Research Reports - Prediction of work resumption and sustainability up to 1 year after mild traumatic brain injury

Neurology. 2017 Oct 31;89(18):1908-1914. doi: 10.1212/WNL.0000000000004604. Epub
2017 Oct 6.

de Koning ME(1), Scheenen ME(1), van der Horn HJ(1), Timmerman ME(1), Hageman
G(1), Roks G(1), Spikman JM(1), van der Naalt J(2).

OBJECTIVE: To study return to work (RTW) after mild traumatic brain injury (mTBI)
at several intervals after injury and to predict RTW on the basis of occupational
factors in addition to demographic, personality, and injury-related factors at 6
and 12 months after injury.
METHODS: This was a prospective cohort study (UPFRONT study, n = 1,151) of
patients with mTBI admitted to the emergency department. Patients received
questionnaires at 2 weeks and 3, 6, and 12 months after injury. RTW was divided
into 3 levels: complete (cRTW), partial (pRTW), and no RTW.
RESULTS: Rates of cRTW increased from 34% at 2 weeks to 77% at 12 months after
injury, pRTW varied from 8% to 16% throughout the year. Logistic regression
(complete vs incomplete RTW) demonstrated that apart from previously identified
predictors such as demographics (e.g., age and education) and injury
characteristics (e.g., cause and severity of injury) and indicators of
psychological distress, occupational factors were of influence on work resumption
after 6 months (area under the curve [AUC] = 0.82), At 12 months, however, the
model was based solely on the presence of extracranial injuries and indicators of
maladaptation after injury (AUC = 0.81).
CONCLUSIONS: RTW after mTBI is a gradual process, with varying levels of RTW
throughout the first year after injury. Different predictors were relevant for
short- vs long-term work resumption, with occupational factors influencing
short-term RTW. However, for both short- and long-term RTW, posttraumatic
complaints and signs of psychological distress early after injury were relevant
predictors, allowing early identification of patients at risk for problematic
work resumption.

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