Abstract
Objectives
To examine the completeness of return to work (RTW) and the degree of productivity
loss in individuals who do achieve a complete RTW after mild traumatic brain injury
(MTBI).
Design
Multisite prospective cohort.
Setting
Outpatient concussion clinics.
Participants
Patients (N=79; mean age, 41.5y; 55.7% women) who sustained an MTBI and were employed
at the time of the injury. Participants were enrolled at their first clinic visit
and assessed by telephone 6 to 8 months postinjury.
Interventions
Not applicable.
Main Outcome Measures
Structured interview of RTW status, British Columbia Postconcussion Symptom Inventory
(BC-PSI), Lam Employment Absence and Productivity Scale (LEAPS), Mini International
Neuropsychiatric Interview, and brief pain questionnaire. Participants who endorsed
symptoms from ≥3 categories with at least moderate severity on the BC-PSI were considered
to meet International Classification of Diseases, 10th Revision criteria for postconcussional syndrome. RTW status was classified as complete if
participants returned to their preinjury job with the same hours and responsibilities
or to a new job that was at least as demanding.
Results
Of the 46 patients (58.2%) who achieved an RTW, 33 (71.7%) had a complete RTW. Participants
with complete RTW had high rates of postconcussional syndrome (44.5%) and comorbid
depression (18.2%), anxiety disorder (24.2%), and bodily pain (30.3%). They also reported
productivity loss on the LEAPS, such as “getting less work done” (60.6%) and “making
more mistakes” (42.4%). In a regression model, productivity loss was predicted by
the presence of postconcussional syndrome and a comorbid psychiatric condition, but
not bodily pain.
Conclusions
Even in patients who RTW after MTBI, detailed assessment revealed underemployment
and productivity loss associated with residual symptoms and psychiatric complications.
Keywords
List of abbreviations:
BC-PSI (British Columbia Postconcussion Symptom Inventory), ICD-10 (International Classification of Diseases, 10th Revision), LEAPS (Lam Employment Absence and Productivity Scale), LEAPS-P (LEAPS productivity subscale), MINI (Mini International Neuropsychiatric Interview), MTBI (mild traumatic brain injury), PCS (postconcussional syndrome), RTW (return to work)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 28, 2017
Footnotes
Supported by a Specific Priorities Research Grant from WorkSafeBC (grant no. RS2014-SP03), and by a Clinician-Scientist Career Development Award from the Vancouver Coastal Health Research Institute.
Disclosures: G.L.I. has been reimbursed by the government, professional scientific bodies, and commercial organizations for discussing or presenting research relating to mild TBI and sport-related concussion at meetings, scientific conferences, and symposiums. He has a clinical practice in forensic neuropsychology involving individuals who have sustained mild TBIs. He is a co-investigator, collaborator, or consultant on grants relating to mild TBI funded by several organizations. He acknowledges unrestricted philanthropic support from ImPACT Applications, Inc. N.D.S. has a private practice in neuropsychology that includes consultation roles with professional sport organizations and disability insurance providers. W.J.P. has a clinical practice in forensic neuropsychiatry involving individuals who have sustained TBIs.
Identification
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© 2017 by the American Congress of Rehabilitation Medicine
