Employment after spinal cord injury in the United States: predictors and barriers

Introduction – Spinal cord injury (SCI) is a health condition that severely affects functioning, quality of life, social participation, and employment outcomes. Methods – This cross-sectional observational study analyzed data from 167 participants with SCI who lived in the United States and participated in the most recent International Spinal Cord Injury Survey (InSCI); it aimed to examine sociodemographic, injury, and support-related predictors of employment and to investigate the perceived barriers to work. Descriptive statistics and binary logistic regression were applied. Results – Overall, 67.7% of the participants were employed; those aged 30–39, had more years of education, and living with a partner showed higher odds of employment. Significant lower odds of employment were observed in those who had a shorter time since injury and were recipients of disability benefits. The most common barriers for the unemployed individuals were insufficient transportation services (82.5%), fear of losing benefits (33.8%) and inaccessible workplaces (11.3%). Discussion – Our findings suggest that employment after SCI is determined from individual characteristics and systemic barriers. The results highlight the importance of education, vocational rehabilitation, accessibility facilitators, and disability benefit policy-related reforms that promote equitable workforce participation, inclusion, and functioning in SCI.