Gregory C Murphy

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Sustained employment achieved following traumatic
spinal cord injury Employer-based barriers and
facilitators

• Gregory C Murphy
• School of Public Health, La Trobe University
• Amanda Young
• Center for Disability Research, Liberty Mutual
  Research Institute for Safety, Hopkinton MA USA

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Introduction

• Four questions need attention if we are to
  improve the quality of vocational services to
  those with disabling injuries
• 1. How did you obtain your post-injury job?
• 2. How satisfactory is / was your position of
  employment
• 3. What is / was the occupational title of the
  job you gained?
• 4. What was the reason for employment cessation
  (if this did occur)?

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Participants

• Data was provided from a study comprised of 459
  Australian people aged between 16 and 65 who were
  surveyed at least 18 months post injury (see
  Murphy et al., 2003).
• Average age of group was 39.6 years
• Average age at time of injury 28.4 years
• 53 had paraplegia
• 52 of the injuries were complete
• 85 of the sample were male
• 26 had completed high school
• 81 were employed pre-injury
• 42 were eligible for compensation

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Sub-groups from the larger study who provided
data for the present inquiry

• A group of 162 individuals who had at some stage
  left a job they had obtained post injury.
• Two smaller groups of 25 and 59 individuals who,
  in spite of possessing high vocational potential,
  had left a job obtained post injury or were, at
  the time of larger survey follow up, not in the
  labour force.
• Respondents in the smaller groups were
  empirically- identified negative surprises from
  the use of DFA in the original study aimed at
  predicting post-injury labour-force status.

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Instrument

• Self-report survey
• Questions included
• Current labour force status
• Reasons for not being employed
• Reasons for leaving any post-injury work gained

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Data analysis

• Simple descriptive statistic (frequencies and
  measures of association) were used to analyse
  data.

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Results

• At the broadest level, among those who had worked
  at any time post injury (289 of the surveyed
  459), the percentage of time employed as a
  proportion of time of available for employment
  averaged 62.2 (standard deviation of 28.9).
• The relatively large standard deviation suggested
  that many had not sustained employment for long
  or had many lengthy interruptions.

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Results

• Reasons for job cessation reported by the larger
  sub-group

Table 1 Reasons for leaving a job gained
post-injury (N162)
Note Percentages add to gt100, owing to some
respondents endorsing multiple categories
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Table 2 Significant associations between
dichotomous study variables and reasons for job
loss
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Reasons for job cessation reported by 25 of those
with high vocational potential
Table 3 Employment cessations by those in the
Negative Surprise group (n25)
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Table 4 Reasons for not working by those in the
Negative Surprise group (n59)
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Discussion

• This study aimed to investigate the reasons for
  people with a spinal cord injury leaving a job
  gained post-injury.
• Assuming the reliability of the information
  provided (see Murphy et al., 1997), the results
  suggested a certain regularity in the frequency
  of reported reasons, with the lack of an on-going
  position being the most commonly reported reason
  for employment being broken.

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Discussion

• Retrenchment was another prominent reported
  reason, although the detail of particular
  retrenchments was not ascertained
• Personal ill-health or injury problems, along
  with retirement, were also commonly reported
  reasons for job loss.

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Discussion

• One potentially encouraging result was that 40
  respondents reported leaving a job for positive
  reasons (New business, better job, family
  reason). Unfortunately this crude category that
  combined three diverse reasons for job
  separations did not provide a clear description
  of what actually occurred to 25 of this
  important group of post-injury employees who left.

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Discussion (continued)

• Results from the Negative Surprises group
  suggested that health concerns were the single
  most prominent factor in job losses. Of the 25
  people in this group of individuals with high
  vocational potential, 44 reported leaving a job
  because of health or injury concerns. The next
  most commonly reported reason was to do with the
  job being only temporary in nature.

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Discussion

• Within the Negative surprises group, the low
  occurrence of reports of jobs being left so that
  the individual could pursue further study was
  disappointing. Post-injury study, although
  infrequently investigated by researchers, has
  been shown to be an independent predictor of both
  return to work and of durable post-injury
  employment.

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Discussion

• Findings from the study suggest that both the
  work conditions as well as the health status of
  those who work with a spinal cord injury needs
  proper assessment. Firstly, what exactly were the
  situations in which a respondent reported leaving
  a job because it was temporary?
• Was the RTW situation more an additional type of
  assessment to guide client and/or employer
  decision making?

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Discussion

• Secondly, the precise nature of these health
  concerns needs to be established. To what extent
  are they work-related? To what extent are they
  related to the aging process? To what extent are
  they the result of person-job mismatch?

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• If any of these concerns involve preventable
  ill-health conditions, then the present study may
  have highlighted an important public health issue
  for rehabilitation practitioners and researchers
  the extent to which subsequent ill health can
  be prevented among those suffering SCI who return
  to work.

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Conclusion

• The present study represents an initial attempt
  to fill in some of the detail associated with the
  post-injury employment achievements and
  experiences of those who suffer a spinal cord
  injury.
• Much more work needs to be done before we have
  even basic answers to the four questions posed at
  the beginning of this paper. It is hoped that the
  present study will stimulate others to gather the
  relevant data.
• Until this is done we will not be able to offer
  reliable, high quality vocational services to
  those considering working after the suffering of
  a traumatic spinal cord injury.

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References

• Murphy, G., McDonald, L. McDonald, S. (1997).
  The reliability of employment information
  provided by spinal cord injured people when
  surveyed two years post injury. Psychological
  Reports, 81, 25-26.
• Murphy, G., Young, A., Brown, King, N.
  (2003).Explaining labour force status following
  spinal cord injury The contribution of
  psychological variables. Journal of
  Rehabilitation Medicine, 35, 276-283.