Perceived job quality among persons with spinal cord injury: The contribution of sociodemographic characteristics, health-related factors, and person-job match.

CONTEXT/OBJECTIVE: Perceived job quality is a key indicator of sustainable work among persons with spinal cord injuries (PwSCI). This study aimed at (a) describing three indicators of perceived job quality (i.e. job satisfaction, job performance, and work stress) among working PwSCI, and (b) identifying whether and how different person-job match dimensions (i.e. interest congruence, demands-abilities fit, needs-supplies fit, and effort-reward imbalance) as well as sociodemographic and health-related factors (e.g. age, sex, SCI-related characteristics, pain problems, and depressive symptoms) are associated with perceived job quality. DESIGN: Cross-sectional, self-report survey. SETTING: Community. PARTICIPANTS: 549 working-age PwSCI who participated in the 2017 community survey of the Swiss Spinal Cord Injury Cohort study and reported being engaged in paid work. OUTCOME MEASURES: Job satisfaction, job performance, and work stress. RESULTS: Higher interest congruence, better needs-supplies fit and lower effort-reward imbalance, as well as female sex, were associated with higher job satisfaction, while higher effort-reward imbalance, poorer demands-abilities fit (underqualification), and - surprisingly - better needs-supplies fit were associated with higher work stress. Moreover, underqualification, worse needs-supplies fit as well as pain, depressive symptoms, and language region were associated with lower job performance. CONCLUSION: Integrating individuals in jobs that match their abilities, interests and needs, and which adequately reward their efforts may contribute to better job quality among PwSCI. Beyond that, common secondary health conditions and comorbidities such as pain and depressive symptoms should receive particular attention in interventions that aim to promote job quality and ultimately sustainable work in the SCI population.

Factors related to sustainable employment of people with acquired brain injury or spinal cord injury: The employer's perspective.

Background: Of those people with an acquired brain injury (ABI) or spinal cord injury (SCI) who initially successfully returned to paid employment, some exit the workforce before reaching official retirement age. Employers play a central role in ensuring a sustainable work situation for employees with a disability and in preventing such exits. However, the factors and mechanisms involved from the employer's perspective are still poorly understood. Purpose: The purpose was to determine factors which, from employer's perspective, have a particularly positive or negative influence on sustainable employment of people with ABI or SCI. Methods: Twenty semi-structured interviews were conducted with employers of people with ABI or SCI and thematically analyzed. Results: Identified factors could be assigned to four thematic areas for both health conditions: socio-demographic and psychological characteristics of the disabled person, their work performance, the work environment, and other social/environmental conditions. Good disability self-management and proactive communication of needs on the part of the employee are contributing factors to long-term employment from the employer's perspective. Differing expectations and assessments of work performance by employees and employers pose a challenge. Employers feel a responsibility to provide an optimal work environment to allow the employee with a disability to reach his or her full potential. This includes appropriate work tasks, development opportunities, a compassionate work team, flexible work arrangements, providing resources to address specific needs, and an inclusive culture. Employers find the support provided by occupational specialists very helpful, as they often lack the knowledge to design the work environment to meet the person's needs. Conclusions: Employers emphasize the benefits of professional support during vocational rehabilitation to prepare employers and employees for long-term, sustainable employment. Such support is often lacking when changes and problems occur at a later stage. Therefore, people with a disability should be able to communicate their work-related needs and take charge of their own health so that problems that arise can be addressed as early as possible. Continued awareness of the environment is also beneficial. In addition, the expansion of low-threshold health-specific support services for long-term problems was found to be of great importance for employers in Switzerland.

Facilitators and Barriers to Sustainable Employment After Spinal Cord Injury or Acquired Brain Injury: The Person's Perspective.

Background: Sustaining employment after initial return to work represents a major challenge for people with a disability. While individuals with spinal cord injury (SCI) and acquired brain injury (ABI) make a prime example for this challenge, their view on factors supporting and hindering sustainable employment have rarely been investigated in depth so far. Purpose: To examine facilitators and barriers to sustainable employment, as perceived by persons with SCI or ABI. Methods: Fourteen focus groups and four individual interviews were conducted and thematically analyzed. Results: Perceived facilitators and barriers to sustainable employment reflected the three biopsychosocial areas of personal, impairment-related and environmental factors. For both condition groups, key facilitators included environmental factors (i.e., aspects of the work organization, the workplace, supportive private and work environment) and personal factors (i.e., the ability to self-advocate, to communicate and to learn how to live with one's own disability). Major barriers comprised injury-related impairments, including decreased mobility and pain for people with SCI and fatigue and limited cognitive resources for persons with ABI, as well as environmental factors related to insurance procedures and the social security system for both conditions. Conclusions: The biopsychosocial factors identified in our study as well as their interplay should receive particular attention to optimally support sustainable employment in vocational integration and work retention practice. Interventions should particularly focus on the empowerment of those affected as well as on the creation of supportive work environments that match their abilities and needs.

Factors influencing sustainable employment of persons with acquired brain injury (ABI) or spinal cord injury (SCI): A qualitative study evaluating the perspective of health and work professionals.

Background: The number of persons with acquired brain injury (ABI) or spinal cord injury (SCI) who leave the labor market early despite successfully return to work post-injury, demonstrates the challenge for them to remain employed. Evidence on how enabling and hindering factors influence daily work across the lifespan and how they affect employment-related services is scarce. Professionals directly involved in work integration can add to this evidence through their experiential knowledge. Purpose: To identify and explore the factors that enable or hinder sustainable employment for persons with ABI or SCI from the perspective of health and work professionals. Methods: We conducted 23 semi-structured interviews with professionals in Switzerland, directly involved in work reintegration and retention of persons with ABI or SCI. Interviews were transcribed verbatim and thematically analyzed. Results: Participants identified three main themes related to the concept of "sustainable employment". First, the value and impact of initial work integration; an early, multidisciplinary, person-centered work integration, with the early involvement of employers is ideal. A good match between the worker and the workplace is sought. Second, critical factors for long-term sustainable work: the main risks for persons with ABI are changing supervisors, workplace restructuring and the introduction of new technologies, while deteriorating health and the occurrence of secondary health problems are the greatest risk for persons with SCI. Third, the relevance of knowledge, experience and attitudes of professionals; Knowledge of the consequences of an ABI or SCI, the legal basis and the social security process, and the attitude of professionals towards the injured worker were considered important. Conclusions: From the professional's perspective, enabling and hindering factors for sustainable employment in the long-term are fundamentally very similar for persons with ABI and SCI. But different physical, mental and neuropsychological effects call for individually adapted measures. While persons with SCI primarily require ongoing medical care, conscious management of changes in the workplace is critical for persons with ABI. For both groups, an easily accessible counseling and support service should be established for work-threatening problems in the long-term. Furthermore, diagnosis-specific training programs for professionals of employment-related services and disability management should be developed.

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.

STUDY DESIGN: Longitudinal, population-based survey. OBJECTIVE: To examine determinants of between-person differences in labor market participation of individuals with spinal cord injury (SCI) living in Switzerland and their potential importance for policy. SETTING: Community. METHODS: Longitudinal information on labor market participation (i.e., paid work or not) was obtained from 1198 and 1035 individuals of working-age participating in the 2012 and 2017 SwiSCI community survey, respectively. Determinants of between-person variation in labor market participation were examined using mixed effects logistic regression, controlling for within-person variation. Employment rates were predicted using counterfactual data for modifiable determinants. RESULTS: The employment rate was 56% for the 2012 and 61% for the 2017 survey. Labor market participation was affected mostly by static (sex, nationality, SCI severity), temporal (age), dynamic (education level, functional independence, chronic pain), and policy-related (general pension, disability pension level) determinants. Counterfactual (what-if) predictions indicated the highest improvement of employment rates for strategies that increase functional independence (up to 6% increase), foster education (5%), reduce chronic pain (2%), or promote a shift to partial disability pensions (15%). CONCLUSIONS: Between-person variation in labor market participation of persons with SCI is influenced by various temporal, static, dynamic, and policy-related determinants. Our results suggest that policy strategies aimed at enhancing the employment rate of the Swiss SCI population may particularly invest in programs promoting functional independence, education, and partial pension levels that are more adequate for ensuring sustainable employment.

International Comparison of Vocational Rehabilitation for Persons With Spinal Cord Injury: Systems, Practices, and Barriers.

Background: Employment rates among people with spinal cord injury or spinal cord disease (SCI/D) show considerable variation across countries. One factor to explain this variation is differences in vocational rehabilitation (VR) systems. International comparative studies on VR however are nonexistent. Objectives: To describe and compare VR systems and practices and barriers for return to work in the rehabilitation of persons with SCI/D in multiple countries. Methods: A survey including clinical case examples was developed and completed by medical and VR experts from SCI/D rehabilitation centers in seven countries between April and August 2017. Results: Location (rehabilitation center vs community), timing (around admission, toward discharge, or after discharge from clinical rehabilitation), and funding (eg, insurance, rehabilitation center, employer, or community) of VR practices differ. Social security services vary greatly. The age and preinjury occupation of the patient influences the content of VR in some countries. Barriers encountered during VR were similar. No participant mentioned lack of interest in VR among team members as a barrier, but all mentioned lack of education of the team on VR as a barrier. Other frequently mentioned barriers were fatigue of the patient (86%), lack of confidence of the patient in his/her ability to work (86%), a gap in the team's knowledge of business/legal aspects (86%), and inadequate transportation/accessibility (86%). Conclusion: VR systems and practices, but not barriers, differ among centers. The variability in VR systems and social security services should be considered when comparing VR study results.

An interdisciplinary approach to job matching: developing an occupation-specific job matching tool for reintegrating persons with spinal cord injury into the labor market.

Purpose: To develop and pretest a comprehensive occupation- and health condition-specific job matching tool for vocational rehabilitation of persons with spinal cord injury.Materials and methods: The study design involved qualitative and quantitative steps. First, an interdisciplinary scoping review covering return-to-work, organizational and vocational psychology research was conducted to devise a conceptual job matching framework. Then, the occupation- and health condition-specific tool content was determined based on a database analysis of jobs performed by persons with spinal cord injury and focus groups with affected persons. Finally, a tool prototype was developed and pretested in a simulation exercise with vocational rehabilitation professionals.Results: The study yielded a tool prototype with matching profiles that structure the demands and characteristics of 415 occupations as well as spinal cord injury-related needs and limitations into a stable, a modifiable, and a needs-supplies dimension of person-job match. Vocational rehabilitation professionals perceived the prototype as helpful for determining target jobs for vocational retraining and for goal-oriented intervention planning.Conclusions: By comprehensively assessing the person-job match of individuals with spinal cord injury, the tool facilitates determining suitable target jobs and interdisciplinary intervention planning in vocational rehabilitation and is thus likely to promote sustainable return to work.Implications for rehabilitationJob matching is crucial for a sustainable work reintegration of persons with disabilities. However, the majority of existing job matching tools lack applicability for return to work because they are (1) not occupation-specific or rely on outdated occupational information, (2) not health condition-specific, and (3) not comprehensive with regard to the relevant aspects for determining a person-job match.Persons with spinal cord injury are a case in point for the need of job matching tools that comprehensively address occupation- and health condition-specific information.The present study responded to the shortcomings of existing job matching tools and uses vocational rehabilitation of persons with spinal cord injury as a case in point for developing a job matching tool that is both occupation- and health condition-specific at the same time.The developed tool was perceived as promising for determining suitable target jobs for vocational retraining of persons with spinal cord injury and for goal-oriented intervention planning in an interdisciplinary vocational rehabilitation setting. The tool's underlying conceptual framework may also serve as a blueprint for developing job matching tools for other types of disabilities.

[Personal Factors of the Bio-Psycho-Social Model (WHO): A Revised Classification by the German Society for Social Medicine and Prevention (DGSMP)]. / Personbezogene Faktoren im bio-psycho-sozialen Modell der WHO: Systematik der Deutschen Gesellschaft für Sozialmedizin und Prävention (DGSMP).

BACKGROUND: In 2010, the ICF working group of Faculty II "Applied Social Medicine and Rehabilitation" of the German Society for Social Medicine and Prevention, DGSMP proposed a classification of personal factors (PF) for the German-speaking area. Meanwhile, the International Classification of Functioning, Disability and Health (ICF) and WHO's bio-psycho-social model were increasingly integrated into the German Social Code (Book IX for Rehabilitation and Participation). It was a legislative decision that the needs assessment for the rehabilitation process must be "comprehensive". AIM: This publication aims to present an updated classification of PF to support the socio-medical assessment. For this purpose other published papers proposing a classification of PF were analyzed, especially the publication of Geyh et al. METHODS: The multiprofessional working group re-examined the basic structure, consistency and selection of factors of the 2010 classification using a qualitative approach and modified them if meaningful and necessary. The principles for the selection of factors were the same as in the 2010 publication (comprehensive, manageable, universal, impartial, relevant, unambiguous, focusing on finality, not regarding causality and non-discriminatory). RESULTS: A fundamental revision was not necessary; the basic structure remained primarily unchanged. Some items were included, excluded, summarized, shifted and editorially or content-related altered. Legal expertise shows that the classification of PF and their individual use for the socio-medical assessment, if necessary for the individual rehabilitation allocation, incur no problems with regard to data-protection regulations. PERSPECTIVES: The revised classification is ready to support users to describe and document relevant influences of the life background of individuals in a structured manner. Thus, influences on functioning and participation can be described comprehensively and transparently based on the bio-psycho-social model. A justiciable allocation of benefits for persons with disabilities is facilitated.

Factors, assessments and interventions related to job matching in the vocational rehabilitation of persons with spinal cord injury.

BACKGROUND: Matching an individual's capabilities, interests and needs with corresponding job demands and characteristics is an established procedure in vocational rehabilitation (VR). Yet, a systematic exposition of specific factors affecting the determination and attainment of a person-job match in VR practice is currently missing. OBJECTIVE: To examine factors, assessments and interventions related to job matching (JM) in VR of persons with spinal cord injury (SCI) by using a literature-based conceptual JM framework. METHODS: Applying a qualitative descriptive design, data were collected by overt non-participant observations across the VR process of two individuals with SCI, representing major return-to-work scenarios (returning to the pre-injury job and preparing for vocational retraining). RESULTS: Person-related, job-related and environmental factors were identified that either played a direct or indirect role in determining and attaining a person-job match. The factors were evaluated by different work-related and medical assessments and were targeted by a number of JM-related interventions. CONCLUSIONS: While our conceptual framework may serve as a generic blueprint to facilitate JM approaches in VR practice, the specific factors identified in our study are particularly valuable for developing JM applications aimed at promoting sustainable return to work for persons with SCI.

Employment pathways of individuals with spinal cord injury living in Switzerland: A qualitative study.

BACKGROUND: Labour market participation (LMP) represents a key goal of rehabilitation for individuals with spinal cord injury (SCI). To achieve this goal, Swiss SCI rehabilitation centres seek, together with their clients, viable follow-up solutions for returning to work after initial rehabilitation. However, the long-term outcomes of such vocational follow-up solutions have not been investigated so far, and there is a paucity of knowledge regarding the various types of employment pathways that persons with SCI living in Switzerland may experience. OBJECTIVE: To examine long-term employment pathways as experienced by individuals with SCI living in Switzerland. METHODS: A qualitative descriptive study design involving narrative interviews with individuals who completed vocational rehabilitation (VR) during their initial rehabilitation. Interviews were transcribed verbatim, and data analysed using an inductive thematic analysis approach. RESULTS: The analysis of the 15 interviews revealed four employment pathways: the pathway of no paid work, the pathway of retraining, the pathway of job adaptation and the pathway of continuing work. CONCLUSIONS: Apart from three pathways leading towards paid employment, our results revealed one pathway that was characterized by permanent unemployment. Individuals facing a pathway of no paid work may benefit from more custom-made vocational follow-up solutions and prolonged job coaching after initial VR.

Disability Benefit Generosity and Labor Force Withdrawal.

A key component for estimating the optimal size and structure of disability insurance (DI) programs is the elasticity of DI claiming with respect to benefit generosity. Yet, in many countries, including the United States, all workers face identical benefit schedules, which are a function of one's labor market history, making it difficult to separate the effect of the benefit level from the effect of unobserved preferences for work on individuals' claiming decisions. To circumvent this problem, we exploit exogenous variation in DI benefits in Austria arising from several reforms to its DI and old age pension system in the 1990s and 2000s. We use comprehensive administrative social security records data on the universe of Austrian workers to compute benefit levels under six different regimes, allowing us to identify and precisely estimate the elasticity of DI claiming with respect to benefit generosity. We find that, over this time period, a one percent increase in potential DI benefits was associated with a 1.2 percent increase in DI claiming.

Does Raising the Early Retirement Age Increase Employment of Older Workers?

Two pension reforms in Austria increased the early retirement age (ERA) from 60 to 62 for men and from 55 to 58.25 for women. We find that raising the ERA increased employment by 9.75 percentage points among affected men and by 11 percentage points among affected women. The reforms had large spillover effects on the unemployment insurance program but negligible effects on disability insurance claims. Specifically, unemployment increased by 12.5 percentage points among men and by 11.8 percentage points among women. The employment response was largest among high-wage and healthy workers, while low-wage and less healthy workers either continued to retire early via disability benefits or bridged the gap to the ERA via unemployment benefits. Taking spillover effects and additional tax revenues into account, we find that for a typical birth-year cohort a one year increase in the ERA resulted in a reduction of net government expenditures of 107 million euros for men and of 122 million euros for women.

The impact of stricter criteria for disability insurance on labor force participation.

This paper studies the effect of a large-scale policy change in the Austrian disability insurance program, which tightened eligibility criteria for men above a certain age. Using administrative data on the universe of Austrian private-sector employees, the results of difference-in-difference regressions suggest a substantial and statistically significant decline in disability enrollment of 6 to 7.4 percentage points and an increase in employment of 1.6 to 3.4 percentage points. The policy change had important spillover effects into the unemployment and sickness insurance program. Specifically, the share of individuals receiving unemployment benefits increased by 3.5 to 3.9 percentage points, and the share receiving sickness insurance benefits, by roughly 0.7 percentage points.