Employment Outcomes Among Clients With Stroke Utilizing Public Vocational Rehabilitation Services in the United States.

Objective: To examine the correlations between individual characteristics among clients with stroke within public vocational rehabilitation (VR) and the employment outcome, as well as the utilization of VR services and their employment outcomes after VR services.

Design: Observational cohort study.

Setting: Nationwide VR data from the Rehabilitation Service Administration Case Service Report for fiscal year 2022.

Participants: Individuals with stroke as primary cause of disability.

Interventions: Not applicable.

Main outcome measures: Employment status and VR service types.

Results: Of those with stroke who received VR services (n=1793), 653 (36.4%) achieved a competitive employment outcome. Black clients were less likely to be competitively employed at closure than White clients, odds ratio (OR, 0.72; 95% CI, 0.56-0.92). Clients whose primary disability was auditory or communicative disabilities were more likely to be competitively employed at closure (OR, 2.25; 95% CI, 1.22-4.17). Regarding VR services, receiving distinct types of VR services significantly was associated with the competitive employment outcome for clients. Clients who received short-term job support services were 6.36 times more likely to be competitively employed at closure than those who did not receive the service (OR, 6.36; 95% CI, 4.28-9.46).

Conclusions: Our results found that race, types of primary disability, level of education, receipt of Supplemental Security Income/Social Security Disability Insurance and the length of the VR services were associated with obtaining or regaining employment among clients with stroke who received public VR services. In terms of VR service patterns, job support services, job placement assistance, rehabilitation technology supports, maintenance services, other services, and VR counseling and guidance were associated with competitive employment outcomes among individuals with stroke.