Article | Published:

Work and wellbeing-related consequences of different return-to-work pathways of persons with spinal cord injury living in Switzerland


Study design

Observational study based on the 2012 community survey of the Swiss Spinal Cord Injury Cohort Study (SwiSCI).


To investigate work and wellbeing-related consequences of different return-to-work (RTW) pathways after SCI.




Using a subsample of 243 SwiSCI participants, we determined whether a respondent had returned to the pre-injury employer, started with a new employer or had not returned to gainful employment post-SCI. For each pathway, descriptive statistics were provided and work and wellbeing-related consequences were examined with regression analyses.


One hundred eleven (45.7%) participants had returned to their pre-injury employer, 80 (32.9%) had changed employers and 52 (21.4%) had never returned to paid work post-SCI. Although returning to the pre-injury employer was associated with a shorter RTW time and a higher current weekly work time compared with starting work with a new employer, no significant differences were found with regard to current employment status and post-SCI work duration. Concerning wellbeing-related outcomes (i.e., income, quality of life and life satisfaction), the two pathways did not differ.


Although lasting RTW had beneficial wellbeing outcomes, the specific pathway initially taken (i.e., pre-injury vs. new employer) appeared less crucial. Although the two pathways seem equally viable, longitudinal data are required to corroborate the present findings, and future research needs to clarify the role of the client triage system and of vocational rehabilitation practices with regard to person–job match and its impact on job satisfaction and job performance.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Ethics declarations

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.

    Bickenbach J, Officer A, Shakespeare T, von Groote P (eds). International perspectives on spinal cord injury. Geneva: World Health Organization, International Spinal CordSociety; 2013.

  2. 2.

    García-Altés A, Pérez K, Novoa A, Suelves JM, Bernabeu M, Vidal J, et al. Spinal cord injury and traumatic brain injury: a cost-of-illness study. Neuroepidemiology. 2012;39:103–08.

  3. 3.

    United Nations. Convention on the Rights of Persons with Disabilities. Retrieved 20 January 2018, from

  4. 4.

    Ramakrishnan K, Loh SY, Omar Z. Earnings among people with spinal cord injury. Spinal Cord. 2011;49:986–9.

  5. 5.

    Krause JS. Adjustment to life after spinal cord injury: a comparison among three participant groups based on employment status. Rehabil Couns Bull. 1992;35:218–29.

  6. 6.

    Meade MA, Reed KS, Saunders LL, Krause JS. It’s all of the above: benefits of working for individuals with spinal cord injury. Top Spinal Cord Inj Rehabil. 2015;21:1–9.

  7. 7.

    Hess D, Meade M, Forchheimer M, Tate D. Psychological well-being and intensity of employment in individuals with a spinal cord injury. Top Spinal Cord Inj Rehabil. 2004;9:1–10.

  8. 8.

    Marti A, Reinhardt JD, Graf S, Escorpizo R, Post MWM. To work or not to work: labour market participation of people with spinal cord injury living in Switzerland. Spinal Cord. 2012;50:521–6.

  9. 9.

    Reinhardt JD, Post MWM, Fekete C, Trezzini B, Brinkhof MWG. Labour market integration of people with disabilities: results from the Swiss Spinal Cord Cohort Study. PLoS ONE. 2016;11:e0166955.

  10. 10.

    Kieser U, Senn J. Invalidität: Alles über Renten, Rechte und Versicherungen, 4. Zürich: vollst. überarb. und aktualisierte Aufl. edn Beobachter; 2011.

  11. 11.

    Bräunlich Keller I. Arbeitsrecht. Zürich: Beobachter-Edition; 2017.

  12. 12.

    Ziegler R. Die berufliche Situation vor und nach Eintritt einer Querschnittlähmung. DMGP Informationsblatt 2005; February 15–18.

  13. 13.

    Chan SK, Man DW. Barriers to returning to work for people with spinal cord injuries: a focus group study. Work. 2005;25:325–32.

  14. 14.

    Chapin MH, Kewman DG. Factors affecting employment following spinal cord injury: a qualitative study. Rehabil Psychol. 2001;46:400–16.

  15. 15.

    Ramakrishnan K, Mazlan M, Julia PE, Abdul Latif L. Return to work after spinal cord injury: factors related to time to first job. Spinal Cord. 2011;49:924–7.

  16. 16.

    Krause JS, Terza JV, Saunders LL, Dismuke CE. Delayed entry into employment after spinal cord injury: factors related to time to first job. Spinal Cord. 2010;48:487–91.

  17. 17.

    Krause JS. Years to employment after spinal cord injury. Arch Phys Med Rehabil. 2003;84:1282–9.

  18. 18.

    Schönherr MC, Groothoff JW, Mulder GA, Eisma WH. Vocational perspectives after spinal cord injury. Clin Rehabil. 2005;19:200–8.

  19. 19.

    Krause JS, Terza JV, Dismuke CE. Factors associated with labor force participation after spinal cord injury. J Vocat Rehabil. 2010;33:89–99.

  20. 20.

    Meade MA, Barrett K, Ellenbogen PS, Jackson MN. Work intensity and variations in health and personal characteristics of individuals with spinal cord injury (SCI). J Vocat Rehabil. 2006;25:13–9.

  21. 21.

    Murphy GC, Young AE. Employment participation following spinal cord injury: relation to selected participant demographic, injury and psychological characteristics. Disabil Rehabil. 2005;27:1297–306.

  22. 22.

    Krause JS, Terza JV, Erten M, Focht KL, Dismuke CE. Prediction of postinjury employment and percentage of time worked after spinal cord injury. Arch Phys Med Rehabil. 2012;93:373–5.

  23. 23.

    Brinkhof MW, Fekete C, Chamberlain JD, Post MW, Gemperli A. Swiss national community survey on functioning after spinal cord injury: Protocol, characteristics of participants and determinants of non-response. J Rehabil Med. 2016;48:120–30.

  24. 24.

    WHOQOL Group. The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties. Social Sci Med. 1998;46:1569–85.

  25. 25.

    FORS. Swiss household panel, wave 14 (individual questionnaire). Lausanne: FORS; 2012.

  26. 26.

    ILO. International Standard Classification of Occupations 2008 (ISCO-08). Geneva: International Labour Organization; 2008.

  27. 27.

    Cleves MA, Gutierrez RG, Gould WW, Marchenko YV. An introduction to survival analysis using Stata. College Station, TX: Rev. edn Stata Press; 2010.

  28. 28.

    Baum CF. Stata tip 63: Modeling proportions. Stata J. 2008;8:299–303.

  29. 29.

    Von Hippel PT. Regression with missing Ys: an improved strategy for analyzing multiply imputed data. Sociol Methodol. 2007;37:83–117.

  30. 30.

    Tomassen PC, Post MW, van Asbeck FW. Return to work after spinal cord injury. Spinal Cord. 2000;38:51–5.

  31. 31.

    Krause JS. Employment after spinal cord injury. Arch Phys Med Rehabil. 1992;73:163–9.

  32. 32.

    BFS. Taschenstatistik der Schweiz 2017. Bern: Bundesamt für Statistik; 2017.

  33. 33.

    Krause JS, Terza JV, Dismuke C. Earnings among people with spinal cord injury. Arch Phys Med Rehabil. 2008;89:1474–81.

  34. 34.

    Jain NB, Sullivan M, Kazis LE, Tun CG, Garshick E. Factors associated with health-related quality of life in chronic spinal cord injury. Am J Phys Med Rehabil. 2007;86:387–96.

  35. 35.

    Tonack M, Hitzig SL, Craven BC, Campbell KA, Boschen KA, McGillivray CF. Predicting life satisfaction after spinal cord injury in a Canadian sample. Spinal Cord. 2008;46:380–5.

  36. 36.

    Marti A, Escorpizo R, Schwegler U, Staubli S, Trezzini B. Employment pathways of individuals with spinal cord injury living in Switzerland: a qualitative study. Work. 2017;58:99–110.

  37. 37.

    Kristof-Brown AL, Zimmerman RD, Johnson EC. Consequences of individuals’ fit at work: a meta-analysis of person-job, person-organization, person-group, and person-supervisor fit. Pers Psychol. 2005;58:281–342.

  38. 38.

    Nützi M, Trezzini B, Medici L, Schwegler U. Job matching: an interdisciplinary scoping study with implications for vocational rehabilitation counseling. Rehabil Psychol. 2017;62:45–68.

  39. 39.

    O’Hare MA, Murphy G. Withdrawal from employment gained post-SCI: precipitating factors. Aust J Rehabil Couns. 2015;21:91–107.

  40. 40.

    Murphy G, Brown D, Athanasou J, Foreman P, Young A. Labour force participation and employment among a sample of Australian patients with a spinal cord injury. Spinal Cord. 1997;35:238–44.

Download references


We are grateful to all the participants of the SwiSCI survey for their time and effort spent in responding to the questions. We also thank Gerold Stucki for helpful feedback on an earlier version of this paper. We further thank the personnel of the SwiSCI study center and the SwiSCI Steering Committee whose members are: Xavier Jordan, Bertrand Léger (Clinique Romande de Réadaptation, Sion); Michael Baumberger, Hans Peter Gmünder (Swiss Paraplegic Center, Nottwil); Armin Curt, Martin Schubert (University Clinic Balgrist, Zürich); Margret Hund-Georgiadis, Kerstin Hug (REHAB Basel, Basel); Hans Georg Koch (Swiss Paraplegic Association, Nottwil); Nadja Münzel (Parahelp, Nottwil); Hardy Landolt (Representative for persons with SCI, Glarus); Mirjam Brach, Gerold Stucki (Swiss Paraplegic Research, Nottwil); Martin Brinkhof, Christine Thyrian (SwiSCI Study Center at Swiss Paraplegic Research, Nottwil).

Author contributions

BT was responsible for designing the study, conducting the data analysis, interpreting results and preparing the article. US and JR contributed to the data interpretation and article preparation.

Funding information

The study was financed by Swiss Paraplegic Research within the framework of the Swiss Spinal Cord Injury Cohort Study (SwiSCI).

Author information

Conflict of interest

The authors declare that they have no conflict of interest.

Correspondence to Bruno Trezzini.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark
Fig. 1