Spinal Cord Injury Survey:
Ten Year Follow-up Study of Employment
James S. Krause, PhD
Principal Investigator
Medical University of South Carolina
1
INSTRUCTIONS: Please read all questions carefully, and attempt to answer all that apply to you. For some items, you
may not remember the exact number requested. If so, please estimate the number as closely as possible rather than
leaving the item blank (an estimate is always better than no response). Most items ask you to circle a number, fill in a
circle, or check a line.
NOTE: Some questions ask about events which occurred PRIOR TO YOUR INJURY, some ask about events which have
occurred SINCE YOUR INJURY, and some ask about CURRENT events. For these and other items we will clearly
indicate in bold or CAPITALIZED letters the time frame for which we would like you to base your answer.
____________
MONTH
WHAT IS TODAY’S DATE?
____________
DAY
____________
YEAR
ABOUT YOU
AY-1. Gender – Are you: (non-standard)
1. Male
2. Female
0. No
1. Yes
AY-2. Are you of Spanish, Latino, or Hispanic origin? (non-standard)
AY-3. What is your race? (non-standard)
1. _____
American Indian/Alaskan Native
4. _____
Black or African American
2. _____
Asian
5. _____
White
3. _____
Native Hawaiian/Pacific Islander
6. _____
More than one race _______________________
AY-4. What is your present marital status? (non-standard)
1. _____
Married
4. _____
Separated
2. _____
Divorced
5. _____
Never married
3. _____
Widowed
6. _____
Member of an unmarried couple
AY-5. How many people reside in your household?
(non-standard)
AY-6. Your year of birth: (non-standard)
________ number of people including yourself and children
_____________
YEAR
AY-7. What is your annual household income from ALL sources & ALL family members? (CDC, 2010; modified BRFSS
responses)
1._____
Less than $10,000
6._____
$35,000 to less than $50,000
2._____
$10,000 to less than $15,000
7._____
$50,000 to less than $75,000
3._____
$15,000 to less than $20,000
8._____
$75,000 to less than $100,000
4._____
$20,000 to less than $25,000
9._____
$100,000 to less than $150,000
5._____
$25,000 to less than $35,000
10. _____
$150,000 or more
EDUCATIONAL HISTORY
Pre-injury Education
EDU-1. At the time of your injury, were you attending school or enrolled in an educational program? (non-standard)
0. ______
No
1. ______
Yes, part-time
2. ______
Yes, full-time
EDU-2. By the time of your injury, how many years of education had you completed? (circle one) (non-standard)
0
1
2
3
4
5
6
7
8
2
9
10
11
12
13
14
15+
Post-injury Education
EDU-3. How many years of education have you completed SINCE your SCI onset? (circle one) (non-standard)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15+
EDU-4. How many hours per week do you CURRENTLY spend in school-related activities (attending classes, studying,
etc.)? For example, if 25 hours, circle 20 in the top row and 5 in the bottom row. (Whiteneck et al, 1992; modified
CHART)
0
(not currently
enrolled)
Hours:
10
20
30
40
50
60
70
80
90
100
<1
1
2
3
4
5
6
7
8
9
EDU-5. Please indicate which of the following educational milestones you have completed. (non-standard)
No, NEVER
completed
Yes, BEFORE
SCI
Yes, AFTER
SCI
a) High school diploma/GED
0
1
2
b) Two-year degree (Associate’s degree)
0
1
2
c) Vocational technology/business school
0
1
2
d) Four-year degree (Bachelor’s degree)
0
1
2
e) Master’s degree or equivalent
0
1
2
f)
0
1
2
Ph.D., M.D. J.D., (or equivalent)
EDU-6. How many total years of education have you completed? (circle one) (non-standard)
<5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24+
ATTITUDES TOWARD EMPLOYMENT
Strongly
Disagree
Disagree
Neutral
Agree
Strongly
Agree
EMP-1. The following statements are about your attitude towards employment (you do not need to be employed for
these items to be relevant to you). Please circle the response indicating your level of agreement with each statement.
1) I have the proper education and/or training to work.
2) I have all the necessary resources to maintain a regular job (transportation,
assistants, etc).
3) I cannot do the same types of jobs that I did before my injury.
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
4) The types of jobs that I can do now just do not interest me.
1
2
3
4
5
5) I have children at home and that makes working difficult.
1
2
3
4
5
6) My health, stamina, or endurance is too poor to maintain a regular job.
1
2
3
4
5
7) Most of my time and energy is used to take care of my SCI needs.
1
2
3
4
5
8) Most jobs that I am trained for are not accessible to people in wheelchairs.
1
2
3
4
5
9) The types of jobs I can do now do not pay enough money to be worthwhile.
1
2
3
4
5
10) Needing attendant help makes working difficult for me.
1
2
3
4
5
11) I do not know much about jobs available to people with disabilities.
1
2
3
4
5
12) My family prefers that I stay home rather than work.
1
2
3
4
5
(Krause & Anson, 1996; Krause & Pickelsimer, 2008: Krause & Reed, 2011)
3
Strongly
Disagree
Disagree
Neutral
Agree
Strongly
Agree
13) Most employers will not hire me because of my disability.
1
2
3
4
5
14) Loss of financial benefits is a barrier to work for me.
1
2
3
4
5
15) I received a large settlement from my injury and do not need money from work.
1
2
3
4
5
16) I am confident in my ability to work.
1
2
3
4
5
17) Working at a job is important to me.
18) Work is not that important to me because I do other important activities, such as
volunteering, homemaking or travel.
19) Pressure ulcers make working difficult or impossible for me to maintain a job.
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
20) I prefer not to work.
1
2
3
4
5
21) My transportation is not sufficient to maintain a job and be a reliable employee.
1
2
3
4
5
22) I am physically capable of working.
1
2
3
4
5
23) Working is worth the effort to me.
1
2
3
4
5
24) I am concerned that working is too stressful.
1
2
3
4
5
25) I get fatigued easily and this makes maintaining a job difficult.
1
2
3
4
5
26) Loss of medical benefits is a barrier to work for me.
1
2
3
4
5
27) Jobs that require long distance travel (airplane, train) make working difficult.
28) Government programs are available to help me to get a job or have helped me to
get a job.
29) Even if I am able to get a job (or already have a job), keeping a job would be (is)
difficult.
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
30) Government programs are more helpful in getting a job rather than keeping a job.
1
2
3
4
5
EMPLOYMENT HISTORY
In this section, a job is considered a paid position of regular employment.
Pre-injury Employment: The following questions ask about your employment history PRIOR to your SCI.
EMP-2. Did you work at any job PRIOR to your injury? (non-standard)
0. No
1. Yes
(If NO, go to EMP-14)
EMP-3 For your most recent pre-injury occupation, in what industry or field would you say you work or worked? (For
example, agriculture or health care) (non-standard)
Response: ______________________________________________________________________
EMP-4. How would you describe your occupation in that industry? (For example, farmer or nurse) (non-standard)
Response: ______________________________________________________________________
EMP-5. Please add anything else you feel will help us to understand your most recent pre-injury job. (non-standard)
Response: ______________________________________________________________________
4
EMP-6. What kind of company did you work for? (If you were working at more than one job, use primary job ) (nonstandard)
1._____
Government
4._____
Self-employed
2._____
Private, for-profit company
5._____
Worked for family business
3._____
Not-for-profit organization
6._____
Other (please specify): _____________
EMP-7. What was the average number of hours per week that you worked from all jobs (if you had more than one)?
For example, if 45 hours, circle 40 in the top row and 5 in the bottom row. (non-standard)
Hours:
10
20
30
40
50
60
70
80
90
100
<1
1
2
3
4
5
6
7
8
9
EMP-8. What was your annual income from your salary/earnings at your pre-injury job? (non-standard)
1._____
Less than $10,000
6._____
$35,000 to less than $50,000
2._____
$10,000 to less than $15,000
7._____
$50,000 to less than $75,000
3._____
$15,000 to less than $20,000
8._____
$75,000 to less than $100,000
4._____
$20,000 to less than $25,000
9._____
$100,000 to less than $150,000
5._____
$25,000 to less than $35,000
10. _____
$150,000 or more
EMP-9. Did your most recent pre-injury employment offer the following benefits? (non-standard)
No
Yes
a) Health insurance
0
1
b) Dental insurance
0
1
c) Holiday pay
0
1
d) Vacation or Personal leave
0
1
e) Retirement
0
1
f)
Short-term disability
0
1
g) Long-term disability
0
1
EMP-10. Were you employed at the time of your injury? (non-standard)
0. ______
No
(If NO, go to EMP-14)
1. ______
Yes, part-time
2. ______
Yes, full-time
EMP-11. How long had you worked at this job? (non-standard)
1. ______
Less than one year
2. ______
One year or more but less
than five years
3. ______
Five years or more
EMP-12. Which of the following was true for this job? (non-standard)
No
Yes
a) It was only temporary or seasonal.
0
1
b) I was only planning on staying for a year or two at most.
0
1
c) It was a job that had opportunities for advancement.
0
1
d) It was in a field or occupation I was planning on continuing.
0
1
e) I wanted to stay at this job indefinitely.
0
1
f)
0
1
It was a job I would have considered doing until retirement.
5
EMP-13. Did your SCI occur while you were working at your job? (non-standard)
0. ______
No
1. ______
Yes, but I did not receive
worker’s compensation.
2. ______
Yes, and I received worker’s
compensation.
Post-injury Employment: The following questions relate to your employment SINCE the onset of your SCI.
EMP-14. Have you worked at any job for pay SINCE your injury? (non-standard)
0. ______
No, have not worked at
any time since SCI onset
(If NO, go to EMP-49)
1. ______
Yes, but currently
unemployed
2. ______
Yes, currently working
EMP-15. As best you can recall, how many years after your SCI onset did you start your first post-injury job? (Please
circle one; Leave blank if you have never worked since your injury) (non-standard)
<1
1
2
3
4
5
6
7
8
9
10
EMP-16. Have you worked in any job FULL-TIME since the onset of your SCI? (non-standard)
0.________
No, have not worked fulltime since SCI onset
1.________
Yes, but not currently
working full-time
2.________
Yes, currently working
full-time
EMP-17. As best you can recall, how many years after your SCI onset did you start your first post-injury FULL-TIME
job? (Please circle one; Leave blank if you have never worked since your injury) (non-standard)
<1
1
2
3
4
5
6
7
8
9
10
EMP-18. How many different employers/companies have you worked for since your injury? (circle one) (non-standard)
1
2
3
4
5
6
7
8
9
10
EMP-19. How many jobs have you worked since your injury? A job is considered a paid position of regular employment.
An individual may move to different jobs within a company. (Please circle one) (non-standard)
1
2
3
4
5
6
7
8
9
10
EMP-20. What best describes your first post-injury job compared to your last pre-injury job? Please answer only if you
worked prior to your injury and have worked at some time since your injury. (non-standard)
No
Yes
a) My pay rate was lower after going back to work after my SCI.
0
1
b) I worked fewer hours after my SCI.
0
1
c) I had fewer responsibilities after my SCI.
0
1
d) I worked in a lower job class after my SCI.
0
1
Return to the Pre-injury Employer: The next set of questions asked about whether you returned to your pre-injury
employer and the circumstances surrounding your return.
EMP-21. Since the onset of your SCI, have you worked for your pre-injury employer? (non-standard)
0.________
No
(If NO, go to EMP-28)
1.________
Yes, at the same job
6
2.________
Yes, at a different job
EMP-22. How many months passed between the onset of your SCI and when you
returned to work with your pre-injury employer? (non-standard)
________________
EMP-23. Was there any break in your employment? (non-standard)
0._____
No, I stayed employed and continued working
1._____
No, I stayed employed but was on medical leave or disability for a while.
2._____
Yes, my employment was terminated, although I was eventually rehired by my pre-injury employer.
EMP-24. If your employment was terminated, was returning to your pre-injury employer the first employment you had
after SCI onset? (non-standard)
0._____
No, I worked with another employer before returning to my pre-injury employer.
1._____
Yes, my first employment after SCI was with my pre-injury employer.
EMP-25.When you first returned to your pre-injury employer, did you first start
working fewer hours? (non-standard)
0. No
1. Yes
EMP-26.Was your pay rate lower (i.e., hourly rate or equivalent)? (non-standard)
0. No
1. Yes
EDU-27. If you returned to the pre-injury employer, are you still working for that
employer? (non-standard)
0. No
1. Yes
Current Employment: The following questions ask about your CURRENT employment.
EMP-28. Are you working now (for pay)? (non-standard)
0. No
1. Yes
(If NO, go to EMP-39)
EMP-29. What is the average number of hours per week you CURRENTLY work? (If you work at more than one job,
please give the total hours for all jobs) For example, if 45 hours, circle 40 in the top row and 5 in the bottom row. (nonstandard)
Hours:
10
20
30
40
50
60
70
80
90
100
<1
1
2
3
4
5
6
7
8
9
EMP-30 What is your annual income from your salary/earnings of your current job? (non-standard)
1._____
Less than $10,000
6._____
$35,000 to less than $50,000
2._____
$10,000 to less than $15,000
7._____
$50,000 to less than $75,000
3._____
$15,000 to less than $20,000
8._____
$75,000 to less than $100,000
4._____
$20,000 to less than $25,000
9._____
$100,000 to less than $150,000
5. _____
$25,000 to less than $35,000
10.____
$150,000 or more
EMP-31. Does your current employment offer the following benefits? (non-standard)
No
Yes
h) Health insurance
0
1
i)
Dental insurance
0
1
j)
Holiday pay
0
1
k) Vacation or Personal leave
0
1
l)
0
1
m) Short-term disability
0
1
n) Long-term disability
0
1
Retirement
7
EMP-32. In what industry or field would you say you currently work? (For example, agriculture or health care)
If you work at more than one job, please list this for your primary job. (non-standard)
Response: ______________________________________________________________________
EMP-33. How would you describe your occupation in that industry? (For example, farmer or nurse) (non-standard)
Response: ______________________________________________________________________
EMP-34. Please add anything else you feel will help us to understand your current job. (non-standard)
Response:
______________________________________________________________________
EMP-35. What kind of company do you work for? (If you are working at more than one job, use your primary job ) (nonstandard)
1._____
Government
4._____
Self-employed
2._____
Private, for-profit company
5._____
Worked for family business
3._____
Not-for-profit organization
6._____
Other (please specify): _____________
EMP-36. How long (YEARS) have you been working for this employer? (non-standard)
<1
1
2
3
4
5
6
7
8
9
10+
EMP-37. Have you ever needed and/or received the following disability accommodations at your current job?
(non-standard)
No, never
needed it
Needed it, but did
NOT receive it
Needed it AND
received it
a) Allowed to work from home
0
1
2
b) Given flexible shifts
0
1
2
c) Allowed frequent rest breaks
0
1
2
d) Provided special assistive equipment
0
1
2
e) General accessibility was improved (ramps, etc)
0
1
2
f)
0
1
2
g) Provided transportation
0
1
2
h) Given adjustments to the actual work tasks (i.e., the job
individualized to your abilities to some degree)
0
1
2
Provided an attendant or clerical assistant
EMP-38. How satisfied are you with this job? (non-standard)
1. ______
2. ______
3. ______
Very Dissatisfied
Dissatisfied
Neutral
4. ______
5. ______
Satisfied
Very Satisfied
Most Recent Post-Injury Job:
EMP-39. If you are not currently working, what was your most recent post-injury occupation, in what industry or field would
you say you work or worked? (For example, agriculture or health care) (If you ARE currently working, go to EMP-51)
(non-standard)
Response: ______________________________________________________________________
EMP-40. How would you describe your occupation in that industry? (For example, farmer or nurse) (non-standard)
Response: ______________________________________________________________________
8
EMP-41. Please add anything else you feel will help us to understand your most recent post-injury job. (non-standard)
Response:
_____________________________________________________________________
_____________________________________________________________________
EMP-42. What was the average number of hours per week you worked at your most recent post-injury job?
For example, if 25 hours, circle 20 in the top row and 5 in the bottom row. (non-standard)
Years:
10
20
<1
1
2
30
3
4
40
5
6
50
7
8
9
EMP-43. What was your annual income from your salary/earnings of your most recent post-injury job? (non-standard)
1._____
Less than $10,000
6._____
$35,000 to less than $50,000
2._____
$10,000 to less than $15,000
7._____
$50,000 to less than $75,000
3._____
$15,000 to less than $20,000
8._____
$75,000 to less than $100,000
4._____
$20,000 to less than $25,000
9._____
$100,000 to less than $150,000
5. _____
$25,000 to less than $35,000
10.____
$150,000 or more
EMP-44. Did your most recent post-injury employment offer the following benefits? (non-standard)
No
Yes
a) Health insurance
0
1
b) Dental insurance
0
1
c) Holiday pay
0
1
d) Vacation or Personal leave
0
1
e) Retirement
0
1
f)
Short-term disability
0
1
g) Long-term disability
0
1
EMP-45. What kind of company did you work for in your most recent post-injury job? (non-standard)
1._____
Government
4._____
Self-employed
2._____
Private, for-profit company
5._____
Worked for family business
3._____
Not-for-profit organization
6._____
Other (please specify): _____________
EMP-46. How long (YEARS) did you work for this employer? (non-standard)
<1
1
2
3
4
5
6
7
8
9
10+
EMP-47. Did you ever need and/or receive the following disability accommodations at your most recent post-injury job?
(non-standard)
No, never
Needed it, but did
Needed it AND
needed it
NOT receive it
received it
a) Allowed to work from home
0
1
2
b) Given flexible shifts
0
1
2
c) Allowed frequent rest breaks
0
1
2
d) Provided special assistive equipment
0
1
2
e) General accessibility was improved (ramps, etc)
0
1
2
f)
0
1
2
0
1
2
0
1
2
Provided an attendant or clerical assistant
g) Provided transportation
h) Given adjustments to the actual work tasks (i.e., the job
individualized to your abilities to some degree)
9
EMP-48.As best you can recall, what month and year did you stop working? (non-standard)
Month:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Year:
EMP-49. Do you hope to return to work at some time in the future? (nonstandard)
0. No
1. Yes
EMP-50. Are you actively looking for work now? (non-standard)
0. No
1. Yes
WORK INCENTIVE PROGRAMS
EMP-51. What best describes your familiarity with the following Social Security Administration work incentive programs?
I have obtained
I have used this
(non-standard)
I have never I have heard
information about
program to try to
heard of it
about it
how it applies to me
become employed
a) The Ticket to Work Program
0
1
2
3
b) Impairment related work expenses
0
1
2
3
c) Plan for achieving self-support
0
1
2
3
d) Medicaid for the working disabled
0
1
2
3
e) Trial work period
0
1
2
3
EMP-52. Since your injury, have you ever received services from the Department
of Vocational Rehabilitation? (non-standard)
0. No
1. Yes
ABOUT YOUR INJURY
AYI-1. Date of onset of spinal cord injury:
(non-standard)
______________
______________
_____________
MONTH
DAY
YEAR
AYI-2. Which of the following best describes how your injury occurred? (non-standard)
1. _____
Sports (such as diving, skiing, or football)
2. _____
Assault (acts of violence, gunshot wound)
3. _____
Transport (motor vehicle crash, motorcycle or bike crash)
4. _____
Fall
5. _____
Medical or Surgical Complications
6. _____
Other
AYI-3. Did you drink any alcoholic beverages within 6 hours of your injury? (non-standard)
0. ______
1. ______
2. ______
No
Yes
Don’t remember
AYI-5. What is your spinal cord injury level? (please circle the highest level only) (non-standard)
Cervical
C1
C2
C3
C4
C5
C6
C7
C8
Thoracic
T1
T2
T3
T4
T5
Lumbar
L1
L2
L3
L4
L5
Sacral
S1
S2
S3
S4
S5
T6
10
T7
T8
T9
T10
T11
T12
AYI-7. Do you need partial or total support from a ventilator on a daily basis (you
use a machine every day to help you breathe)? (non-standard)
0. No
1. Yes
To determine whether your injury is neurologically complete, it is necessary to ask whether you have sensation or
voluntary movement below your injury level, and specifically whether either of these is present in the areas
controlled by the lowest segments of the spine which is the anal-buttocks area.
AYI-8. SENSATION OR FEELING (non-standard)
a) Do you have sensation or feeling in the anal area or immediate surrounding areas (this is
needed to determine whether your injury is neurologically sensory complete)?
0. No
1. Yes
b) Do you have any sensation or feeling below your level of injury?
0. No
1. Yes
0. No
1. Yes
0. No
1. Yes
0. No
1. Yes
AYI-9. VOLUNTARY MOVEMENT (do not include spasms or uncontrolled movement) (non-standard)
a) Are you able to voluntarily contract your anal sphincter (this is needed to determine whether
your injury is neurologically motor complete?
b)
Do you have any voluntary movement below your level of injury (such as wiggling your toes or
moving one or both of your legs)?
c) Do you have voluntary movement below your level of injury that helps you to do functional
activities, such as helping you to stand, walk, wheel your chair, transfer in or out of your chair,
open a door, or another activity?
AYI-10. What best describes your use of manual or electric wheelchairs? (non-standard)
1. _____
Only use manual wheelchair
4. _____
Mostly use electric wheelchair or scooter
2. _____
Mostly use manual wheelchair
5. _____
Only use electric wheelchair or scooter
3. _____
Use manual and electric chair about equally
6. _____
I never use/need a wheelchair/scooter
WALKING ABILITY
WLK-1. Are you able to walk at all? (non-standard)
0. No
1. Yes
IF YOU ANSWERED YES to Are you able to walk at all?, PLEASE CONTINUE WITH THE REST OF THIS SURVEY.
IF YOU ANSWERED NO to Are you able to walk at all?, the SURVEY IS COMPLETE.
(non-standard)
h) If yes, are you able to walk 10 meters (just more than 10 yards or almost 33 feet)?
0. No
1. Yes
i)
If yes, are you able to walk 150 feet (half a football field)?
0. No
1. Yes
j)
If yes, are you able to walk 1000 feet (over 3 football fields)?
0. No
1. Yes
0. No
1. Yes
0. No
1. Yes
k) Are you able to walk up a flight of 12-14 stairs?
WLK-2. Have you made a 100% complete recovery, meaning you function now as if the
injury never occurred? (non-standard)
WLK-3. What is your primary method of getting around?
(non-standard)
1. _____
Walking
2._____
Wheelchair
END OF SURVEY
THANK YOU VERY MUCH FOR YOUR PARTICIPATION!
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3._____
Both about equally
Date Verified:
____________
ID # ____________
____________
____________
FOR OFFICE USE ONLY
Date Entered:
Verified by:
____________
Date Rec’d:
____________
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Entered by:
This survey is for research purposes only. If you have concerns for your mental or physical
well-being, please contact a service provider with clinical expertise in your area.
Check Req’d: ____________
Please feel free to enter any questions, comments, or suggestions you may have about our
research, or, if you prefer, call us at 866-313-9963, email Dr. James Krause at
[email protected], or write to us at:
Dr. James Krause, College of Health Professions
77 President St., Suite C101, MSC 700,
Charleston, SC 29425
References
Centers for Disease Control and Prevention (CDC). (2010). Behavioral Risk Factor Surveillance System Survey
Questionnaire. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention, from: http://www.cdc.gov/brfss/questionnaires/pdf-ques/2010brfss.pdf.
Krause, J. S., & Anson, C. A. (1996). Self-perceived reasons for unemployment cited by persons with spinal cord injury:
Relationship to gender, race, age and level of injury. Rehabilitation Counseling Bulletin, 39(3), 217-227.
Krause, J. S., & Pickelsimer, E. (2008). Relationship of perceived barriers to employment and return to work five years
later: A pilot study among 343 participants with spinal cord injury. Rehabilitation Counseling Bulletin, 51(2), 118-121.
Krause, J. S., & Reed, K. S. (2011). Barriers and facilitators to employment after spinal cord injury: underlying dimensions
and their relationship to labor force participation. Spinal Cord, 49(2), 285-291.
Whiteneck, G. G., Charlifue, S. W., Gerhart, K. A., Overholser, J. D., & Richardson, G. N. (1992). The Craig Handicap
Assessment and Reporting Technique. Englewood, CO: Craig Hospital.
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