Abstract
Grauwmeijer E, Heijenbrok-Kal MH, Haitsma IK, Ribbers GM. A prospective study on employment
outcome 3 years after moderate to severe traumatic brain injury.
Objectives
To evaluate the employment outcome in patients with moderate to severe traumatic brain
injury (TBI) and to identify which patients are at risk of unemployment 3 years after
injury.
Design
Prospective cohort study.
Setting
Patients with moderate and severe TBI discharged from the neurosurgery departments
of 3 level 1 trauma centers in The Netherlands.
Participants
Patients aged 18 to 65 years (N=113; mean age ± SD, 33.2±13.1y; 73% men) who were
hospitalized with moderate (26% of patients) to severe (74% of patients) TBI.
Interventions
Not applicable.
Main Outcome Measures
The main outcome measure was employment status. Potential predictors included patient
characteristics, injury severity factors, functional outcome measured at discharge
from the acute hospital with the Glasgow Outcome Scale (GOS), Barthel Index (BI),
and FIM, and cognitive functioning measured with the Functional Assessment Measure
(FAM).
Results
Ninety-four patients (83%) completed the 3-year follow-up. The employment rate dropped
from 80% preinjury to 15% at 3 months postinjury and gradually increased to 55% after
3 years. The employment rate significantly increased from 3 months up to 1 year, but
it did not change significantly from 1 to 3 years postinjury. Age, length of hospital
stay, discharge to a nursing home (vs home), psychiatric symptoms, and BI, GOS, FIM,
and FAM scores were found to be significant univariate determinants for employment
status. By using multiple logistic regression analysis, the FAM score (adjusted odds
ratio 1.1; P<.000) and psychiatric symptoms (adjusted odds ratio .08; P<.019) were selected as independent predictors for employment status. A FAM cutoff
score of less than 65 to identify patients at risk of long-term unemployment had a
good diagnostic value.
Conclusions
Patients with TBI with psychiatric symptoms and impaired cognitive functioning at
hospital discharge are at the highest risk of long-term unemployment. These factors
should be the focus of vocational rehabilitation.
Key Words
List of Abbreviations:
BI (Barthel Index), FAM (Functional Assessment Measure), GCS (Glasgow Coma Scale), GOS (Glasgow Outcome Scale), ROC (receiver operating characteristics), RTW (return to work), TBI (traumatic brain injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 16, 2012
Footnotes
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.
In-press corrected proof published online on Apr 16, 2012, at www.archives-pmr.org.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
