Rates of Employment and Return to Work After Spinal Cord Lesion Onset in Israel

Objective: To assess the employment rates, rates of return to work (RTW) in Israel, and factors affecting these rates after the onset of traumatic and nontraumatic spinal cord lesions (SCLs). Design: Longitudinal retrospective cohort study, collecting demographic, clinical, and employment data from hospital records and by phone interviews. Setting: A rehabilitation medical center. Participants: Inpatients with SCLs (N=487) and no comorbidities, aged 43±14 years at SCL onset, 72% men, 45% traumatic, admitted to rehabilitation between 2010 and 2022. Interventions: Not applicable. Main Outcome Measures: Rates of employment and RTW, and factors affecting them. Results: Patients’ American Spinal Injury Association Impairment Scale grades at discharge from rehabilitation were A, B, C, D, and E (normal according to the International Standards for Neurological Classification of Spinal Cord Injury(in 16.2%, 2.9%, 16.6%, 64.1%, and 0.2% of cases, respectively. The mean discharge Spinal Cord Independence Measure III score was 68±19). Before SCL onset, 79% of the patients had been employed. At any time after SCL onset, one-third (33.1%; 95% CI, 28.9%-37.2%) of the sample were employed; 29.7% and 35.8% for traumatic vs nontraumatic SCL. The RTW rate for those previously employed was 36.9% (95% CI, 32.0%-41.9%); 29% and 43.9% for traumatic vs nontraumatic SCL. Employment was independently related to former employment, education, and higher discharge Spinal Cord Independence Measure III scores (P<.01). The level of injury, American Spinal Injury Association Impairment Scale grade, and SCL etiology had no independent association with employment or RTW. Factors perceived as assisting employment after SCL onset (catalysts) were motivation, rehabilitation process, and support of family, friends, or colleagues. Reported reasons for not working (obstacles) were disability, pain, older age, sleep disturbances, mental condition, studying, and inaccessibility. Conclusions: Employment and RTW rates after SCL were low compared to those of people with other disabilities nationwide and to people with SCL in Western countries. The main catalysts were patient motivation and rehabilitation, and the main obstacles were disability and pain. To enhance employment after SCL, rehabilitation and an adequate national policy should be implemented. Rehabilitation should include vocational training and management of complications, pain, and patients’ motivation.