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Relationship between employment and quality of life and self-perceived health in people with spinal cord injury: an international comparative study based on the InSCI Community Survey

Spinal Cord volume 62, pages 110–116 (2024)Cite this article

Subjects

Abstract

Study design

Cross-sectional study.

Objectives

Work-related disability is common in persons with spinal cord injury (SCI). The aims of this study are to examine the associations of employment with self-perceived health (SPH) and quality of life (QoL) across 22 countries and to explore the covariates around employment and SPH and QoL.

Setting

Community.

Methods

We analyzed 9494 community-dwelling persons with SCI aged 18–65. We performed an adjusted regression and path analysis. The independent variable was ‘employment’ and the dependent variables were two single items: QoL (very poor to very good) and SPH (excellent to poor). Covariates included the Gross Domestic Product (GDP), education, time since SCI, age, gender, years of employment after SCI, SCI level (paraplegia, tetraplegia), and completeness of SCI.

Results

Participants’ mean age was 47, 74% were male, and 63% had paraplegia. We found an association between employment and QoL and SPH. While the magnitude of the effect of employment on QoL did not differ across GDP quartiles, its perceived effect on QoL was found to be significant in the highest GDP quartile. Employment was predictive of good SPH in two GDP quartiles (Q1 and Q4), but significant across all quartiles when predicting poor perceptions, with the magnitude of effect varying significantly.

Conclusions

Employment is closely related to QoL and SPH depending on the GDP. We may positively influence the QoL and SPH in the SCI population to promote better employment outcomes by considering the infrastructure and economy.

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Fig. 1: Path analysis results. % = proportion of the sample, regression coefficients.

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Data availability

The datasets generated during and analyzed during the current study are not publicly available due to multinational data sharing agreement governed by institutional ethics/Institutional Review Boards and government policies on open data sharing.

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Acknowledgements

This study is based on data from the International Spinal Cord Injury (InSCI) Community Survey, providing the evidence for the Learning Health System for Spinal Cord Injury (LHS-SCI, see Am J Phys Med Rehabil 2017;96(Suppl):S23–S34). The LHS-SCI is an effort to implement the recommendations described in the WHO report International Perspectives on Spinal Cord Injury (Bickenbach J et al. Geneva: WHO Press; 2013). The members of the InSCI Steering Committee are: James Middleton, Julia Patrick Engkasan, Gerold Stucki, Mirjam Brach, Jerome Bickenbach, Mirja Gross-Hemmi, Christine Thyrian, Linamara Battistella, Jianan Li, Brigitte Perrouin-Verbe, Christoph Gutenbrunner, Christina-Anastasia Rapidi, Luh Karunia Wahyuni, Mauro Zampolini, Eiichi Saitoh, Bum-Suk Lee, Alvydas Juocevicius, Nazirah Hasnan, Abderrazak Hajjioui, Marcel W.M. Post, Anne Catrine Martinsen, Piotr Tederko, Daiana Popa, Conran Joseph, Mercè Avellanet, Michael Baumberger, Apichana Kovindha, and Reuben Escorpizo. Funding: No financial assistance was received in support of the study.

Author information

Authors and Affiliations

  1. The University of Vermont, Department of Rehabilitation and Movement Science, Burlington, VT, USA

    Reuben Escorpizo & Shelly Naud

  2. Swiss Paraplegic Research, Nottwil, Switzerland

    Reuben Escorpizo & Urban Schwegler

  3. Centre of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Centre Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands

    Marcel W. M. Post

  4. University of Groningen, University Medical Centre Groningen, Centre for Rehabilitation, Groningen, The Netherlands

    Marcel W. M. Post

  5. Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland

    Urban Schwegler

  6. Universiti Malaya, Lumpur, Malaysia

    Julia Engkasan

  7. Clinic of Rehabilitation, Department of Spinal Cord Injuries, St Olavs hospital, Trondheim University Hospital, Trondheim, Norway

    Annette Halvorsen

  8. Department of Medical Quality Registries, St Olavs hospital, Trondheim University Hospital, Trondheim, Norway

    Annette Halvorsen

  9. Division of Rehabilitation, Princess Alexandra Hospital, and The Hopkins Centre, Metro South Health and Griffith University, Brisbane, Australia

    Timothy Geraghty

  10. Kennedy Krieger Institute / Johns Hopkins School of Medicine, Baltimore, MD, USA

    Cristina Sadowsky

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Contributions

RE was responsible for conceptualizing the project, writing the protocol and report, interpreting results, and revision and reviewing of the manuscript prior to submission. SN was responsible for writing the protocol, analyzing data, interpreting results, writing, revision and reviewing of the manuscript prior to submission. MWMP participated in the conceptualization and writing of the protocol, interpreting results, writing, revision, and reviewing of the manuscript prior to submission. US participated in the conceptualization and writing of the protocol, interpreting results, writing, revision, and reviewing of the manuscript prior to submission. JE participated in the conceptualization and writing of the protocol, interpreting results, writing, revision, and reviewing of the manuscript prior to submission. AH participated in the conceptualization and writing of the protocol, interpreting results, writing, revision, and reviewing of the manuscript prior to submission. TG participated in the conceptualization and writing of the protocol, interpreting results, writing, revision, and reviewing of the manuscript prior to submission. CS participated in the conceptualization and writing of the protocol, interpreting results, writing, revision, and reviewing of the manuscript prior to submission.

Corresponding author

Correspondence to Reuben Escorpizo.

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Competing interests

The authors declare no competing interests.

Ethical approval

Each participating country received approval from its respective Institutional Review Boards or Ethical Committees. The study complied with the Declaration of Helsinki. All procedures performed in studies involving human participants were approved by the ethical committees of each country. Consent to participate was administered to participants before their participation.

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Escorpizo, R., Naud, S., Post, M.W.M. et al. Relationship between employment and quality of life and self-perceived health in people with spinal cord injury: an international comparative study based on the InSCI Community Survey. Spinal Cord 62, 110–116 (2024). https://doi.org/10.1038/s41393-023-00953-8

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