Employment following SCI is recognized as an important component of life and has been studied since the early 1950s [5]. Not only does gainful employment help individuals achieve economic self-sufficiency; it is considered a source of personal growth [6] and disability adjustment [7], and it is associated with social integration and life satisfaction [8]. Published studies demonstrate considerable variation in employment rates among individuals with SCI (2–80 %), largely due to variations in sample characteristics such as the participants’ age, duration of injury, and work experience prior to injury, as well as differences in how the concept of “employment” is defined [9]. Despite this, evidence from systematic reviews [10] suggests that since the 1970s, the rate of employment for persons with SCI is between 30 % and 50 %. The most recent data from the US Model Systems suggests that 35 % of people with SCI are employed 20 years post-injury (https://​www.​nscisc.​uab.​edu) compared to an average unemployment rate of the US general population of 6.1 % for a 20-year period (1993–2013) [10].

There is a crucial need to explain why involvement in employment is significantly lower in individuals with SCI than the general population and this is despite the significant proportion of unemployed people with SCI judge themselves able to work and wish to work [11]. Over the past decades there have been significant advances in environmental features, including assistive devices (technology, robotics, environmental controls) and accessible design, in addition to the attenuation of disability-related prejudices. Despite this progress, it is astonishing that the employment rate has not improved sufficiently enough to promote full integration in terms of employment of those individuals with SCI.

This dilemma reveals the complexity of returning to work. An individual’s employment state is also a result of a complex interaction between personal and environmental characteristics [12, 13]. Given the advancements described above, it is incorrect to state that people with SCI experience low employment rates only because of intrinsic or personal characteristics [12]. To ensure a higher likelihood of success in returning to work, interventions must target several factors, including work retraining, interventions geared towards the environment, and addressing other modifiable factors.

Disability evaluation starts by identifying those functioning domains that must be assessed and evaluated from the perspective of the patient and healthcare professionals. A list of domains is provided by existing ICF Core Sets, namely, the ICF Core Set for SCI, which was developed to capture SCI-related functioning and disability depending on the temporal setting: early post-acute and long-term settings.