Education, independent mobility, and living independently predicts employment after spinal cord injury


According to an Italian study, published in the journal Spinal Cord, education level, independent mobility, and living independently are all predictors of employment after spinal cord injury whereas older age, being married, and tetraplegia are all predictors of unemployment. The study also found that four years after incurring a spinal cord injury, 42.1% of patients have found employment but 62% report a worsening in employment position.

The multicentre, prospective study was a follow-up study, using a 24-question telephone interview, of patients in the GISEM study (Pagliacci et al, Spinal Cord 2003; 41: 620-28). The aim was to assess employment status, predictors of employment, and the effect of being employed (or not being employed) on quality of life.


They found that 42.1% of patients had some form of employment four years after their inclusion in the original study. Marco Franceschini, Department of Rehabilitation, IRCSS San Raffaele Pisana, Rome, Italy, and his co authors reported that this figure correlated with what has been found in other studies of employment after spinal cord injury. They wrote: “In our opinion, this should be considered a good result, considering that at the time of the study in Italy, it was very difficult to find a job for people who had lost an employment at advanced age, mostly when disabled.”


Of those who were employed, many of them reported a change in job type, job timetable, or other job characteristics. Overall, 43.7% of patients lost the employment that they had prior to their injury and 62% reported a worsening in employment status.  According to the unemployed patients, the most common reason for the lack of work was difficulty in finding a suitable job (31.9%).


Patients who did have a job were younger (33.8±11.5 years vs. 47.6±16.8 years), had spent longer in education (76.5% had an education of 8-13 years and 14.1% had an education of more than 13 years compared with 62.2% and 3.4%, respectively, of those not employed), and were less likely to be married (21.8 vs. 57.9%). As well as these factors, bowel continence, independence in mobility, the ability to drive, participating in the community and the ability to live alone were also predictors of employment. However, patients with a tetraplegia were more likely to be unemployed than those lower spinal lesions.


As might be predicted, patients who were employed reported having a better quality of life than those who were not employed. They were found to have a better sex life, more likely to leave for leisure reasons, and to practice more hobbies and sports. These findings were despite the fact that more patients who were employed complained of having fewer social contacts in leisure time than those who were not employed.


Franceschini et al reported that their data support the view that several interventions may favour employment after spinal cord injury. They wrote: “Rehabilitation programmes should go beyond the approach focused on in-house activities and bridge to occupational therapy and social reintegration.”