Stability of employment after traumatic brain injury

Abstract

Although substantial information exists about factors related to who returns to work and time taken to return to work after traumatic brain injury (TBI), less is known about the stability of the work experience after the injury. One hundred sixty-five workers with complicated mild to severe traumatic brain injury were followed for 3 to 5 years postinjury. Work stability definitions included amount of time worked (amount of time worked divided by time observed postinjury) and maintenance of uninterrupted employment once a person returned to work. Amount of time worked was significantly and systematically related to brain injury severity, neuropsychological functioning at 1-month postinjury, and preinjury characteristics such as prior work stability and earnings. However, once persons returned to work, the ability to maintain uninterrupted employment was largely related to premorbid characteristics such as being older, higher income before the injury, or a preinjury job with benefits. It was also related to higher neuropsychological functioning at 1-month postinjury (reflecting the combined effects of premorbid functioning and traumatic brain injury severity), but not related to neurologic indices of severity.

Sick leave after traumatic brain injury The person or the diagnosis - Which has greater impact?

“…Work situation prior to TBI seems to predictive for RTW after the injury [1,3]. The question whether there is any association between financial compensation for injury and RTW is not clarified [13].…”

The Influence of Cultural Background on Experiences and Beliefs about Traumatic Brain Injury and their Association with Outcome

“…This might have been partly related to the use of a multidimensional handicap measure as opposed to some of the more commonly used unidimensional outcome measures, such as return to employment, which is arguably more likely to be associated with age and have also been more strongly associated with PTA duration (Machamer, Temkin, Fraser, Doctor, & Dikmen, 2005;. It nevertheless suggests that variables other than injury severity were contributing to outcome.…”

Call for an Integrative and Multi-Disciplinary Approach to Traumatic Brain Injury (TBI)

“…While most can lead independent lives, moderate TBI patients tend to have pervasive, long-standing cognitive deficits, are emotionally dysregulated, and experience significant anxiety and depression (Hiott & Labbate, 2002;Robinson & Jorge, 2002). Return to work is more variable, with many moderate TBI patients unable to achieve sustained employment or become fully integrated into their community (Machamer et al, 2005;Sherer et al, 2002). Other factors such as lower levels of education, increased distractibility, and higher levels of neuroticism at time of injury are also associated with decreased likelihood of employment, marriage and having a driver's license following a brain injury (Schretlen, 2000).…”

“…Factors most consistently associated with employment outcome include pre-injury occupation status, functional status at discharge, global cognitive functioning, perceptual abilities, executive functioning, involvement in vocational rehabilitation services and emotional status (Ownsworth & McKenna, 2004). Stability of employment, which differs from employment outcome, is related to pre-morbid characteristics, such as, being older and having a higher income before injury, and higher neuropsychological functioning at 1-month post-injury (Machamer et al, 2005). Assessment scales used by rehabilitation professions include the Disability Rating Scale (DRS), Functional Independence Measure (FIM), Community Integration Questionnaire (CIQ) and Functional Status Examination (FSE) (Rappaport, Hail, Hopkins, Belieza, & Cope, 1982;Keith, Granger, Hamilton, & Sherwin, 1987;Willer, Ottenbacher, & Coad, 1994;Dikmen, Machamer, Miller, Doctor, & Temkin, 2001).…”

“…Traumatic brain injury (TBI) is a major health concern causing a wide range of cognitive and behavioral impairments (Levin, 1995;Lezak & O'Brian, 1988;Millis et al, 2001;Ponsford, Oliver, & Curran, 1995) that of-ten lead to decades of disability, reduced independence, unemployment and poor social and familial relations (Machamer, Temkin, Fraser, Doctor, & Dikmen, 2005;Sherer et al, 2002). The societal impact of such injuries is alarming.…”