ArticleEuropean journal of physical and rehabilitation medicine2026
Real-world participation after spinal cord injury: longitudinal associations with return to work and long-term social integration.
Article in European journal of physical and rehabilitation medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundParticipation after spinal cord injury (SCI) includes work reintegration and social integration, but their shared and distinct correlates remain unclear.
aimTo examine longitudinal associations with return to work and social integration after SCI, and to estimate the relative contribution of predictor blocks.
designSecondary analysis of a registry.
settingCommunity follow-up within the United States Spinal Cord Injury Model Systems Public Use Database (2021ARPublic). POPULATION: Adults with SCI; return-to-work analyses included participants working pre-injury and aged 18-64 years at injury, whereas social integration analyses included adult observations with valid Craig Handicap Assessment and Reporting Technique (CHART) Social Integration scores.
methodsGeneralized estimating equation models assessed competitive employment and CHART Social Integration. A year-5 Shapley-type block decomposition compared baseline/injury, function/mobility, and symptom-burden, psychosocial, and contextual blocks.
resultsPrimary models included 16,574 observations from 10,195 participants for employment and 26,028 observations from 16,410 participants for social integration. Higher mobility, education, and life satisfaction were positively associated with both outcomes. Non-private residence and Non-Hispanic Black race were associated with less favorable participation in both domains. Pain severity was more clearly associated with lower employment odds, whereas depressive symptoms were more clearly associated with lower social integration. At year 5, function and mobility accounted for the largest share of explained variation for return to work (40.86%) and social integration (47.13%).
conclusionsReturn to work and social integration overlap but are not interchangeable after SCI. These findings are associative rather than causal. CLINICAL REHABILITATION IMPACT: Mobility, education, psychosocial well-being, and residential context may help guide rehabilitation planning.
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