Exploring the Factors Affecting Labour Market Participation for Individuals with Cerebral Palsy: A Scoping Review

DATABASE	SEARCH STRATEGY
Scopus	TITLE ((“Cerebral Palsy” OR “CP”) AND “employment*” AND NOT “children”)
PubMed	(“Cerebral Palsy”[Title/Abstract] OR “CP”[Title/Abstract]) AND “employment*”
ProQuest	abstract((Cerebral Palsy) AND (employment) NOT children)
Google Scholar	allintitle: Cerebral Palsy OR CP AND “employment” -Children
AUB Primo	All fields is (exactly) “Cerebral Palsy” AND All fields is (exactly) “employment*” NOT “children”

Table 2

Inclusion and exclusions criteria.

INCLUSION CRITERIA	EXCLUSION CRITERIA
□ Research focusing on employment and individuals with CP □ Young adults and adults with CP (age 16+) □ Publications in English □ Research after year 2000 □ Peer-reviewed	□ Research studies focusing on children □ Research before the year 2000 □ Literature reviews □ Publications in languages other than English □ Grey or non-research literature

Table 3

PPC model.

POPULATION	CONCEPT	CONTEXT	TYPES OF EVIDENCE
Individuals with CP (age 16+).	Factors influencing on labour market participation (employment).	International (Literature in English).	Research studies in English, published after the year 2000.

Table 4

Study Overview.

AUTHOR(S), YEAR	STUDY POPULATION	STUDY AIM	METHODOLOGY	KEY FINDINGS
Andersson, C., and Mattsson, E., 2001	363 adults with CP. 125 males, 96 females (20–58 years)	To describe problems and resources, including employment aspects	A questionnaire (survey)	24% are employed full-time, while 18% receive a disability pension. Most live independently, with or without home services.
Asuman, D., Gerdtham, U-G., Alriksson-Schmidt, A.I., Nordin, M., and Jarl, J., 2023	77.971 individuals made up of all 13,000 persons with CP in Sweden and 64,971 persons in a comparison group	To explore the labour market consequences of CP and the pathways through which it affects labour outcomes	Data from multiple Swedish National Population Registers from 1990 to 2015	Having cerebral palsy reduces labour market participation, education rates, and income levels.
Benner, J., Hilberink, S., Veenis, T., VanDer Slot, W., and Roebroeck, M., 2017	65 adults with CP. 33 males, 32 females	To explore employment over a 14-year period	Prospective cohort study with self-reported employment data (survey)	Long-term labour market participation is influenced by education, intellectual impairment, and motor function.
Bertels, N., Molenaers, G., Van Campenhout, A., Craenen, K., and Franki, I., 2023	80 adults with CP. Median age: 31. 39 males, 41 females	To explore the impact of contributing factors on employment	Standardised tests and questionnaires	Labour market participation is correlated with cognitive abilities, mobility, social participation, daily activities, and fatigue.
Bottos, M., Feliciangeli, A., Sciuto, L., Gericke, C., and Vianello, A., 2001	72 adults with CP born between 1934–1980. Median age: 33. 43 males, 29 females	To examine the evolution from childhood to adulthood, including employment aspects	Data collected using case notes and through direct assessments (survey, health data)	Higher education increases labour market participation.
Huang, I., Holzbauer, J., Chronister, J., Fong, C., and O’Neil, J., 2013	3162 individuals with CP. 1.820 males, 1.342 females, age range 16–54	To examine the relationship between vocational rehabilitation services and employment outcomes	Data from the US Department of Education Rehabilitation Service Administration Case Service Report database (registry)	Vocational rehabilitation, such as on-the-job training, job search assistance, on-the-job support, job coaching, support services and job accommodations, improves labour market participation.
Lowman, D.K., West, S.L., andMcMahon, B.T., 2005	1.392 complaints filled between 1992–2003	To examine employment discrimination experiences	Analysis of the American database EEOC (registry)	Hiring discrimination accounts for 15.4%, a significantly higher proportion compared to the 5.3% observed among complaints from individuals with other types of disabilities.
Magill-Evans, J., Galambos, N., Darrah, J., and Nickerson, C., 2008	76 persons between the ages of 20–30 with CP or spina bifida (SB). 35 males, 41 females	To identify personal, family, and community factors that facilitate or hinder employment	Mixed method. Participants completed survey and semi structured interviews	Nearly half of the participants are unemployed. Gender (with females being less likely to be employed), IQ, and reliance on transportation collectively explain 42% of the variance in labour market participation.
McNaughton, D., Light, J., and Arnold, K., 2009	8 males with CP who use augmentative and alternative communication	To explore successful full-time employment experiences	Online focus group interview	Internships, social networks, and coworker support facilitate labour market participation, while transport and stigma are barriers.
Törnbom, K., Törnbom, M., and Sunnerhagen, S., 2017	20 individuals with CP or SB. age 35–55. 9 females, 11 males	To explore experiences of participation in employment and social life	Semi structured interviews	Several participants have experienced dismissal due to disability discrimination.
Mesterman, R., Leitner, Y., Yifat, R., Gilutz, G., Levi-Hakeini, O., Bitchonsky, O., Rosenbaum, P., and Harel, S., 2010	203 people with CP followed between 1975–1994. 61% males	To describe the long-term psychosocial outcomes of CP, including education and employment outcomes	Cross-sectional telephone survey	Education is crucial for labour market participation.
Michelsen, S. I., Uldall, P., Kejs, A. M. T., and Madsen, M., 2005	819. 471 males, 348 females with CP born between 1965–1978, and 4406 controls born between 1965–1978	To find predictors in childhood of subsequent education and employment	Data obtained from several Danish registries	Higher cognitive abilities, education, and mobility significantly improve labour market participation.
Michelsen, S. I., Uldall, P., Hansen, T., and Madsen, M., 2006	416 participants with CP born between 1965–1970. 243 males, 173 females; mean age 32, compared to 2247 age-matched individuals	To explore and compare adults with and without CP, regarding different social related factors including employment	Data obtained from several Danish registries	Individuals with cerebral palsy have significantly lower labour market participation rates than people without disabilities.
Mik-Meyer, N., 2016	19 employers and 43 colleagues who worked closely with an employee with CP in 13 different work organizations	To explore how able-bodied co-workers engage in the ‘othering’ of colleagues with CP	Interviews	Employers’ and educational institutions’ attitudes affect the labour market participation of individuals with cerebral palsy.
Murphy, K., Molnar, G., and Lankasky, K., 2000	101 participants with CP, age 27–74 years. 48 females, 53 males	To assess the social and employment status of adults with CP	Data form PULTIBEC (registry), and a standardized questionnaire	53% are competitively employed. Education beyond high school is the most significant factor for achieving labour market participation, especially for individuals with severe CP.
Opheim, A., Jahnsen, R., Olsson, E., and Stanghelle, J. K., 2009	149 participants, mean age 40.5, with CP. 76 male, 73 females	To compare walking function, pain, fatigue and employment rates, 7 years after an initial survey	A multidimensional questionnaire	Pain and fatigue reduce work capacity and labour market participation.
Pagliano, E., Casalino, T., Mazzanti. S., Bianchi, E., Fazzi, E., Picciolini, O., Frigerio. A., Rossi, A., et al., 2021	109 individuals with CP followed from infancy and recalled for assessment at ages between 18–50. 53 females, 56 males	To assess quality of life and participation including employment rates	Mixed methods. Involving semi-structured interviews, observation, and surveys	Quality of life and labour market participation are interlinked.
Pettersson, K., and Rodby-Bousquet, E., 2021	1.888 adults with CP. 1.030 males, 858 females enrolled in the Swedish CP follow-up program, median age 25	To analyse living conditions and social outcomes, including employment	Cross-sectional registry-based study	Only one in six has competitive employment. Women with CP are half as likely to be employed as men.
Rasalingam, A., Brekke, I., and Dahl, E. Helseth S., 2021	Young adults with different somatic long-term health challenges born between 1990–1996 (421.110 in total)	To examine the consequences of somatic long-term health challenges including consequences in education and income	Data obtained from the Norwegian Patient Registry, which is linked to other registries	CP reduce education and income levels, and possibly more than individuals with other lifelong disabilities.
Reddihough, D. S., Jiang, B., Lanigan, A., Reid, S. M., Walstab, J. E., and Davis, E., 2013	334 individuals with CP (age 20–30). 171 males, 164 females, compared to a population-based control group (2.152)	To investigate functional abilities and social outcomes, including employment	Telephone survey, public access electoral roll (registry)	Functional abilities correlate with labour market participation
Shrader, M., Wade, C., Lennon, N., Shields, T., Salazar-Torres, J., Howard, J., andMiller, F., 2021	126 adults with CP (mean age 29,7). 70 males, 56 females	To describe well-being by assessing education, employment, physical function, walking activity, and healthcare	Patient-reported outcomes (survey), and pedometer data (health data)	Physical function affects both education and labour market participation.
Törnbom, M., Jonsson, U., and Sunnerhagen, K. S., 2014	72 individuals. 40 males, 32 females, with CP or spina bifida (SB)	To compare work participation in 2009 with 1997	Survey by telephone	Labour market participation and work hours decreases with age.
Van Der Slot, W. M., Nieuwenhuijsen, C., Van Den Berg-Emons, R. J., Wensink-Boonstra, A. E., Stam, H. J., and Roebroeck, M. E., 2010	56 adults with CP (mean age 36.4). 62% males	To assess participation including in employment and health-related quality of life	Survey	Almost half of individuals with CP experience employment difficulties and have lower health-related quality of life.
Verhoef, J. A. C., Bramsen, I., Miedema, H. S., Stam, H. J., and Roebroeck, M. E., 2014	74 adults with CP (age 16–20). 45 males, 29 females	To document the development of work participation over a 4-year period	Observational longitudinal cohort study, surveys	Employment and labour market participation increases with age.

Table 5

Key Factors Affecting Labour Market Participation.

Individual factors	Education Age Severity of CP Gender	Andersson and Mattsson (2001), Asuman et al. (2023), Benner et al. (2017), Bertels et al. (2023), Bottos et al. (2001), Mesterman et al. (2010), Michelsen et al. (2005), Michelsen et al. (2006), Murphy et al. (2000), Opheim et al. (2009), Pagliano et al. (2021), Pettersson and Rodby-Bousquet (2021), Rasalingam et al. (2021), Reddihough et al. (2013), Törnbom et al. (2014), Van Der Slot et al. (2010), Verhoef et al. (2014)
Contextual factors	Discrimination Transportation Supportive networks and accommodation	Mik-Meyer (2016), Lowman, West, and McMahon (2005), Törnbom et al. (2017), Shrader et al. (2021), Magill-Evans et al. (2008), McNaughton et al. (2009), Huang et al. (2013)