Occupational Categories and Return to Work After Traumatic Brain Injury: A Multicenter Study

Abstract 

Walker WC, Marwitz JH, Kreutzer JS, Hart T, Novack T. Occupational categories and return to work after traumatic brain injury: a multicenter study.

Objective

To further evaluate determinants of return to work (RTW) after traumatic brain injury (TBI), with focus on the relation between preinjury occupational category and RTW outcome.

Design

Prospective collaborative cohort study.

Setting

Seventeen National Institute on Disability and Rehabilitation Research–designated Traumatic Brain Injury Model Systems.

Participants

Consecutive sample of 1341 patients (age range, 18–62y) who were hospitalized with a TBI diagnosis, received both acute neurotrauma services and inpatient rehabilitation services, consented to participate, were employed before injury, and completed a 1-year follow-up assessment.

Intervention

An inpatient interdisciplinary brain injury rehabilitation program.

Main Outcome Measure

Competitive employment at 1 year postinjury.

Results

Participants were categorized into 1 of 3 groups depending on preinjury occupational title: professional/managerial (n=192), skilled (n=751), or manual labor (n=398). Chi-square analyses were computed to examine changes across occupation groups between preinjury occupation group and postinjury RTW. The rate of successful RTW was greatest for professional/managerial (56%), lower for skilled (40%), and lowest for manual labor (32%), yielding an odds ratio of 2.959 between the highest and lowest groups. Of those with successful RTW, most did so within the same occupational category grouping. A multiple logistic regression showed that preinjury occupation, education level, discharge FIM score, age, sex, marital status, and hospital length of stay each influenced RTW.

Conclusions

Prior research has shown that preinjury employment status (employed vs unemployed) greatly influences the odds of successful RTW after TBI. A related hypothesis, that occupational classification also influences RTW outcome, has been understudied and has yielded conflicting results. The current study shows convincingly that the type of occupation influences RTW outcome, with the best prospect for RTW among people with professional/managerial jobs. Occupational category should be examined in the future development of predictive models for RTW after TBI.

Key Words: Brain injuries, Employment, Occupations, Rehabilitation, Treatment outcome