Stability of employment after brain injury: a 7-year follow-up study

Abstract

Forty-three patients with severe traumatic brain injury (n = 24), cerebrovascular diseases (n = 15), or other acquired brain damage (n = 4) were followed-up 7-8 years after neuropsychological rehabilitation including a vocational re-entry programme. Current vocational status and work history since rehabilitation were investigated by means of a structured interview. Before interview, the patients were classified on the basis of medical records into four groups: (A) patients with minor residual neuropsychological impairments, (B) patients with minor impairments but psychopathological symptoms, (C) patients with persistent neuropsychological impairments showing no psychopathological symptoms, and (D) patients with persistent impairments and psychopathological symptoms. For patients in group A, a good, and for those in group D, a poor long-term employment outcome was predicted, while no predictions were made for the intermediate groups. Of the 43 interviewed subjects, 16 (37%) reported a stable return to work at pre-morbid level and seven (16%) at a lower level. In eight patients (19%), persisting difficulties in maintaining work were documented. Twelve subjects (28%) had retired within a period of 2 years after work trial. The relationship between patient classification and long-term employment outcome was only weak. Four out of 11 patients with a good prognosis (group A) experienced vocational adjustment problems or had retired. Three out of 10 patients with a poor prognosis (group D) were able to continue successfully with their previous jobs. These cases are described in detail. The employment outcome of the intermediate groups was very heterogeneous. The results suggest that particular attention should be paid to the long-term consequences of a reduced capacity for work, even if minor in degree. The success of patients despite a poor prognosis illustrate unsolved problems in relation to the ecological validity of neuropsychological measures of executive dysfunctions.

The evidence for the cost-effectiveness of rehabilitation following acquired brain injury

“…There was some fluctuation in sustainability of employment over three years follow-up. Nevertheless, 50-60% of the sample achieved long-term and cost-effective vocational outcomes, and these figures are broadly similar to those reported by Possl et al 13 in their seven-year follow-up study. Abrams et al 14 reported a cost-benefit analysis of a work reentry programme for TBI patients in California.…”

Minimizing the effect of TBI-related physical sequelae on vocational return

“…Studies have demonstrated poorer overall functional outcomes with persistent visual deficits [69,106,108] and poorer RTW with visual perceptual deficits after TBI [109]. Vocational efforts for individuals who have visual deficits that are of clinical significance are typically introduced once an individual has returned to the community.…”

“…Fatigue has been shown to be a clinically relevant symptom up to 10 years postinjury [134,[168][169], the Fatigue, both physical and mental, has been demonstrated to negatively affect functional performance [134,161,[170][171] and return to vocational efforts [109,172]. Treatments focus on managing underlying physical (endocrine, infectious, cardiovascular) and psychological (depression, stress) factors and use of neurostimulant agents (e.g., methylphenidate) [83].…”

Self-rated health and return to work after first-time stroke

“…A German study found that 28% of the patients who returned to work in a mixed population (head injury and stroke), left the workforce permanently within a 2-year period (12). This suggests that remaining at work may be a challenge for these patients.…”