Trabalho na lesão medular: análise das trajetórias de retorno e dos preditores de trabalho remunerado

Abstract

Involvement in work activities has multiple benefits for individuals with spinal cord injury (SCI), including economic rewards, social contact and a sense of well-being and satisfaction with life. Return to and sustained work are important goals of rehabilitation in individuals with SCI. Traumatic SCI represents 80% of cases and affects mainly young adults with the potential for participation in the labor market. However, the evidence shows that work rates among individuals with SCI are low compared to the general population, producing relevant social and economic costs. The international literature has identified solid associations between working after SCI and sociodemographic, injury and functional factors. However, the different methodologies used, including different definitions and legislation of work as well as policies for reinsertion of workers prevent a consensus on the factors that affect the work in this group. The investigation psychosocial factors such as perception of ability to work and satisfaction with the work status can contribute to timely and individual-centered interventions to improve vocational potential after SCI. In addition, it is important to identify factors that explore the different work trajectories after SCI. This dissertation aimed to characterize individuals with spinal cord injury according to their work status and the trajectories of returning to paid work and to determine the predictive factors of paid work status. This is a longitudinal study developed at the Sarah Network of Rehabilitation Hospitals. Participants were individuals with traumatic spinal cord injury, residing in Belo Horizonte and the metropolitan area, aged between 18 and 60 years old at the time of the injury and admitted to the Rehabilitation Program between 2000 and 2017. In the first stage of the study, sociodemographic, clinical and functional information were collected from electronic medical records opened during admission and discharge from the service. In the second stage, an online survey was conducted between January and March 2020 to collect data on paid work, the use of transportation, ability to work and satisfaction with the work status. The final sample consisted of 154 participants in the two stages. The median age at the time of SCI was 30 years, with most of the participants being male (81%), single (55%), with one or more children (54%), and with incomplete elementary school (38%). Only 7% of the sample had post-secondary school. The main cause of SCI was traffic accident (41%), followed by violence (25%). More than half of the participants had complete motor paraplegia (56%). All participants had at least one of the complications related to SCI. Among the 154 participants, 23% were working at the time of the survey. The average time to start a paid job after SCI was 2.3 (2.1) years. Three trajectories of returning to work were identified among the 138 individuals who worked on the date of injury: did not return to work (78%); returned to the same occupation (9%); and returned to a different occupation (12%). We observed that the group that returned to the same occupation had a higher proportion of individuals with higher education, incomplete SCI, walking without assistance, higher Functional Independence Measure (FIM) score and driving their own car (p <0.05). Individuals who returned to a different occupation returned to study in greater numbers compared to other trajectories. Based on the multivariate analysis, the lowest number of complications after the injury, returning to study, a good perception of the ability to work and satisfaction with the current work situation were predictors of the paid work status among the participants. The adjusted coefficient (R2adj) of the complete model was 56.5% (p = 0.001). The results of the present study allow us to infer that individuals with SCI in active age, submitted to a rehabilitation program and living in the Brazilian urban area had a low rate of paid work. Specific interventions to minimize complications and encourage return to studies can favor work after SCI.