of PLWSCI that will inform the study on the perspective of the patient on vocational rehabilitation needs or desires during acute care and in-patient rehabilitation. This group will inform the study on the employment rate amongst people living with spinal cord injuries as well as factors that influence employment. This group will also inform the study on the perceived barriers and facilitators of employment | Other: Focus groups, semistructured interviews and Delphi rounds<br> <br> |
| Stakeholders<br>Representatives from the following departments or organisations will be invited to participate in the interviews and focus groups: Government Departments: Education Social Development Health Labour Transport Private Companies: Insurance Companies and Health Risk Management companies Non-profit Organisations QASA DPSA | Other: Focus groups, semistructured interviews and Delphi rounds<br> <br> |
| Experts<br>A delphi technique will be used to get an expert opinion and consensus on the aspects of the model to be developed. | Other: Focus groups, semistructured interviews and Delphi rounds<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| A multidisciplinary model to guide employment amongst people living with spinal cord injuries | The final model will be developed using all the information gained from the Phase one and two of the study. A validation process will be done through the delphi rounds. | 18 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Systematic Review of effective Vocational Rehabilitation interventions amongst People Living With Spinal Cord Injuries | The review study will follow the Chocrane A journal article will be published in a peer reviewed journal. | Five Months | 
| Rehabilitation Practices that promote employability of People Living with Spinal Cord Injuries | Stage 2 and Stage Three of Phase one will develop a matrix or guideline of vocational rehabilitation interventions throughout the phases of rehabilitation. | Three months | 
| Employment and Factors that affect employment amongst People living with Spinal Cord Injuries | Employment rates and nature of employment will be quantified using the International Labour Organisation definition of employment. The Factors affecting employment will also be quantified using the modified Life Situation Questionnaire. | Five months | 
| Barriers and Facilitators of employment amongst people living with spinal cord injuries. | Interviews and focus groups will be conducted to determine the barriers and facilitators of employment amongst PLWSCI. | 8 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Spinal Cord Injury and Employment