Original research| Volume 99, ISSUE 2, P250-256, February 2018

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Work Productivity Loss After Mild Traumatic Brain Injury

  • Noah D. Silverberg
    Corresponding author Noah D. Silverberg, PhD, Rehabilitation Research Program, GF Strong Rehab Centre, 4255 Laurel St, Vancouver, BC, Canada V5Z 2G9.
    Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada

    Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, British Columbia, Canada

    Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
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  • William J. Panenka
    British Columbia Neuropsychiatry Program, Vancouver, British Columbia, Canada

    Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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  • Grant L. Iverson
    Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA

    Spaulding Rehabilitation Hospital, Boston, MA

    Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA
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      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).


      Multisite prospective cohort.


      Outpatient concussion clinics.


      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.


      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.


      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.


      Even in patients who RTW after MTBI, detailed assessment revealed underemployment and productivity loss associated with residual symptoms and psychiatric complications.


      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)
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