Which people with traumatic paraplegia return to work?

Calliga, Magda Constance Nunes dos Santos; Porto, Lauro Antonio

doi:10.1590/1413-81232018246.15682017

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FREE THEMES • Ciênc. saúde colet. 24 (6) • June 2019 • https://doi.org/10.1590/1413-81232018246.15682017 copy

Which people with traumatic paraplegia return to work?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This research aimed to investigate the factors that affect the return to work of individuals with traumatic paraplegia and to characterize post-injury work by means of a cross-sectional epidemiological study without statistical inference. The participants were patients at the Spinal Cord Injury Program of the Sarah Rehabilitation Hospital, Salvador, Brazil. The descriptive analysis used mean and standard deviation for continuous variables and proportions for categorical variables. Male predominated among the 42 respondents, with a mean age of 36 years. Mean schooling years was 9 years. Twenty-two respondents returned to work, 21 of which were in the informal labor market. Mean time to return to work was 3 years. The main reasons for returning to work were need for money, personal satisfaction and contact with other people. In this study, returning to work is relevant for adults with spinal cord injury, providing them with higher income and better quality of life. We also noted the importance of higher education level for the successful return to work. Therefore, it is necessary to improve the return to work process, the qualification and professional rehabilitation of these workers.

Keywords
Return to work; Paraplegia; Spinal cord injuries; Rehabilitation

Return to work	Yes (n = 22)		No (n = 20)

Characteristics	n	%	n	%
Gender
Men	17	51.5	16	48.5
Women	5	55.5	4	44.5
Age (years, per quartiles)
1st quartile (31 years)	4	50.0	4	50.0
2º quartile (35.5 years)	7	53.8	6	46.2
3º quartile (41 years)	8	80.0	2	20.0
4º quartile (51 years)	3	27.3	8	72.7
Schooling (years of study)
0	0	0.0	1	100.0
1 to 9 years	8	44.4	10	55.6
10 to 12 years	8	50.0	8	50.0
13 and over	6	85.7	1	14.3
Current income
Same	2	33.3	4	66.7
Lower	9	60.0	6	40.0
Higher	11	52.4	10	47.6
Source of income other than pension (1)
None	1	6.3	15	93.8
Current work	19	100.0	0	0.0
Public servant	1	100.0	0	0.0
Real estate rental	3	60.0	2	40.0
Other sources of income	2	50.0	2	50.0
Economic class
A1/A2	1	100.0	0	0.0
B1/B2	9	81.8	2	18.2
C1/C2	12	46.2	14	53.8
D	0	0.0	3	100.0
E	0	0.0	1	100.0
Origin
Salvador	1	33.3	2	66.7
Metropolitan Region of Salvador	0	..	2	100.0
Inland Bahia State	15	51.7	14	48.3
Northeast – Capital	2	100.0	0	..
Northeast – Inland	4	66.7	2	33.3
Living alone
Yes	1	14.3	6	85.7
No	21	60.0	14	40.0
Marital status
Single	7	46.7	8	53.3
Married or with companion	12	57.1	9	42.9
Separated or divorced	3	50.0	3	50.0
Children
Yes	10	50.0	10	50.0
No	12	54.5	10	45.5
Transportation used (1)
Own adapted car only	11	78.6	4	21.4
Friends or family car only	2	33.3	4	66.7
Own non-adapted car only	2	66.7	1	33.3
Taxi only	0	0.0	1	100.0
Combination of transportation means	7	41.2	10	58.8
Employment at the time of spinal cord injury
Formally employed	8	50.0	8	50.0
Public servant	2	100.0	0	0.0
Self-employed	8	100.0	7	0.0
Informally employed	4	44.4	5	55.6
Etiology of injury
Firearm bullet	9	50.0	9	50.0
Car or motorcycle accident	10	58.8	7	41.2
Fall from height	2	40.0	3	60.0
Melee weapon	1	50.0	1	50.0
Type of injury
Complete	17	54.8	14	45.2
Incomplete	5	45.4	6	54.6
Work accident injury
Yes	6	50.0	6	50.0
No	16	53.3	14	46.7
Was confirmed as work accident
Yes	2	28.6	5	71.4
No	4	80.0	1	20.0
Received compensation
Yes	2	100.0	0	0.0
No	4	40.0	6	60.0
Participated in a professional rehabilitation program
Yes	0	..	0	..
No	22	52.4	20	47.6

Return to work	Yes (n = 22)		No(n = 20)

	n	%	n	%
BDI (indicator suggesting evidence of depression)
Minimum intensity	19	52.8	17	47.2
Light intensity	1	50	1	50
Moderate and serious intensity	0	..	0	..
Not evaluated	2	50	2	50
Realms of the WHOQOL-bref (quality of life indicator)
Physical
Mean	65.2		58.7
Standard Deviation	8.9		14.3
Psychological
Mean	70.1		66.2
Standard Deviation	11.2		10.5
Personal Relationships
Mean	69.3		70.8
Standard Deviation	21.7		11.9
Environmental
Mean	60.4		59.2
Standard Deviation	19.4		14.8
Current work capacity (scale from 0 to 10)
Mean	8.3		5.3
Standard Deviation	1.6		3.2
Minimum	5		0
Maximum	10		10

	n	%
Sickness benefits (1)
Yes	10	50
No	10	50
Disability retirement (1)
Yes	10	50
No	10	50
Tried to return to work
Yes	3	15
No	17	85
Difficulties to return to work (2,3
Accessibility		2
Fear of being unemployed		1
Relying on someone else to take out and put the wheelchair in the car		1
Stress to complete 8 hours work		1
Why aren’t you working? (3,4)
I cannot perform the previous activity		8
Few opportunities		5
Low schooling		4
It is hard		4
Risk to be unemployed and without benefits		3
Fear of skin injury		2
Dedicated to studies		2
Dedicated to public examination		2
Other reasons		8

	n	%
Sickness benefits (1)
Yes	8	36.4
No	14	63.6
Disability retirement (1)
Yes	11	50
No	11	50
Time to return to work (years)
≤2	12	54.5
3-5	8	36.4
8-11	2	9.0
Mean	3.18
Standard Deviation	2.57
Current work requirements
Mental/intellectual	3	13.6
Physical	2	9.1
Both	17	77.3
Current employment
Public servant	1	4.5
Self-employed	18	81.8
Informally employed	3	13.6
Daily workload (hours)
Mean	5
Standard Deviation	2.01
Number of days worked in a week
1	2	9.1
2	2	9.1
3	1	4.5
4	4	18.2
5	8	36.4
6	3	13.6
7	2	9.1
Access to rooms needed at work
Yes	7
No	15	31.8
No access to restroom	2	68.2
Interventions at the workplace
Yes	15	68.2
No	7	31.8
Main interventions at the workplace (2)
Ramps	8	36.4
Workload adjustment	7	31.8
Restroom fit	3	13.6
Increased doors width	3	13.6

	n	%
Support network at work (1)
No one	2	9.1
Colleague	7	31.8
Boss	1	4.5
Family member	10	45.4
Student	2	9.1
Security people	2	9.1
Bystander	3	13.6
Employees	1	4.5
Reason for return to work (1)
Establishing contact with other people	11	50
Personal satisfaction	15	68.2
Need money	17	77.3
See abilities and overcome limits	1	4.5
Not to stay idle	2	9.1
Main difficulties identified to return to or keep work (1)
Accessibility	15	68.2
No public transport	10	45.5
Few adapted buses	4	18.2
Feeling as if no one believes in you	3	13.6
Impossible to keep the previous activity	3	13.6
Low schooling	3	13.6
Main facilitators to return to or keep work (1)
Will power	10	45.5
Having an adapted car	9	40.9
Work at home	5	22.7
To have participated in the rehabilitation program	3	13.6
Go back to study	3	13.6
Not feeling intimidated	3	13.6
Work satisfaction
Very dissatisfied	1	4.5
Dissatisfied	0	0
Not satisfied, nor dissatisfied	6	27.3
Satisfied	9	40.9
Very satisfied	6	27.3
Expectation to continue in current work two years from now
It’s improbable	0	0
It’s not quite certain	2	9.1
Very probable	20	90.9

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

MCNS Calliga was responsible for the design and delineation of the article, participated in all stages of the research, bibliographic review, data collection, database preparation, descriptive analysis and writing of the manuscript. LA Porto contributed to the bibliographic review, the analysis and interpretation of the data and the writing of the article. The authors performed a critical review of the version of the article sent to the journal.