Logo for the Journal of Rehab R and D

Volume 46 Number 7, 2009
   Pages 919 — 930

Abstract —  Methods of a multisite randomized clinical trial of supported employment among veterans with spinal cord injury

Lisa Ottomanelli, PhD;1* Lance Goetz, MD;1 Charles McGeough, MS;2 Alina Suris, PhD;3 Jennifer Sippel, PhD;1 Patricia Sinnott, PT, PhD, MPH;4-5 Todd H. Wagner, PhD;6 Daisha J. Cipher, PhD7

1Department of Veterans Affairs (VA) North Texas Health Care System, Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical School, Dallas, TX; 2VA Central Office, Office of Mental Health, Psychosocial Rehabilitation and Recovery Therapeutic and Supported Employment Services, Washington, DC; 3VA North Texas Health Care System, Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX; 4VA Health Economics Resource Center (HERC), Center for Primary Care Outcomes and Research and Center for Health Policy, Stanford University, Stanford CA; 5Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA; 6VA HERC, Health Research and Policy, Stanford University School of Medicine, Stanford, CA; 7VA North Texas Health Care System, School of Nursing, University of Texas at Arlington, Arlington, TX

Abstract — This article compares the methods of a randomized multisite clinical trial of evidence-based supported employment with conventional vocational rehabilitation among veterans with spinal cord injury (SCI). The primary hypothesis is that, compared with conventional vocational rehabilitation (i.e., standard care), evidence-based supported employment will significantly improve competitive employment outcomes and general rehabilitation outcomes. The secondary hypothesis is that evidence-based supported employment in SCI will be more cost-effective than standard care. The current article describes the clinical trial and presents baseline data. The present sample includes 301 veterans with SCI, which includes paraplegia (50%), high tetraplegia (32%), and low tetraplegia (18%). Baseline data indicate that 65% of this sample of employment-seeking veterans with SCI had never been employed postinjury, despite the fact that nearly half (41%) had received some type of prior vocational rehabilitation. These rates of unemployment for veterans with SCI are consistent with the rates reported for community samples of persons with SCI. Forthcoming outcome data will provide much needed insights into the best practices for helping these veterans restore vocational goals and improve overall quality of life.

Clinical Trial Registration: NCT00117806, "A spinal cord injury vocational integration program: Implementation and outcomes"; http://clinicaltrials.gov/ct2/show/NCT00117806/.

Key words: Department of Veterans Affairs, employment, evidence-based practice, multicenter trial, persons with disabilities, randomized controlled trial, rehabilitation, research design, spinal cord injuries, supported employment.


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