Research Reports - Work productivity loss after mild traumatic brain injury

Arch Phys Med Rehabil. 2017 Jul 28. pii: S0003-9993(17)30492-6. doi:
10.1016/j.apmr.2017.07.006. [Epub ahead of print]

Silverberg ND(1), Panenka WJ(2), Iverson GL(3).

OBJECTIVE: To examine the completeness of return to work (RTW) and the degree of
productivity loss in individuals who do achieve a complete RTW after mild
traumatic brain injury (MTBI).
DESIGN: Multi-site prospective cohort.
SETTING: Outpatient concussion clinics.
PARTICIPANTS: Seventy-nine patients (M=41.5 years old, 55.7% female) who
sustained an MTBI and were employed at the time of the injury. Participants were
enrolled at their first clinic visit and assessed by telephone 6-8 months
post-injury.
INTERVENTION: None.
MEASURES: Structured interview of RTW status, British Columbia Postconcussion
Symptom Inventory (BC-PSI), Lam Employment Absence and Productivity Scale
(LEAPS), MINI Neuropsychiatric Interview, brief pain questionnaire. Participants
who endorsed symptoms from three or more categories with at least moderate
severity on the BC-PSI were considered to meet International Classification of
Diseases-10 criteria for postconcussional syndrome. RTW status was classified as
complete if participants returned to their pre-injury job with the same hours and
responsibilities or to a new job that was at least as demanding.
RESULTS: Of the 46 (58.2%) patients who achieved a RTW, 33 (71.7%) had a complete
RTW. Participants with complete RTW had high rates of postconcussional syndrome
(44.5%) and comorbid depression (18.2%), anxiety disorder (24.2%), and bodily
pain (30.3%). They also reported productivity loss on the LEAPS, such as "getting
less work done" (60.6%) and "making more mistakes" (42.4%). In a regression
model, productivity loss was predicted by the presence of postconcussional
syndrome and a comorbid psychiatric condition, but not bodily pain.
CONCLUSION: Even in patients who RTW after MTBI, detailed assessment revealed
underemployment and productivity loss associated with residual symptoms and
psychiatric complications. 

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