Monday, 25 March 2013

Vocational rehabilitation helps keep you employed. Or does it?

#MSBlog: Vocational rehab and employment status. Chicken or Egg? Talk about stating the obvious.

Epub: Chiu et al. State vocational rehabilitation services and employment in multiple sclerosis. Mult Scler. 2013 Mar 21.

BACKGROUND: Obtaining and maintaining suitable employment can be a significant challenge for MSers.


OBJECTIVE: The objective of this article is to identify what vocational rehabilitation (VR) services (within the USA) helped MSers obtain and maintain employment, after controlling for the effect of demographic covariates and disability-related government benefits.

METHODS: They retrieved data from the Rehabilitation Services Administration (RSA) 911 database in the fiscal year (FY) 2009, and used VR services as predictors to predict employment outcomes of MSers by hierarchical logistic regression.

RESULTS: A total of 924 out of 1920 MSers (48.1%) were successfully employed after receiving VR services. Logistic regression analysis results indicated that cash benefits (OR =0.51, p < 0.001) and public medical benefits (OR =0.76, p < 0.01) were negatively associated with employment outcomes, whereas counseling and guidance (OR = 1.68, p < 0.001), job placement assistance (OR = 2.43, p < 0.001), on-the-job supports (OR = 1.62, p < 0.01), maintenance services (OR = 1.59, p < 0.01), and assistive technology services (OR =2.09, p < 0.001) were significant predictors of positive employment outcomes.

CONCLUSION: VR services were found to be associated with employment status. MSers experiencing problems obtaining or maintaining employment should be encouraged to pursue services from state VR agencies.



"Are the findings of this work surprising? No not at all! This study is a good example of why descriptive studies get such a bad reputation. All they are saying is that MSers who are receiving cash benefits and public medical benefits are more likely to be unemployed. Chicken or egg? If you are unemployed you are less likely to have health insurance and therefore need benefits. On the other hand counselling and guidance, job placement assistance, on the job support, maintenance services and assistive technologies was associated with employment; not surprising as some of these intervention relate to having a job in the first place. A proper scientific study would randomise MSers to either best supportive care or a specific intervention, using employment at a point in time as the outcome, to see if the intervention works. This is why we have so little time for bad science." 

"The original abstract refers to MSers being called clients. In our polls no one likes being called a client, which is why we edit abstracts. This reminds me to check on status of our manuscript on this. I think we need to give the editor a nudge."

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