J Rehabil Med 47 ORIGINAL REPORT J Rehabil Med 2015 Preview © 2015 The Authors. doi: 10.2340/16501977-1980 Journal Compilation © 2015 Foundation of Rehabilitation Information. ISSN 1650-1977 Objectives: To describe a novel early vocational rehabilita- tion programme (In-Voc) for inpatients with spinal cord in- jury and to report early vocational outcomes. Design: Observational longitudinal cohort study. Subjects: One hundred adults with spinal cord injury admit- ted to spinal units in Sydney, Australia within a 24-month period. Methods: In-Voc was offered to all inpatients within the irst 6 months of acquired spinal cord injury and was provided by trained vocational consultants. Baseline demographics, opinions about work readiness, details of the vocational ser- vices provided and preliminary employment outcomes were documented. Results: The In-Voc programme was relatively short in du- ration (median 11 weeks, range 3–39 weeks) with a median total of 9.1 h (range 1–75.2 h) of service delivered per par- ticipant. At case closure (median 3 weeks post-discharge), 29/84 (34.5%) of participants were in paid employment (7% full-time, 8% part-time, 7% on sick leave, and 12% working with hours unknown), 36% were unemployed (6% seeking work, 16% not seeking work, 14% job seeking status un- known), 13% were students or in-training, and 17% were in vocational rehabilitation. Conclusion: Our research suggests that implementing an early vocational rehabilitation programme with individuals in the hospital setting is feasible and has good potential for enhancing post-injury labour-force participation. Key words: spinal cord injury; inpatient; employment; voca- tional rehabilitation. J Rehabil Med 2015; 47: 00–00 Correspondence address: James Middleton, John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, 2065 Sydney, Australia. E-mail: james.middleton@ sydney.edu.au Accepted Mar 27, 2015; Epub ahead of print XXX ?, 2015 INTRODUCTION Spinal cord injury (SCI) commonly affects multiple body structures and functions, resulting in activity limitations and reduced community participation, such as employment. A review by Ottomanelli & Lind (1) concluded that the average rate of any remunerative employment for individuals after SCI is only approximately 35%, yet the beneits of employment are clear (2). In interpreting any aggregate post-SCI employ- ment rate, it is important to note that, in the initial years after injury, vocational achievement is appreciably reduced. In their review of post-SCI employment rates (reported in over 20 studies conducted across 4 geographical regions), Young & Murphy (3) concluded that “employment data collected a year or less post-injury are associated with a much lower employ- ment rate” (p. 7). In the North American studies reviewed by Young & Murphy, the employment rate at 1 year post-injury was approximately 14%. The steady rise in employment with increasing years post-injury is clear in the pattern of employ- ment rates reported by Krause et al. (4) and conirmed by Young & Murphy (3), where the employment rates following SCI increased progressively at each of the 1, 2, 5 and 10-year follow-ups, plateauing at approximately 35% at 10 years, thereafter reaching 39% at the 20-year anniversary of injury. In a recent review of models of effective vocational re- habilitation (VR) service delivery, provision of “Supported Employment” (SE) and inter-agency collaborations were found to be among the “best practices” (5). The Individual Placement and Support (IPS) model of SE has consistently demonstrated positive outcomes for individuals with mental health disorders in multiple randomized controlled trials (6). It was recently shown in a irst ever randomized controlled trial among veter- ans with SCI in an outpatient and community setting to be 2.5 times more likely to result in competitive employment. It was suggested that, perhaps, better outcomes may be achieved if VR is offered closer to the time of initial injury before social disenfranchisement and reliance on disability beneits become ingrained (7). VR is not generally provided during inpatient rehabilitation in Australian SCI units. Where services are available, they are typically delivered post-discharge from hospital with referral to a community provider. Due to the suboptimal return-to- work (RTW) rates achieved presently (3), there is a clear need to develop new models to improve vocational outcomes following SCI. The aims of this paper are: irst, to describe a novel pilot programme, called In-Voc, that provides early VR during the subacute phase of inpatient rehabilitation after an acquired EARLY ACCESS TO VOCATIONAL REHABILITATION FOR SPINAL CORD INJURY INPATIENTS James W. Middleton, PhD 1 , Deborah Johnston, MBMSc 1 , Gregory Murphy, PhD 2 , Kumaran Ramakrishnan, MD 1 , Nerida Savage, Grad Dip Hlth Sc 3 , Rachel Harper, B Occ Th 3 , Jacquelyn Compton, B App Sci (Occ Thy) 3 and Ian D. Cameron, PhD 1 From the 1 John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, The University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, 2 Latrobe University, Melbourne and 3 CRS Australia, Department of Human Services, Australia