Abstract
Objective
To describe the 10-year patterns of employment for individuals of working age discharged
from a Traumatic Brain Injury Model Systems (TBIMS) center between 1989 and 2009.
Design
Secondary data analysis.
Setting
Inpatient rehabilitation centers.
Participants
Patients aged 16 to 55 years (N=3618) who were not retired at injury, received inpatient
rehabilitation at a TBIMS center, were discharged alive between 1989 and 2009, and
had at least 3 completed follow-up interviews at postinjury years 1, 2, 5, and 10.
Interventions
Not applicable.
Main Outcomes Measure
Employment.
Results
Patterns of employment were generated using a generalized linear mixed model, where
these patterns were transformed into temporal trajectories of probability of employment
via random effects modeling. Covariates demonstrating significant relations to growth
parameters that govern the trajectory patterns were similar to those noted in previous
cross-sectional research and included age, sex, race/ethnicity, education, preinjury
substance misuse, preinjury vocational status, and days of posttraumatic amnesia.
The calendar year in which the injury occurred also greatly influenced trajectories.
An interactive tool was developed to provide visualization of all postemployment trajectories,
with many showing decreasing probabilities of employment between 5 and 10 years postinjury.
Conclusions
These results highlight that postinjury employment after moderate to severe traumatic
brain injury (TBI) is a dynamic process, with varied patterns of employment for individuals
with specific characteristics. The overall decline in trajectories of probability
of employment between 5 and 10 years postinjury suggests that moderate to severe TBI
may have unfavorable chronic effects and that employment outcome is highly influenced
by national labor market forces. Additional research targeting the underlying drivers
of the decline between 5 and 10 years postinjury is recommended, as are interventions
that target influencing factors.
Keywords
List of abbreviations:
NDB (National Database), PTA (posttraumatic amnesia), TBI (traumatic brain injury), TBIMS (Traumatic Brain Injury Model Systems)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 13, 2015
Footnotes
Supported by the Traumatic Brain Injury Model Systems (TBIMS) National Data and Statistical Center Grant from the National Institute on Disability and Rehabilitation Research (NIDRR) (grant no. H133A110006); TBIMS Centers grants from NIDRR (grant no. H133A120032); The Institute for Rehabilitation and Research Memorial Hermann (grant no. H133A120020); Moss Rehabilitation Research Institute (grant no. H133A120037); Spaulding Rehabilitation Hospital, Harvard Medical School (grant no. H133A120085); Rusk Rehabilitation at New York University School of Medicine (grant no. H133A120100); Indiana University School of Medicine (grant no. H133A120035); and a TBIMS Follow-up Center subcontract via an NIDRR Prime Award (award no. H133A110006).
The TBIMS National Database is supported by the NIDRR and created and maintained by the TBIMS Centers Program.
This article is intended to promote the exchange of ideas among researchers and policymakers. The views expressed in it are part of ongoing research and analysis and do not necessarily reflect the position of the U.S. Department of Education.
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
