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Predicting change in labour market participation of people with spinal cord injury (SCI): longitudinal evidence from the Swiss SCI community survey


Study design

Longitudinal, population-based survey.


To examine change in labour market participation (LMP) of people with spinal cord injury (SCI) living in Switzerland and to identify predictors of increase, decrease and stability in LMP between 2012 and 2017.




Longitudinal information on LMP (i.e., weekly workload) was obtained from 311 gainfully employed, working-age individuals who participated in the Swiss Spinal Cord Injury Cohort Study (SwiSCI) community survey in 2012 and were still of working age at the time of completing the 2017 questionnaire. Statistical preselection of the predictors of change in LMP was carried out by implementing the least absolute shrinkage and selection operator (LASSO) in a multinomial logistic regression model. The final set of predictors was selected by comparison of several multinomial logistic regression models.


Out of 311 participants, almost half (43%) changed their LMP between 2012 and 2017, 48 increased their weekly workload, 49 reduced and 37 participants left the labour market prematurely. Age at time of the survey, years of education, having children, intention to change weekly workload, high satisfaction with daily routine, extra-time needs for transportation and managing support were associated with change in LMP.


Modifiable factors like education and satisfaction with daily routine should receive particular attention in the context of job retention strategies. More longitudinal research focusing on key employment transitions and trajectories over the life course of persons with SCI is needed to complement, validate and extend our findings.

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Fig. 1: Overview on the study selection and size of our study.

Data availability

Owing to our commitment to SwiSCI study participants and their privacy, datasets generated during the current study are not made publicly available but can be provided by the SwiSCI Study Centre based on reasonable request (


  1. Trezzini B, Schwegler U, Reinhardt JD. Work and wellbeing-related consequences of different return-to-work pathways of persons with spinal cord injury living in Switzerland. Spinal Cord. 2018;56:1166–75.

    Article  Google Scholar 

  2. Ferdiana A, Post MW, Hoekstra T, van der Woude LH, van der Klink JJ, Bultmann U. Employment trajectories after spinal cord injury: results from a 5-year prospective cohort study. Arch Phys Med Rehabil. 2014;95:2040–6.

    Article  Google Scholar 

  3. 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 (Read, Mass). 2017;58:99–110.

    Article  Google Scholar 

  4. Post MW, Reinhardt JD, Avellanet M, Escorpizo R, Engkasan JP, Schwegler U, et al. Employment among people with spinal cord injury in 22 countries across the world: results from the international spinal cord injury community survey. Arch Phys Med Rehabil. 2020;101:2157–66.

    Article  Google Scholar 

  5. Frieden L, Winnegar AJ. Opportunities for research to improve employment for people with spinal cord injuries. Spinal Cord. 2012;50:379–81.

    CAS  Article  Google Scholar 

  6. Arango-Lasprilla JC, Ketchum JM, Francis K, Lewis A, Premuda P, Wehman P, et al. Race, ethnicity, and employment outcomes 1, 5, and 10 years after spinal cord injury: a longitudinal analysis. PMR. 2010;2:901–10.

    Article  Google Scholar 

  7. Schwegler U, Fekete C, Finger M, Karcz K, Staubli S, Brinkhof MWG. Labor market participation of individuals with spinal cord injury living in Switzerland: determinants of between-person differences and counterfactual evaluation of their instrumental value for policy. Spinal Cord. 2021;59:429–40.

    Article  Google Scholar 

  8. Leiulfsrud AS, Solheim EF, Reinhardt JD, Post MWM, Horsewell J, Biering-Sørensen F, et al. Gender, class, employment status and social mobility following spinal cord injury in Denmark, the Netherlands, Norway and Switzerland. Spinal Cord. 2020;58:224–31.

    Article  Google Scholar 

  9. Trenaman L, Miller WC, Querée M, Escorpizo R. Modifiable and non-modifiable factors associated with employment outcomes following spinal cord injury: a systematic review. J spinal cord Med. 2015;38:422–31.

    Article  Google Scholar 

  10. Escorpizo R, Miller W, Trenaman L, Smith E. Work and Employment Following Spinal Cord Injury. In: Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC et al., (eds). Spinal Cord Injury Rehabilitation Evidence. Version 6.0. Vancouver: SCIRE Project, 2018.

  11. 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.

    Article  Google Scholar 

  12. Reinhardt JD, Post MW, Fekete C, Trezzini B, Brinkhof MW. Labor market integration of people with disabilities: results from the Swiss spinal cord injury cohort study. PLoS ONE. 2016;11:e0166955.

    Article  Google Scholar 

  13. Marti A, Boes S, Lay V, Escorpizo R, Trezzini B. The association between chronological age, age at injury and employment: Is there a mediating effect of secondary health conditions? Spinal Cord. 2016;54:239–44.

    CAS  Article  Google Scholar 

  14. Schwegler U, Fellinghauer CS, Trezzini B, Siegrist J. For the Swi SCISG. Factors associated with labor market participation of persons with traumatic SCI in Switzerland: analyzing the predictive power of social background, health, functional independence, and the environment. Spinal Cord. 2020;58:411–22.

    Article  Google Scholar 

  15. De Pietro C, Camenzind P, Sturny I, Crivelli L, Edwards-Garavoglia S, Spranger A et al. Switzerland: health system review. 2015.

  16. Scheel‐Sailer A, Post MW, Michel F, Weidmann‐Hügle T, Baumann, Hölzle R. Patients’ views on their decision making during inpatient rehabilitation after newly acquired spinal cord injury—A qualitative interview‐based study. Health Expectations. 2017;20:1133–42.

    Article  Google Scholar 

  17. Staubli S, Schwegler U, Schmitt K, Trezzini B. ICF-based process management in vocational rehabilitation for people with spinal cord injury. In: Handbook of Vocational Rehabilitation and Disability Evaluation. Springer, 2015, pp 371–96.

  18. Nützi M, Schwegler U, Staubli S, Ziegler R, Trezzini B. Factors, assessments and interventions related to job matching in the vocational rehabilitation of persons with spinal cord injury. Work (Read, Mass). 2019;64:117–34.

    Article  Google Scholar 

  19. Gross-Hemmi MH, Pacheco, Barzallo D. People with Spinal Cord Injury in Switzerland. Am J Phys Med Rehabilitation. 2017;96:S116–9.

    Article  Google Scholar 

  20. Post MW, Brinkhof MW, von Elm E, Boldt C, Brach M, Fekete C, et al. Design of the Swiss Spinal Cord Injury Cohort Study. Am J Phys Med Rehabil/Assoc Academic Physiatrists. 2011;90:S5–16.

    Article  Google Scholar 

  21. Swiss Spinal Cord Injury Cohort Study (SwiSCI). Community survey. 2018; 2021(30 August).

  22. Ehrmann C, Reinhardt JD, Joseph C, Hasnan N, Perrouin-Verbe B, Tederko P, et al. Describing functioning in people living with spinal cord injury across 22 countries: a graphical modeling approach. Arch Phys Med Rehabilitation. 2020;101:2112–43.

    Article  Google Scholar 

  23. Tibshirani R. Regression Shrinkage and Selection via the Lasso. J R Stat Soc Ser B (Methodol). 1996;58:267–88.

    Google Scholar 

  24. Breiman L. Bagging predictors. Mach Learn. 1996;24:123–40.

    Google Scholar 

  25. McElreath R. Statistical rethinking: A Bayesian course with examples in R and Stan, Chapman and Hall/CRC, 2018.

  26. Team RC. R: A language and environment for statistical computing. 2013.

  27. Friedman J, Hastie T, Tibshirani R, Narasimhan B, Tay K, Simon N et al. Package ‘glmnet’. Journal of Statistical Software. 2010a 2021; 33(1).

  28. Ripley B, Venables W, Ripley MB. Package ‘nnet’. R package version. 2016;7:700.

    Google Scholar 

  29. Stekhoven DJ, Bühlmann P. MissForest—non-parametric missing value imputation for mixed-type data. Bioinformatics. 2012;28:112–8.

    CAS  Article  Google Scholar 

  30. 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.

    CAS  Article  Google Scholar 

  31. 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 Rehabilitation. 2015;21:1–9.

    Article  Google Scholar 

  32. Holmlund L, Guidetti S, Eriksson G, Asaba E. Return to work in the context of everyday life 7-11 years after spinal cord injury - a follow-up study. Disabil Rehabil. 2018;40:2875–83.

    Article  Google Scholar 

  33. Meade MA, Reed KS, Krause JS. The Impact of health behaviors and health management on employment after SCI: physical health and functioning. Top Spinal Cord Inj Rehabilitation. 2016;22:39–48.

    Article  Google Scholar 

  34. Richardson A, Samaranayaka A, Sullivan M, Derrett S. Secondary health conditions and disability among people with spinal cord injury: A prospective cohort study. J Spinal Cord Med. 2021;44:19–28.

    Article  Google Scholar 

  35. Kalpakjian CZ, Scelza WM, Forchheimer MB, Toussaint LL. Preliminary reliability and validity of a spinal cord injury secondary conditions scale. J Spinal Cord Med. 2007;30:131–9.

    Article  Google Scholar 

  36. Office TFS. Household Budget Survey: results 2019. 2021; (17.02.2022).

  37. Office TFS. Distribution of net wages 2018. 2020; (17.02.2022).

  38. OECD Switzerland.; (17.02.2022).

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We thank the SwiSCI Steering Committee with its members Xavier Jordan, Fabienne Reynard (Clinique Romande de Réadaptation, Sion); Michael Baumberger, Hans Peter Gmünder (Swiss Paraplegic Centre, Nottwil); Armin Curt, Martin Schubert (University Clinic Balgrist, Zürich); Margret Hund-Georgiadis, Kerstin Hug (REHAB Basel, Basel); Laurent Prince (Swiss Paraplegic Association, Nottwil); Heidi Hanselmann (Swiss Paraplegic Foundation, Nottwil); Daniel Joggi (Representative of persons with SCI); Nadja Münzel (Parahelp, Nottwil); Mirjam Brach, Gerold Stucki (Swiss Paraplegic Research, Nottwil); Armin Gemperli (SwiSCI Coordination Group at Swiss Paraplegic Research, Nottwil).


SwiSCI is hosted and funded by Swiss Paraplegic Research. The present study was conducted as part of a PhD thesis and supported by the Swiss National Science Foundation (SNSF) under grant no. 10531C_173322.

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Authors and Affiliations



BT, CE, MEF and KK were responsible for designing the conceptual framework of the study. CE and KK conducted the statistical analysis. KK, CE and BT prepared the manuscript. MEF, US and AS substantially contributed to the data interpretation and the article preparation. AS provided valuable input from vocational integration practice.

Corresponding author

Correspondence to Katarzyna Karcz.

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Competing interests

The authors declare no competing interests.

Ethics approval

Ethical approval for Survey 2012 was approved by the principal ethics committee on research involving humans of the Canton of Lucerne (KEK Luzern, internal application 11042, approved 28.06.2011) and subsequently endorsed by the additional involved cantonal ethics committees of Cantons Basel-Stadt (EK Basel, internal application 306/11, approved 06.09.2011) and Valais (CCVEM Sion, internal application CCVEM042/11, approved 06.12.2011). Ethical approval for Survey 2017 was granted by the leading ethical institution Ethikkommision Nordwest-und Zentralschweiz (EKNZ, Project-ID: 11042 PB_2016–02608, approved Dec 2016). We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

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Karcz, K., Ehrmann, C., Finger, M.E. et al. Predicting change in labour market participation of people with spinal cord injury (SCI): longitudinal evidence from the Swiss SCI community survey. Spinal Cord (2022).

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