Research Reports - Employment outcome ten years after traumatic brain injury

J Neurotrauma. 2017 Apr 27. doi: 10.1089/neu.2016.4846. [Epub ahead of print]

Grauwmeijer E(1), Heijenbrok-Kal M(2), Haitsma I(3), Ribbers G(4).

The objective of this prospective cohort study was to evaluate the probability of
employment and predictors of employment in patients with moderate to severe
Traumatic Brain Injury (TBI) over 10 years follow-up. 113 patients (18-67 years)
were included with follow-up measurements 3, 6, 12, 18, 24, 36 months and ten
years after TBI. Potential predictors of employment probability included patient
characteristics, injury severity factors, functional outcome measured at
discharge from the hospital with the Glasgow Outcome Scale (GOS), Barthel Index
(BI), Functional Independence Measure (FIM), and the Functional Assessment
Measure (FAM). Forty-eight patients (42%) completed the 10-year follow-up. Three
months after TBI, 12% was employed, which gradually, but significantly increased
to 57% after 2-years follow-up (p<.001), followed by a significant decrease to
43% (p=.041) after ten years. Ten years after TBI, we found that employed persons
had less severe TBI, shorter length of hospital stay (LOS), and higher scores on
the GOS, BI, FIM, and FAM at hospital discharge than unemployed persons. No
significant differences in age, sex, educational level, living with
partner/family or not, pre-injury employment, professional category, psychiatric
symptoms, or discharge destination were found. Longitudinal multivariable
analysis showed that time, pre-injury employment, FAM, and LOS were independent
predictors of employment probability. We concluded that employment probability
ten years post moderate or severe TBI is related to injury severity and
pre-injury employment. Future studies on vocational rehabilitation should focus
on modifiable factors and take into consideration the effects of national
legislation and national labor market forces. 

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