Lisa Ottomanelli1, Scott D Barnett2, Lance L Goetz3. 1. Veterans Affairs Health Services Research and Development (R&D)/Rehabilitation Research & Development Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital, Tampa, FL; Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa, FL. Electronic address: lisa.ottomanelli@va.gov. 2. Veterans Affairs Health Services Research and Development (R&D)/Rehabilitation Research & Development Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans' Hospital, Tampa, FL. 3. Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA.
Abstract
OBJECTIVE: To examine if supported employment (SE) remains more effective than treatment as usual (TAU) in returning veterans to competitive employment after spinal cord injury (SCI) at 2-year follow-up. DESIGN: Prospective, randomized, controlled, multisite trial of SE versus TAU with 24 months of follow-up. SETTING: SCI centers. PARTICIPANTS: Subjects (N=201) were enrolled and completed baseline interviews. At interventional sites, subjects were randomized to SE (n=81) or TAU (n=76). At observational sites, 44 subjects were enrolled in a nonrandomized TAU condition. INTERVENTION: The intervention was a SE program called the SCI Vocational Integration Program, which followed the principles of the individual placement and support model of SE for persons with mental illness. MAIN OUTCOME MEASURES: Competitive employment in the community within 2 years. RESULTS: For the entire 2-year follow-up period, SE subjects were significantly more likely to achieve employment (30.8%; 95% confidence interval [CI], 21.8-41.6) than either the TAU subjects at the intervention sites (10.5%; 95% CI, 5.2-19.7; P<.001) or the TAU subjects at the observational sites (2.3%; 95% CI, 0.0-12.9; P<.002). Most subjects who obtained competitive employment did so in year 1, and the average time to first employment was about 17 weeks. CONCLUSIONS:SE was better than usual practices in improving employment outcomes for veterans with SCI across a 2-year follow-up period. Although SE continued to be superior to traditional practices over the entire study, the first year of participation in SE may represent a critical window for achieving employment after SCI.
RCT Entities:
OBJECTIVE: To examine if supported employment (SE) remains more effective than treatment as usual (TAU) in returning veterans to competitive employment after spinal cord injury (SCI) at 2-year follow-up. DESIGN: Prospective, randomized, controlled, multisite trial of SE versus TAU with 24 months of follow-up. SETTING: SCI centers. PARTICIPANTS: Subjects (N=201) were enrolled and completed baseline interviews. At interventional sites, subjects were randomized to SE (n=81) or TAU (n=76). At observational sites, 44 subjects were enrolled in a nonrandomized TAU condition. INTERVENTION: The intervention was a SE program called the SCI Vocational Integration Program, which followed the principles of the individual placement and support model of SE for persons with mental illness. MAIN OUTCOME MEASURES: Competitive employment in the community within 2 years. RESULTS: For the entire 2-year follow-up period, SE subjects were significantly more likely to achieve employment (30.8%; 95% confidence interval [CI], 21.8-41.6) than either the TAU subjects at the intervention sites (10.5%; 95% CI, 5.2-19.7; P<.001) or the TAU subjects at the observational sites (2.3%; 95% CI, 0.0-12.9; P<.002). Most subjects who obtained competitive employment did so in year 1, and the average time to first employment was about 17 weeks. CONCLUSIONS: SE was better than usual practices in improving employment outcomes for veterans with SCI across a 2-year follow-up period. Although SE continued to be superior to traditional practices over the entire study, the first year of participation in SE may represent a critical window for achieving employment after SCI.
Authors: Lisa Mueller; William R Wolfe; Thomas C Neylan; Shannon E McCaslin; Rachel Yehuda; Janine D Flory; Tassos C Kyriakides; Rich Toscano; Lori L Davis Journal: Psychiatr Rehabil J Date: 2019-04-01
Authors: Georg Zimmermann; Lisa-Maria Bolter; Ronny Sluka; Yvonne Höller; Arne C Bathke; Aljoscha Thomschewski; Stefan Leis; Simona Lattanzi; Francesco Brigo; Eugen Trinka Journal: J Evid Based Med Date: 2019-06-23