Employment Probability Trajectories Up To 10 Years After Moderate-To-Severe Traumatic Brain Injury

Abstract

Aims: To examine trajectories of employment probability up to 10 years following moderate-to-severe traumatic brain injury (TBI) and identify significant predictors from baseline socio-demographic and injury characteristics.Methods: A longitudinal observational study followed 97 individuals with moderate-to-severe TBI for their employment status up to 10 years post injury. Participants were enrolled at the Trauma Referral Center in South-Eastern Norway between 2005 and 2007. Socio-demographic and injury characteristics were recorded at baseline. Employment outcomes were assessed at 1, 2, 5, and 10 years. Hierarchical linear modeling (HLM) was used to examine employment status over time and assess the predictors of time, gender, age, relationship status, education, employment pre-injury, occupation, cause of injury, acute Glasgow Coma Scale (GCS) score, duration of post-traumatic amnesia (PTA), CT findings, and injury severity score, as well as the interaction terms between significant predictors and time.Results: The linear trajectory of employment probabilities for the full sample remained at ~50% across 1, 2, 5, and 10-years post-injury. Gender (p = 0.016), relationship status (p = 0.002), employment (p < 0.001) and occupational status at injury (p = 0.005), and GCS (p = 0.006) yielded statistically significant effects on employment probability trajectories. Male gender, those in a partnered relationship at the time of injury, individuals who had been employed at the time of injury, those in a white-collar profession, and participants with a higher acute GCS score had significantly higher overall employment probability trajectories across the four time points. The time*gender interaction term was statistically significant (p = 0.002), suggesting that employment probabilities remained fairly stable over time for men, but showed a downward trend for women. The time*employment at injury interaction term was statistically significant (p = 0.003), suggesting that employment probabilities were fairly level over time for those who were employed at injury, but showed an upward trend over time for those who had been unemployed at injury.Conclusion: Overall employment probability trajectories remained relatively stable between 1 and 10 years. Baseline socio-demographic and injury characteristics were predictive of employment trajectories. Regular follow-up is recommended for patients at risk of long-term unemployment.

Prognostic factors for medical and productivity costs, and return to work after trauma

“…Our study showed that the probability of RTW decreased over time, but did not stabilize up to 24 months after injury. In contrast with RTW rates in moderate to severe TBI patients [46], in which RTW rates remained stable between 1 and 10 years after injury, RTW rates could still increase with time in our study population. A longer follow-up is necessary to conclude which patients remain unemployed.…”

Early Predictors of Employment Status One Year Post Injury in Individuals with Traumatic Brain Injury in Europe

“…For instance, the most recent systematic review/meta-analysis on employment outcomes world-wide found an employment rate of 35% one year following moderate to severe TBIs [6]. In addition, the rate of employment was higher compared with those reported from other countries, such as the Netherlands (50% complete return to work [48]), Australia (56% considering competitively employed and paid work trial [13]), Norway (50% [15]; 55% [14]), and the United Kingdom (74% [49]; 60-75% [50]), and is higher compared to those reported from the USA based on the TBI model systems (range between 28% to 35% [19,34,51,52]), and lower compared to the reported rate from Taiwan (79% [27]).…”

“…Past studies have reported employment rates that range from 8-72% in individuals with TBI during the first year after the injury [6][7][8]. Factors influencing employment status include age at the time of trauma [9][10][11][12][13][14], gender [9,12,[15][16][17], ethnicity [17], marital or partner relationship status prior to injury [9,15,[18][19][20], education level [8,10,13,[19][20][21][22], previous employment status [8,10,13,15,18,21,[23][24][25], occupation type [15,18,26], severity of the injury [8,11,[13][14][15]18,23,[27][28][29]…”

What characterises work and workplaces that retain their employees following acquired brain injury? Systematic review

“…Second, the under-representation found in our review of manual workers among those who retain work after ABI is supported in new single studies,48 49 as well as studies with other patient groups 50. No included studies empirically examined potential mechanisms behind this possible link 51.…”