Vocational Rehabilitation for Adults with Disabilities: A Narrative Systematic Review of Interventions, Employment Outcomes, and Their Determinants

Work is central to adult life, yet adults with disabilities remain far less likely to be employed than their non-disabled peers, and vocational rehabilitation (VR) is the principal service response to that gap. This review asks what VR interventions improve competitive employment for adults with disabilities, how large the effects are, and what personal, service, employer, and policy factors condition them. We conducted a structured search of the biomedical literature and synthesised seventeen studies, drawn predominantly from systematic reviews and meta-analyses, in a narrative framework organised by intervention type and population. Three findings stand out. First, supported employment delivered according to the Individual Placement and Support (IPS) model has the strongest and most consistent evidence base, roughly doubling rates of competitive employment relative to traditional train-then-place services across diverse settings. Second, for adults returning to work after acquired injury or illness, including traumatic brain injury, spinal cord injury, stroke, multiple sclerosis, and musculoskeletal conditions, coordinated, early, work-focused interventions that engage the workplace outperform clinic-only care, though the evidence is more heterogeneous. Third, outcomes are shaped as much by context, employer attitudes, benefit structures, labour-market conditions, and the local economy, as by the intervention itself, which helps explain why effect sizes vary across jurisdictions. We discuss the implications for rights-based employment policy under the Convention on the Rights of Persons with Disabilities and for settings such as the United Arab Emirates that frame disability through the lens of People of Determination. The review's limitations include reliance on secondary syntheses and predominance of high-income-country evidence. We conclude that the field knows, with reasonable confidence, that place-then-train models work; the outstanding task is implementation at scale and adaptation to local labour markets.