{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T03:03:23Z","timestamp":1787886203495,"version":"build-2784847793"},"reference-count":53,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T00:00:00Z","timestamp":1649894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Return to work is a challenging aspect of community integration for individuals with disabilities. The reintegration of individuals with spinal cord injury (SCI) is multifactorial; hence, regional challenges need to be investigated in the context of their clinical attributes and perceptions. A total of 121 male participants above 18 years of age with diagnosis of SCI and living at home were included in this cross-sectional survey. The study was conducted at a tertiary care rehabilitation facility in Saudi Arabia. The most common reported clinical barriers to employment were mobility, bladder incontinence, spasticity, musculoskeletal pain, and neuropathic pain. Bladder incontinence and musculoskeletal pain were the most common perceived clinical barriers for individuals with paraplegia and tetraplegia, respectively. A significant difference was observed for bowel incontinence as a reported barrier (p = 0.024) among adults less than thirty years of age in comparison with those older than thirty years. Spasticity as a barrier was reported more among patients who were older than thirty years (54.0%) compared to those younger than thirty years of age (37.9%) (p = 0.077). Twenty-two (23.7%) participants with paraplegia reported transfers as a perceived barrier to employment, which was significant (p = 0.014), and it was also reported as a significant barrier (p = 0.001) in individuals with tetraplegia (56%). This study shows that clinical conditions associated with SCI are considered potential barriers to employment by individuals with SCI. In terms of priority, the perceived barriers between individuals with tetraplegia and paraplegia were mostly different. This shows the need to consider relevant secondary health care conditions in goal setting while planning for employment in individuals with SCI.<\/jats:p>","DOI":"10.3390\/ijerph19084747","type":"journal-article","created":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T21:44:06Z","timestamp":1649972646000},"page":"4747","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Perceived Clinical Barriers to Employment for Males with Spinal Cord Injury in Saudi Arabia"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2670-4538","authenticated-orcid":false,"given":"Ahmad H.","family":"AlWashmi","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad Zaheer","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, King Fahad Medical City, Riyadh 12231, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sami","family":"Ullah","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, King Fahad Medical City, Riyadh 12231, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4894-9325","authenticated-orcid":false,"given":"Saeed Bin","family":"Ayaz","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Combined Military Hospital Jhelum, Jhelum 49600, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nourah Hamad","family":"AlKeaid","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, King Fahad Medical City, Riyadh 12231, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hind Miqad","family":"Alotaibi","sequence":"additional","affiliation":[{"name":"Department of Nursing, King Fahad Medical City, Riyadh 12231, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.1016\/j.apmr.2009.04.006","article-title":"A prospective study of factors influencing return to work after traumatic spinal cord injury in Taiwan","volume":"90","author":"Lin","year":"2009","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1038\/sc.2011.131","article-title":"Occurrence and predictors of employment after traumatic spinal cord injury: The GISEM Study","volume":"50","author":"Franceschini","year":"2012","journal-title":"Spinal Cord"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"133","DOI":"10.3233\/WOR-162381","article-title":"The meaning of employment from the perspective of persons with spinal cord injuries in six European countries","volume":"55","author":"Leiulfsrud","year":"2016","journal-title":"Work"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1310\/sci2203-183","article-title":"Early Access to Vocational Rehabilitation for Inpatients with Spinal Cord Injury: A Qualitative Study of Patients\u2019 Perceptions","volume":"22","author":"Ramakrishnan","year":"2016","journal-title":"Top. Spinal Cord Inj. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2875","DOI":"10.1080\/09638288.2017.1362597","article-title":"Return to work in the context of everyday life 7\u201311 years after spinal cord injury\u2014A follow-up study","volume":"40","author":"Holmlund","year":"2018","journal-title":"Disabil. Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s10926-009-9204-1","article-title":"Understanding decisions about work after spinal cord injury","volume":"20","author":"Fadyl","year":"2010","journal-title":"J. Occup. Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"63","DOI":"10.3233\/NRE-2012-0775","article-title":"An effective community-based mentoring program for return to work and school after brain and spinal cord injury","volume":"31","author":"Wright","year":"2012","journal-title":"NeuroRehabilitation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1037\/rep0000117","article-title":"Environmental barriers and social participation in individuals with spinal cord injury","volume":"62","author":"Tsai","year":"2017","journal-title":"Rehabil. Psychol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1179\/2045772315Y.0000000031","article-title":"Modifiable and non-modifiable factors associated with employment outcomes following spinal cord injury: A systematic review","volume":"38","author":"Trenaman","year":"2015","journal-title":"J. Spinal Cord Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1080\/09638288.2017.1312566","article-title":"The experience of attempting to return to work following spinal cord injury: A systematic review of the qualitative literature","volume":"40","author":"Hilton","year":"2018","journal-title":"Disabil. Rehabil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"xi","DOI":"10.1682\/JRRD.2014.05.0119","article-title":"Optimizing medical care to facilitate and sustain employment after spinal cord injury","volume":"51","author":"Thomas","year":"2014","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1038\/sc.2011.16","article-title":"Return to work after spinal cord injury: Factors related to time to first job","volume":"49","author":"Ramakrishnan","year":"2011","journal-title":"Spinal Cord"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/S0003-9993(00)90084-4","article-title":"Predictors for return to work after spinal cord injury: A 3-year multicenter analysis","volume":"81","author":"Hess","year":"2000","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1080\/09638280701320839","article-title":"Return to work following spinal cord injury: A review","volume":"29","author":"Lidal","year":"2007","journal-title":"Disabil. Rehabil."},{"key":"ref_15","unstructured":"Saudi Arabia (2020, August 04). General Authority for Statistics. Demographic Survey. Riyadh, Available online: https:\/\/www.stats.gov.sa\/sites\/default\/files\/disability_survey_2017_en.pdf."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1038\/sc.2012.65","article-title":"Traumatic spinal cord injury in Saudi Arabia: An epidemiological estimate from Riyadh","volume":"50","author":"Alshahri","year":"2012","journal-title":"Spinal Cord"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"269","DOI":"10.5144\/0256-4947.1992.269","article-title":"Epidemiological survey of spinal cord injury: A study of 377 patients","volume":"12","year":"1992","journal-title":"Ann. Saudi Med."},{"key":"ref_18","first-page":"000106","article-title":"Traumatic Spinal Cord Injury (TSCI) in King Fahd Medical City, an Epidemiological Study","volume":"1","author":"Alshahri","year":"2016","journal-title":"Neurol. Neurother."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"300","DOI":"10.22603\/ssrr.2019-0118","article-title":"An Epidemiological Overview of Spinal Trauma in the Kingdom of Saudi Arabia","volume":"4","author":"Baksh","year":"2020","journal-title":"Spine Surg. Relat. Res."},{"key":"ref_20","unstructured":"Saudi Arabia (2020, September 03). General Authority for Statistics. Labor Market. Riyadh; 2018 Third Quarter, Available online: https:\/\/www.stats.gov.sa\/sites\/default\/files\/labour_market_3q_2018_0.pdf."},{"key":"ref_21","unstructured":"World Bank Open Data (2020, September 03). Labor Force, Female (% of Total Labor Force)\u2014Saudi Arabia 1990\u20132019. Available online: https:\/\/data.worldbank.org\/indicator\/SL.TLF.TOTL.FE.ZS?locations=SA."},{"key":"ref_22","first-page":"e3886","article-title":"Vocational Rehabilitation Awareness among Spinal Cord Injury Male Patients in Saudi Arabia: A Brief Communication","volume":"11","author":"Alwashmi","year":"2019","journal-title":"Cureus"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.apmr.2004.10.025","article-title":"Return to work after spinal cord injury in Taiwan: The contribution of functional independence","volume":"86","author":"Jang","year":"2005","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"341","DOI":"10.3233\/NRE-141111","article-title":"Predictors of functional outcome in patients with traumatic spinal cord injury after inpatient rehabilitation: In Saudi Arabia","volume":"35","year":"2014","journal-title":"NeuroRehabilitation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"104","DOI":"10.11604\/pamj.2013.16.104.2902","article-title":"Traumatic spinal cord injury in Saudi Arabia: A review of the literature","volume":"16","author":"Robert","year":"2013","journal-title":"Pan Afr. Med. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1080\/10790268.2018.1531609","article-title":"Long-term compliance with bladder management in patients with spinal cord injury: A Saudi-Arabian perspective","volume":"43","author":"AlSaleh","year":"2020","journal-title":"J. Spinal Cord Med."},{"key":"ref_27","unstructured":"(2020, August 04). The Labor Market in Saudi Arabia: Background, Areas of Progress, & Insights for the Future. Harvard Kennedy School Evidence for Policy Design. Available online: https:\/\/epod.cid.harvard.edu\/sites\/default\/files\/2019-08\/EPD_Report_Digital.pdf."},{"key":"ref_28","unstructured":"(2020, September 04). Center for International Communication. [Press Release] (5 June 2018). Available online: https:\/\/twitter.com\/cicsaudi\/status\/1003998939455148032?lang=bn."},{"key":"ref_29","unstructured":"Saudi Arabia (2020, August 04). General Authority for Statistics. Labor Market Statistics Q1 2020. Riyadh, Available online: https:\/\/www.stats.gov.sa\/sites\/default\/files\/labor_market_statistics_q12020_en_1.pdf."},{"key":"ref_30","unstructured":"Saudi Arabia (2020, August 04). General Authority for Statistics. Demographic Survey. Riyadh, Available online: https:\/\/www.stats.gov.sa\/sites\/default\/files\/en-demographic-research-2016_2.pdf."},{"key":"ref_31","unstructured":"Saudi Arabia (2020, September 04). Ministry of Human Resource and Social Development. Human Resources Development Fund. Job Accommodations for Persons with Spinal Cord Injury Edition 1. Tawafuq. Available online: https:\/\/www.hrdf.org.sa\/Content\/Tawafuq\/Content\/documents\/Disability-Confidence\/300317_Spinal_Final_EN.pdf."},{"key":"ref_32","first-page":"217","article-title":"Self-perceived reasons for unemployment cited by persons with spinal cord injury: Relationship to gender, race, age and level of injury","volume":"39","author":"Krause","year":"1996","journal-title":"Rehabil. Couns. Bull."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1080\/10790268.2009.11754553","article-title":"Review of critical factors related to employment after spinal cord injury: Implications for research and vocational services","volume":"32","author":"Ottomanelli","year":"2009","journal-title":"J. Spinal Cord Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/0021-9681(78)90053-X","article-title":"Variables associated with obtaining and sustaining employment among spinal cord injured males: A follow-up of 760 veterans","volume":"31","author":"Hanson","year":"1978","journal-title":"J. Chronic Dis."},{"key":"ref_35","first-page":"157","article-title":"Long-term adjustment and community reintegration following spinal cord injury","volume":"26","author":"Boschen","year":"2003","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"141","DOI":"10.3233\/JVR-2011-0542","article-title":"Factors associated with employment among veterans with spinal cord injury","volume":"34","author":"Ottomanelli","year":"2011","journal-title":"J. Vocat. Rehabil."},{"key":"ref_37","first-page":"149","article-title":"Vocational rehabilitation service patterns and employment outcomes for Hispanics with spinal cord injuries","volume":"35","author":"Cardoso","year":"2011","journal-title":"Rehabil. Res. Policy Educ."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"207","DOI":"10.3233\/JVR-180929","article-title":"Barriers and facilitators to employment as reported by people with physical disabilities: An across disability type analysis","volume":"48","author":"Graham","year":"2018","journal-title":"J. Vocat. Rehabil."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1038\/sc.2013.178","article-title":"The association of assistive mobility devices and social participation in people with spinal cord injuries","volume":"52","author":"Tsai","year":"2014","journal-title":"Spinal Cord"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1038\/sc.2012.112","article-title":"Engagement in occupational activities and pressure ulcer development in rehabilitated South Indian persons with spinal cord injury","volume":"51","author":"Mathew","year":"2013","journal-title":"Spinal Cord"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1016\/S0003-9993(99)90263-0","article-title":"Employment after spinal cord injury: An analysis of cases from the Model Spinal Cord Injury Systems","volume":"80","author":"Krause","year":"1999","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1310\/1WMH-35Q6-12B5-3WMN","article-title":"Aging and self-reported barriers to employment after spinal cord injury","volume":"6","author":"Krause","year":"2001","journal-title":"Top. Spinal Cord Inj. Rehabil."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1177\/104365960201300206","article-title":"Culturally sensitive caring for Saudi patients","volume":"13","year":"2002","journal-title":"J. Transcult. Nurs."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1038\/sc.2017.24","article-title":"Longitudinal employment outcomes of an early intervention vocational rehabilitation service for people admitted to rehabilitation with a traumatic spinal cord injury","volume":"55","author":"Hilton","year":"2017","journal-title":"Spinal Cord"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1080\/10790268.2006.11753886","article-title":"Worklife after traumatic spinal cord injury","volume":"29","author":"Pflaum","year":"2006","journal-title":"J. Spinal Cord Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1080\/09687590410001689494","article-title":"Disability, gender, and unemployment relationships in the United States from the behavioral risk factor surveillance system","volume":"19","author":"Randolph","year":"2004","journal-title":"Disabil. Soc."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"38","DOI":"10.5535\/arm.2014.38.1.38","article-title":"Factors that influence employment after spinal cord injury in South Korea","volume":"38","author":"Kang","year":"2014","journal-title":"Ann. Rehabil. Med."},{"key":"ref_48","first-page":"13","article-title":"Work intensity and variations in health and personal characteristics of individuals with Spinal Cord Injury (SCI)","volume":"25","author":"Meade","year":"2006","journal-title":"J. Vocat. Rehabil."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1310\/sci2101-20","article-title":"Facilitators and barriers to employment among veterans with spinal cord injury receiving 12 months of evidence-based supported employment services","volume":"21","author":"Cotner","year":"2015","journal-title":"Top. Spinal Cord Inj. Rehabil."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1080\/16501970500522739","article-title":"Work participation among persons with traumatic spinal cord injury and meningomyelocele1","volume":"38","author":"Valtonen","year":"2006","journal-title":"J. Rehabil. Med."},{"key":"ref_51","first-page":"182","article-title":"An investigation into the employment and occupation of patients with a spinal cord injury","volume":"32","author":"Castle","year":"1994","journal-title":"Paraplegia"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1038\/sj.sc.3101257","article-title":"Functional ability, perceived exertion and employment of the individuals with spi-nal cord lesion in Taiwan","volume":"40","author":"Wang","year":"2002","journal-title":"Spinal Cord"},{"key":"ref_53","unstructured":"Saudi Arabia (2022, April 04). Rights of People with Disabilities. Riyadh, Available online: https:\/\/www.my.gov.sa\/wps\/portal\/snp\/careaboutyou\/RightsOfPeopleWithDisabilities."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/8\/4747\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:53:59Z","timestamp":1760136839000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/8\/4747"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,14]]},"references-count":53,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["ijerph19084747"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19084747","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,14]]}}}