DESIGN: Cross-sectional survey.
SETTING: Community.
PARTICIPANTS: People of employable age (N=9875; 18-64 y) with traumatic or non-traumatic SCI (including cauda equina syndrome) who were at least 18 years of age at the time of the survey, living in the community, and able to respond to one of the available language versions of the questionnaire.
INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: The observed employment rate was defined as performing paid work for at least 1 hour a week, and predicted employment rate was adjusted for sample composition from mixed logistic regression analysis.
RESULTS: A total of 9875 participants were included (165-1174 per country). Considerable differences in sample composition were found. The observed worldwide employment rate was 38%. A wide variation was found across countries, ranging from 10.3% to 61.4%. Some countries showed substantially higher or lower employment rates than predicted based on the composition of their sample. Gaps between the observed employment rates among participants with SCI and the general population ranged from 14.8% to 54.8%. On average, employment rates were slightly higher among men compared with women, but with large variation across countries. Employment gaps, however, were smaller among women for most countries.
CONCLUSIONS: This first worldwide survey among people with SCI shows an average employment rate of 38%. Differences between observed and predicted employment rates across countries point at country-specific factors that warrant further investigation. Gaps with employment rates in the general population were considerable and call for actions for more inclusive labor market policies in most of the countries investigated.
MATERIALS AND METHODS: Six focus groups were conducted using a semi-structured interview guide on 40 informants (employed multiethnic survivors). Survivors were stratified into three groups for successfully RTW, and another three groups of survivors who were unable to return to work. Each of the three groups was ethnically homogeneous. Thematic analysis using a constant comparative approach was aided by in vivo software.
RESULTS: Participants shared numerous barriers and facilitators which directly or interactively affect RTW. Key barriers were physical-psychological after-effects of treatment, fear of potential environment hazards, high physical job demand, intrusive negative thoughts and overprotective family. Key facilitators were social support, employer support, and regard for financial independence. Across ethnic groups, the main facilitators were financial-independence (for Chinese), and socialisation opportunity (for Malay). A key barrier was after-effects of treatment, expressed across all ethnic groups.
CONCLUSIONS: Numerous barriers were identified in the non-RTW survivors. Health professionals and especially occupational therapists should be consulted to assist the increasing survivors by providing occupational rehabilitation to enhance RTW amongst employed survivors. Future research to identify prognostic factors can guide clinical efforts to restore cancer survivors to their desired level/type of occupational functioning for productivity and wellbeing.