Research Reports - A prospective study on employment outcome 3 years after moderate to severe traumatic brain injury
Arch Phys Med Rehabil. 2012 Jun;93(6):993-9
Grauwmeijer E, Heijenbrok-Kal MH, Haitsma IK, Ribbers GM
OBJECTIVES: To evaluate the employment outcome in patients with moderate
to severe traumatic brain injury (TBI) and to identify which patients are at risk
of unemployment 3 years after injury.
DESIGN: Prospective cohort study.
SETTING: Patients with moderate and severe TBI discharged from the neurosurgery
departments of 3 level 1 trauma centers in The Netherlands.
PARTICIPANTS: Patients aged 18 to 65 years (N=113; mean age ± SD, 33.2±13.1y; 73%
men) who were hospitalized with moderate (26% of patients) to severe (74% of
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: The main outcome measure was employment status. Potential
predictors included patient characteristics, injury severity factors, functional
outcome measured at discharge from the acute hospital with the Glasgow Outcome
Scale (GOS), Barthel Index (BI), and FIM, and cognitive functioning measured with
the Functional Assessment Measure (FAM).
RESULTS: Ninety-four patients (83%) completed the 3-year follow-up. The
employment rate dropped from 80% preinjury to 15% at 3 months postinjury and
gradually increased to 55% after 3 years. The employment rate significantly
increased from 3 months up to 1 year, but it did not change significantly from 1
to 3 years postinjury. Age, length of hospital stay, discharge to a nursing home
(vs home), psychiatric symptoms, and BI, GOS, FIM, and FAM scores were found to
be significant univariate determinants for employment status. By using multiple
logistic regression analysis, the FAM score (adjusted odds ratio 1.1; P<.000) and
psychiatric symptoms (adjusted odds ratio .08; P<.019) were selected as
independent predictors for employment status. A FAM cutoff score of less than 65
to identify patients at risk of long-term unemployment had a good diagnostic
CONCLUSIONS: Patients with TBI with psychiatric symptoms and impaired cognitive
functioning at hospital discharge are at the highest risk of long-term
unemployment. These factors should be the focus of vocational rehabilitation.