Research Reports - Employment outcome ten years after traumatic brain injury

J Neurotrauma. 2017 Jun 14. doi: 10.1089/neu.2016.4846. [Epub ahead of print]

Grauwmeijer E(1)(2), Heijenbrok-Kal MH(1)(2), Haitsma IK(3), Ribbers GM(1)(2).

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-year follow-up. One hundred nine patients
(18-67 years) were included with follow-up measurements 3, 6, 12, 18, 24, and 36
months and 10 years post-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 post-TBI, 12% were employed, which gradually, but
significantly, increased to 57% after 2-years follow-up (p < 0.001), followed by
a significant decrease to 43% (p = 0.041) after 10 years. Ten years post-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 10 years after 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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