Adaptive occupational alignment: a processual model of workforce reintegration after spinal cord injury

Despite progressive policy commitments, employment outcomes for individuals with spinal cord injuries (SCI) remain low, highlighting the need to examine both systemic and individual-level factors influencing return to work. This study explores how workforce participation is sustained through the interaction of structural conditions, relational supports, and adaptive agency among individuals with spinal cord injury following rehabilitation.

A qualitative multiple-case design was employed. In-depth interviews were conducted with 10 individuals who had returned to work following spinal cord injury. Data were analysed thematically.

Three overarching themes were identified: Structural Conditions and Inclusive Design, Social Support and Relational Resilience, and Agency, Adaptation, and Career Growth. The findings demonstrate that workforce sustainability emerges through the interaction of accessibility, relational support, and individual agency, yet remains vulnerable to persistent structural and symbolic barriers.

Drawing on these findings, the study advances an Adaptive Occupational Alignment model, conceptualizing workforce reintegration as an ongoing, multi-level process through which health needs, workplace practices, and relational supports are dynamically aligned to sustain participation over time.