Estimating Return to Work and Associated Factors After Sudden Onset of Chronic Impairment: A Population-Based Study of Individuals With Spinal Cord Injury in Switzerland

Objective To describe return to work (RTW) after spinal cord injury (SCI). Design Longitudinal data from the Swiss Spinal Cord Injury Cohort Study (SwiSCI) and biographical work-life data from a SwiSCI-nested survey. Setting Community. Participants A total of four hundred and forty-two (N=442) working-age individuals with SCI completed the Biographical Survey (men: 73.3%; women: 26.7%). Working age was defined according to Swiss standards as 16-64 years for women and 16-65 years for men. Interventions Not applicable. Main Outcome Measures RTW time, RTW rate, and RTW hazard ratio (HR; for contrasting RTW rates). We applied time-to-event survival analysis using flexible parametric survival models. Results Eighty-six percent of the participants returned to work after SCI, with a median RTW time of 6 months. RTW rates increased over time, both overall and across subgroups with different personal and injury-specific characteristics. We found significantly lower RTW rates for women (HR: 0.58, 95% confidence interval [CI]: 0.44-0.76), non-Swiss (HR: 0.50, CI: 0.34-0.73), and individuals with complete tetraplegia (HR: 0.53, CI: 0.34-0.84), compared to men, Swiss, and individuals with incomplete paraplegia, respectively. Individuals with physically demanding pre-SCI jobs, such as craft workers (HR: 0.44, CI: 0.27-0.72) and plant and machine operators (HR: 0.44, CI: 0.22-0.88), had lower RTW rates than those with less physically demanding pre-SCI jobs (eg, managers). A subgroup analysis showed lower RTW rates among individuals with urinary tract infections (HR: 0.42, CI: 0.23-0.76) or low mobility scores (HR: 1.03, CI: 1.0-1.07). Conclusions RTW rates and time vary across individuals with SCI based on injury-related, personal, and occupational characteristics. This underscores that vocational rehabilitation should adopt a personalized approach that allows for adequate RTW timeframes for individuals with different personal, clinical, and career-related characteristics.