Employment, health outcomes, and life satisfaction after spinal cord injury: comparison of veterans and nonveterans

Article metrics

  • 51 Accesses


Study design

Retrospective cohort study.


To explore differences between veterans and nonveterans with spinal cord injury (SCI) for employment, health, and satisfaction with life outcomes after controlling for demographic and injury characteristics.


Hospitals in the Spinal Cord Injury Model System of care.


A total of 9754 (85% nonveterans and 15% veterans) adults with traumatic SCI interviewed from 2000 and 2015 and completed follow-up years 1, 5, and 10 were included in this study. Employment status and the Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF) measured employment. The SF-36 for self-perceived health status, CHART-SF, and rehospitalization determined health outcomes. Satisfaction with life was measured by the Satisfaction with Life Scale (SWLS). Secondary data analyses using χ2, t-tests, and generalized estimating equations (GEEs) model to determine group differences with control of demographic and injury characteristics.


There were no significant differences for employment and SWL between nonveterans and veterans. There were some differences in health outcomes; whereas, veterans had better physical independence and mobility compared with nonveterans.


Interventions for both groups should target adults with a disability from SCI, be customized for varying levels of injury that address differences in healthcare systems, demographic backgrounds, economic resources, disincentives, and motivation.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Data archiving

The datasets generated during and/or analyzed during the current study are available in the National Spinal Cord Injury Statistical Center [https://www.nscisc.uab.edu/Public_Pages/Database] [36].


  1. 1.

    Jain NB, Ayers GD, Peterson EN, Harris MB, Morse L, O’Connor KC, et al. Traumatic spinal cord injury in the United States, 1993–2012. J Am Med Assoc. 2015;313:2236–43. https://doi.org/10.1001/jama.2015.6250.

  2. 2.

    Devivo MJ. Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal Cord. 2012;50:365–72. https://doi.org/10.1038/sc.2011.178.

  3. 3.

    Department of Veteran Affairs. VA and spinal cord. https://www.va.gov/opa/publications/factsheets/fs_spinal_cord_injury.pdf. Accessed 25 Aug 2018.

  4. 4.

    Krause JS, Saunders LL. Health, secondary conditions, and life expectancy after spinal cord injury. Arch Phys Med Rehabil. 2011;92:1770–5. https://doi.org/10.1016/j.apmr.2011.05.024.

  5. 5.

    Adriaansen JE, Van Asbeck FWA, Lindeman E, Van Der Woude LHV, De Groot S, Post MWM. Secondary health conditions in persons with spinal cord injury for at least 10 years: design of a comprehensive long-term cross-sectional study. Disabil Rehabil. 2013;35:1104–10. https://doi.org/10.3109/096382288.2012.712196.

  6. 6.

    Saunders LL, Krause JS, Focht KL. A longitudinal study of depression in survivors of spinal cord injury. Spinal Cord. 2012;50:72–7. https://doi.org/10.1038/sc.2011.83.

  7. 7.

    Ullrich PM, Spungen AM, Atkinson D, Bombardier CH, Chen Y, Erosa NA, et al. Activity and participation after spinal cord injury: state-of-the-art report. Arch Phys Med Rehabil. 2012;49:155–274. https://doi.org/10.1682/JRRD.2010.06.0108.

  8. 8.

    Migliorini C, Callaway L, New P. Preliminary investigation into subjective well-being, mental health, resilience, and spinal cord injury. J Spinal Cord Med. 2013;36:660–5. https://doi.org/10.1179/2045772313Y.0000000100.

  9. 9.

    Richardson LK, Frueh C, Acierno R. Prevalence estimates of combat-related post-traumatic stress disorder: critical review. Aust N Z J Psychiatry. 2010;44:4–19. https://doi.org/10.3109/00048670903393597.

  10. 10.

    Morin R, editor. For many injured veterans, a lifetime of consequences. Washington, DC: Pew Research Center. 2011. http://www.pewresearch.org/topics/military-and-veterans/2011.

  11. 11.

    Hoerster KD, Lehavot K, Simpson T, McFall M, Reiber G, Nelson KM. Health and health behavior differences: U.S. military, veterans, and civilian men. Am J Prev Med. 2010;43:483–9. https://doi.org/10.1016/j.amepre.2012.07.029.

  12. 12.

    Bray RM, Pemberton MR, Lane ME, et al. Substance use and mental health trends among U.S. military active duty personnel: key findings from the 2008 DoD Health Behavior Survey. Mil Med. 2010;175:390–9. https://doi.org/10.7205/MILMED-D-09-00132.

  13. 13.

    Hedrick B, Pape TL, Heinemann AW, Ruddell JL, Reis J. Employment issues and assistive technology use for persons with spinal cord injury. J Rehabil Res Dev. 2006;43:185–98. https://doi.org/10.1682/jrrd.2005.03.0062.

  14. 14.

    LaVela SL, Evans CT, Prohaska TR, Miskevics S, Ganesh SP, Weaver FM. Males aging with a spinal cord injury: prevalence of cardiovascular and metabolic conditions. Arch Phys Med Rehabil. 2012;93:90–95. https://doi.org/10.1016/j.apmr.2011.07.201.

  15. 15.

    Ullrich PM, Jenson MP, Loeser JD, Cardenas DD. Pain intensity, pain interference and characteristics of spinal cord injury. Spinal Cord. 2008;46:451–5. https://doi.org/10.1038/sc.2008.5.

  16. 16.

    Fortman A, Rutledge T, McCulloch RC, Shivpuri S, Nisenzon AN, Muse J. Satisfaction with life among veterans with spinal cord injuries completing multidisciplinary rehabilitation. Spinal Cord. 2013;51:482–6. https://doi.org/10.1038/sc.2012.172.

  17. 17.

    LaVela SL, Etingen B, Miskevics S, Heinemann AW. What determines low satisfaction in individuals with spinal cord injury? J Spinal Cord Med. 2018;1–9. https://doi.org/10.1080/10790268.2018.1466480.

  18. 18.

    van Koppenhagen CF, Post MW, van der Woude LH, de Grppt S, de Wotte LP, van Asbeck FW, et al. Recovery of life satisfaction in persons with spinal cord injury during inpatient rehabilitation. Am J Phys Med Rehabil. 2009;88:887–95. https://doi.org/10.1097/PHM.0b013e3181b71afe.

  19. 19.

    Hale-Gallardo J, Jia H, Delisle A, Levy C, Osorio V, Smith J, et al. Enhancing health and independent living for veterans with disabilities by leveraging community-based resources. J Multidiscip Health. 2017;10:41–7. https://doi.org/10.2147/jmdh.s118706.

  20. 20.

    Chen Y, Devivo MJ, Richards JS, Sanagustin TB. Spinal cord injury model systems: review of program and national database from 1970 to 2015. Arch Phys Med Rehabil. 2016;97:1797–804. https://doi.org/10.1016/j.apmr.2016.02.027.

  21. 21.

    Ware JE, Sherbourne CD. The MOS 36-Ltem short-form health survey (SF-36). Med Care. 1992;30:473–83. https://doi.org/10.1097/00005650-199206000-00002.

  22. 22.

    Mchorney CA, Johne W, Anastasiae R. The MOS 36-item short-form health survey (SF-36). Med Care. 1993;31:247–63. https://doi.org/10.1097/00005650-199303000-00006.

  23. 23.

    Whiteneck GG, Brooks CA, Charlifue S, Gerhart KA, Mellick D, Overholser D, et al. Guide for use of the CHART: craig handicap assessment and reporting technique [internet]. Englewood (CO): Craig Hospital; 1992. https://craighospital.org/uploads/CraigHospital.CHARTManual.pdf.

  24. 24.

    Whiteneck GG, Brooks CA, Charlifue S, Gerhart KA, Mellick D, Overholser D, et al. Quantifying handicap: a new measure of long-term rehabilitation outcomes. Arch Phys Med Rehabil. 1992;73:519–26. https://www.archives-pmr.org/article/0003-9993(92)90185-Y/pdf.

  25. 25.

    Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assess. 1985;49:71–5. https://doi.org/10.1207/s15327752jpa4901_13.

  26. 26.

    Post MW, Leeuwen CM, Koppenhagen CF, Groot SD. Validity of the life satisfaction questions, the life satisfaction questionnaire, and the satisfaction with life scale in persons with spinal cord injury. Arch Phys Med Rehabil. 2012;93:1832–7. https://doi.org/10.1016/j.apmr.2012.03.025.

  27. 27.

    Twisk JWR. Applied longitudinal data analysis for epidemiology. Cambridge UK: Cambridge University Press; 2013.

  28. 28.

    Olsen A, O’Leary S. Military veterans and social security: 2010 update. Soc Secur Bull. 2011;71: 1–15. https://ssrn.com/abstract=1831443.

  29. 29.

    Krause JS, Reed KS. Barriers and facilitators to employment after spinal cord injury: underlying dimensions and their relationship to labor force participation. Spinal Cord. 2010;49:285–91. https://doi.org/10.1038/sc.2010.110.

  30. 30.

    Inge KJ, Cimera RE, Revell WG, Wehman PH, Seward HE. Employment outcomes for individuals with spinal cord injuries: 2011–2013. J Vocat Rehabil. 2015;42:85–96. https://doi.org/10.3233/JVR-140726.

  31. 31.

    Ottomanelli L, Lind L. Review of critical factors related to employment after spinal cord injury: implications for research and vocational services. J Spinal Cord Med. 2009;32:503–31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792457/.

  32. 32.

    Krause JS, Saunders L, Staten D. Race-ethnicity, education, and employment after spinal cord injury. Rehabil Couns Bull. 2010;53:78–86. https://doi.org/10.1177/0034355209345161.

  33. 33.

    Ottomanelli L, Sippel JL, Cipher DJ, Goetz LL. Factors associated with employment among veterans with spinal cord injury. Spinal Cord. 2011;34:141–50. https://doi.org/10.3233/JVR-2011-0542.

  34. 34.

    Chen Y, He Y, DeVivo MJ. Changing demographics and injury profile of new traumatic spinal cord injuries in the United States, 1972–2014. Arch Phys Med Rehabil. 2016;97:1610–9. https://doi.org/10.1016/j.apmr.2016.03.017.

  35. 35.

    Wang V, Allen K, Van Houtven CH, Coffman C, Sperber N, et al. Supporting team to optimize function and independence in Veterans: a multi-study program and mixed methods protocol. Implement Sci. 2018;13:1–14. https://doi.org/10.1186/s13012-018-0748-3.

  36. 36.

    The University of Alabama at Birmingham. National Spinal Cord Injury Model Systems (SCIMS) Database. https://www.nscisc.uab.edu/Public_Pages/Database.

Download references


The contents of this publication were developed with grants (grant nos 90SI5016 and 90SI5002) from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this publication do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.

Author information

KWG was responsible for developing the research idea, developing aims and objectives, searching the literature, extracting and analyzing the data, interpreting the results, creating the reference list, and writing the manuscript. YC was responsible for extracting and analyzing the data, writing sections of manuscript, and creating tables. SPB was responsible for interpreting the results and providing feedback on the manuscript. SDM was responsible for interpreting results and providing feedback on the manuscript. JSK was responsible for data access and retrieval, developing research idea, developing aims and objectives, interpreting results, providing feedback on the manuscript, and providing overall mentorship on entire project.

Correspondence to Kelli W. Gary.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics statement

We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers for this database were followed before this information was used as secondary data to conduct this research.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark