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Volume 89, Issue 12, Supplement, Pages S51-S60 (December 2008)


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Prediction of Return to Productivity After Severe Traumatic Brain Injury: Investigations of Optimal Neuropsychological Tests and Timing of Assessment

Robin E. Green, PhD, CPsychabCorresponding Author Informationemail address, Brenda Colella, MAb, Deborah A. Hebert, MSc(Kin)ab, Mark Bayley, MD, FRCPCb, Han Sol Kang, BScb, Christine Till, PhD, CPsychd, Georges Monette, PhDc

Abstract 

Green RE, Colella B, Hebert DA, Bayley M, Kang HS, Till C, Monette G. Prediction of return to productivity after severe traumatic brain injury: investigations of optimal neuropsychological tests and timing of assessment.

Objectives

(1) To examine predictive validity of global neuropsychological performance, and performance on timed tests (controlling for manual motor function) and untimed tests, including attention, memory, executive function, on return to productivity at 1 year after traumatic brain injury (TBI). (2) To compare predictive validity at 8 weeks versus 5 months postinjury. (3) To examine predictive validity of early degree of recovery (8wk–5mo postinjury) for return to productivity.

Design

Longitudinal, within subjects.

Setting

Inpatient neurorehabilitation and community.

Participants

Patients (N=63) with moderate to severe TBI.

Interventions

Not applicable.

Main Outcome Measures

Primary outcome: return to productivity at 1 year postinjury. Primary predictors: neuropsychological composite scores. Control variables: posttraumatic amnesia, acute care length of stay (LOS), Glasgow Coma Scale score, age, and estimated premorbid intelligence quotient.

Results

Return to productivity was significantly correlated with global neuropsychological performance at 5 months postinjury (P<.05) and showed a trend toward significance at 8 weeks. Performance on the untimed composite score, and more specifically executive and memory functions, mirrored this pattern. Logical Memory performance significantly predicted return to productivity, but not other memory tests. Timed tests showed no significance or trend at either time point. Early degree of recovery did not predict return to productivity. Among control variables, only acute care LOS was predictive of return to productivity.

Conclusions

Findings validate utility of early neuropsychological assessment for predicting later return to productivity. They also provide more precise information regarding the optimal timing and test type: results support testing at 5 months postinjury on untimed tests (memory and executive function), but not simple attention or speed of mental processing. Findings are discussed with reference to previous literature.

a Graduate Department of Rehabilitation Sciences, University of Toronto, Toronto, ON, Canada

b Toronto Rehabilitation Institute Toronto, Toronto, ON, Canada

c Department of Mathematics and Statistics, York University, Toronto, ON, Canada

d Department of Psychology, York University, Toronto, ON, Canada

Corresponding Author InformationReprint requests to Robin Green, PhD, CPsych, Toronto Rehabilitation Institute, 550 University Ave, Toronto, ON, M5G 2A2, Canada

 Supported by the Canadian Institutes of Health Research (grant nos. MOP-67072, MOP-86704).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

PII: S0003-9993(08)01492-5

doi:10.1016/j.apmr.2008.09.552


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