Return to work after rehabilitation following traumatic brain injury

Abstract

The relationship of medical variables and discharge functional status to vocational and educational outcomes was examined in 79 closed head-injured patients who were consecutively admitted to an inpatient rehabilitation hospital during a two-year period. A follow-up study, conducted after hospital discharge (median, 16.5 months), found that 66% (n = 52) of the patients had returned to work or school, while 34% (n = 27) did not. Patients were divided into return and non-return to work groups. Traditional variables included age, severity of brain-damage as characterized by CT head scan, duration of post-traumatic amnesia, duration of coma, length of stay and acute inpatient rehabilitation program. Discharge functional scores were analysed by t-tests and chi-square analysis. Results suggest that traditional factors of younger age, shorter length of coma, minimal CT head scan findings and shorter length of stay were significant contributors to educational/vocational outcome. Their significance was enhanced by discharge functional profile measurement of medical, physical and psychological/neuropsychological integrity. Those functional measures not significant were in social, vocational, recreational and communication areas. These factors may continue to improve over a longer period of time and should be tracked in the post-acute rehabilitation phase for their significance in return to work/school.

Competitive re-employment after severe traumatic brain injury: clinical, cognitive and behavioural predictive variables

“…From a community re-integration perspective, the study also confirms that it is important to conduct ecologically oriented comprehensive wideranging cognitive and behavioural assessments to identify his cognitive strengths and weaknesses at the different stages of recovery, and to direct vocational treatment with behavioural predictive factors in mind. A satisfying outcome in terms of eventually re-acquired functional independence does not necessarily mean successfully competitive re-employment; this is in agreement with the generally sustained opinion affirming that, first cognitive, behavioural and emotional problems and, subsequently, physical deficits have a potentially negative effect on family and social integration [14,33].…”

Minimizing the effect of TBI-related physical sequelae on vocational return

“…A brief review of return to work (RTW) literature reveals contradicting findings regarding the effect of injury severity on RTW [11][12][13]. RTW rates have been tied to injury severity [9,[13][14], although not all investigators have found a relationship between injury severity and RTW [12,[15][16].…”

“…RTW rates have been tied to injury severity [9,[13][14], although not all investigators have found a relationship between injury severity and RTW [12,[15][16]. Despite the varying results, it is important to note that some individuals who sustained very severe injuries are able to return to employment relatively unhindered [7,13].…”

Cost-benefits associated with social outcome from neurobehavioural rehabilitation

“…Long-term debilitating behavioural change is common regardless of injury severity [18] and while return to work is clearly a laudable aim and has an obvious economic benefit, it represents an unrealistic goal for many [19][20][21][22][23]. Indeed many brain-injured adults have no constructive means of occupying their time [24,25].…”