Predictors of return to work in spinal cord injury - a systematic review

Abstract

during night) was significantly higher in patients with SAS compared with those without sleep apnea. No association was observed between glycemic variability during sleep and apnea-hypopnea index or severity of SAS. Conclusions In conclusion, higher glucose variabilty is present in patients with sleep apnea and parameters that describes the severity of SAS (apnea-hypopnea index, oxigen desaturation index) were significantly correlated with mean amplitude of glocose excursions and standard deviation of glucose excursion during continuous glucose monitoring. Key messages: The association between sleep apnea syndrome (SAS) and diabetes has important clinical, epidemiological and public health implications. In conclusion, higher glucose variabilty is present in patients with sleep apnea. Background In spinal cord injury (SCI) occurred in young people, return to work (RTW) is desirable. Methods-Quantitative and qualitative systematic review relying on three steps searching strategy in databases-Scopus, PubMed, etc. was performed. 48 articles out of 280 were retained for data extraction after critical appraisal by pairs of reviewers. SCI patients and vocational rehabilitation (VR) professionals worldwide were investigated through quantitative and qualitative techniques. Studies selected were those determining: employment outcomes of SCI persons, injury-related status, and functional status, pre-and post-injury work-related variables. Tools applied: demographics, Motor Index Score (MIS), length between SCI onset and first post-injury employment. Possible predictors were tested with logistic regression, Cox regression and correlation analysis. Qualitative approach: in depth interviews focused on factors influencing the RTW decisions, expectations about paid work, and perspectives of VR professionals. Results RTW rates <25% for those with heavy and strenuous physical work pre-injury. Factors influencing employments rates: being male and having a light-to-moderate physical job pre-injury, high scores on Barthel Index, high educational level and education post-injury, ability to use public or private transport independently, age at injury time <20 years. Average time since SCI until first post-injury job: 5 years. Qualitative approach: decisions about employment after SCI being influenced by: ability to work, presence of competing responsibilities, access to a suitable job, benefits of work. SCI persons reported difficulties to plan returning to work and lack of support. Conclusions Vocational rehabilitation strategies should consider: assessing job suitability, availability of job opportunities searching strategies, facilitating transportation. Employment after SCI is associated with better QoL. Getting functional independence training during rehabilitation is highly associated with RTW.