Factors associated with post spinal cord injury employment: A systematic review and meta-analysis

PURPOSE: To identify factors associated with post spinal cord injury (SCI) employment, exploring differences between high-income (HIC) and low/middle-income (LMIC) countries. METHODS: This systematic review and meta-analysis included, Embase, CINAHL, PsycINFO, and Scopus. Articles discussing post-SCI employment were included and excluded if data were not disaggregated by "employed/unemployed" or did not include SCI-only sub-groups. Factors reported in three articles were considered for meta-analyses, using a random effects model to estimate odds ratios (OR) and mean differences (MD). RESULTS: Fifty-two articles were included. Forty-six studies were from HIC and six from LMIC. Twelve factors were significantly associated with post-SCI employment: Paraplegia (OR: 1.39), living alone (OR: 2.59), driving (OR: 4.76), no wheelchair use (OR: 0.44), (5), less activity limitations (MD: 0.67), being married (OR: 1.49), (7) being white (OR: 2.16), being younger at the time of study (MD: -0.24) and at the time of injury (MD: -0.30), time since injury (MD: 0.31), higher education (OR: 2.20), and income (OR: 0.15). Subgroup analyses showed that three of these factors were significantly associated with post-SCI employment only in HIC. CONCLUSIONS: All factors significantly associated with post-SCI employment were identified in HIC studies; there is a paucity of evidence on factors in LMIC.