Research Reports - Ten year employment patterns of working age individuals after traumatic brain injury
Arch Phys Med Rehabil. 2015 Aug 13. pii: S0003-9993(15)00652-8. doi: 10.1016/j.apmr.2015.07.020. [Epub ahead of print]
Cuthbert JP(1), Pretz CR(2), Bushnik T(3), Fraser RT(4), Hart T(5),
Kolakowsky-Hayner SA(6), Malec JF(7), O'Neil-Pirozzi TM(8), Sherer M(9).
OBJECTIVE: Describe the 10 year patterns of employment for individuals of working
age discharged from a Traumatic Brain Injury Model Systems (TBIMS) center between
1989 and 2009.
DESIGN: Secondary data analysis.
SETTING: Inpatient rehabilitation centers.
PARTICIPANTS: Patients aged 16 to 55 years who were not retired at injury,
received inpatient rehabilitation at a TBIMS center, were discharged alive
between 1989 and 2009 and had at least 3 completed follow up interviews at
post-injury years 1, 2, 5 and 10 (n=3,618).
MAIN OUTCOMES MEASURE: Employment RESULTS: Patterns of employment were generated
using a generalized linear mixed model, where these patterns were transformed
into temporal trajectories of probability of employment via random effects
modeling. Covariates demonstrating significant relationships to growth parameters
that govern the trajectory patterns were similar to those noted in previous
cross-sectional research and included age, sex, race/ethnicity, education,
pre-injury substance misuse, pre-injury vocational status and days of
post-traumatic amnesia. Calendar year in which the injury occurred also greatly
influenced trajectories. An interactive tool was developed to provide
visualization of all post-employment trajectories, with many showing decreasing
probabilities of employment between 5 and 10 years post-injury.
CONCLUSIONS: These results confirm that post-injury employment after moderate to
severe TBI is a dynamic process, with varied patterns of employment for
individuals with specific characteristics. The overall decline in trajectories of
probability of employment between 5 and 10 years post-injury suggests that
moderate to severe TBI may have unfavorable chronic effects, and/or that
employment outcome is highly influenced by national labor market forces.
Additional research targeting the underlying drivers of the decline between 5 and
10 years post-injury is recommended, as are interventions that target influencing