Vocational outcome indicators in atypically recovering mild TBI: A post-intervention study

Abstract

Beyond issues of MTBI etiology, a key question remains the characterization and early identification of those individuals at risk of poor functional outcome. Using a retrospective analysis, the current study aimed at identifying the specific indicators related to return to work in adults with both symptomatic MTBI and functional impacts, having completed a specialized intervention program. In terms of outcome, 59.1% of the cohort (n = 110) returned to some form of work-related activity by the end of intervention whereas the rest had not. Three of the sixteen variables studied were retained (logistic regression) as providing unique and significant (p < 0.05) contributions to the prediction outcome model, namely age, number of subjective symptoms and the presence of a public insurance provider. There was also an interaction between the presence of a public insurance provider and referral delay. Overall percentage of cases correctly classified by the model was 70%, positive predictive accuracy was 72.9%, whereas negative predictive accuracy was 65%. Our findings suggest that any studies attempting to assess functional outcome need to take account of the multifactorial nature of MTBI, including not only more objective psychological/physiological variables related to the injury, but also subjective complaints and environmental factors.

Predictors for Return to Work in Subjects with Mild Traumatic Brain Injury

“…RTW and vocational status represent one of the best indicators of real world functioning [ 11 ]. Identifying predictors for delayed RTW may help to identify those who may benefit from a follow-up rehabilitation program [ 3 , 12 – 14 ].…”

“…However, the majority of patients who return to work still present symptoms, and recently published reviews found different predictors for functional recovery in general as compared to RTW [ 3 , 17 , 18 ]. Preinjury variables, such as education, occupational factors (job independence and decision-making latitude), and age, are well-documented predictors for RTW [ 3 , 4 , 8 , 12 , 19 ].…”

“…Only the total numbers of symptoms reported at follow-up 12 to 36 months after MTBI were related to vocational status at follow-up [ 20 ]. Other postinjury predictors for RTW are nausea or vomiting on hospital admission, severe pain early after injury, fatigue, dizziness, number of subjective symptoms, cognitive variables, financial compensation-seeking, and environmental factors such as social interaction [ 3 , 4 , 8 , 12 , 19 , 21 , 22 ]. Among several postinjury factors, headache and widespread pain are a common complication after MTBI [ 23 – 26 ].…”

Experimental Traumatic Brain Injury Induces Chronic Glutamatergic Dysfunction in Amygdala Circuitry Known to Regulate Anxiety-Like Behavior

“…Despite clinical prevalence, the pathophysiology contributing to affective symptoms following dTBI is poorly understood, resulting in misdiagnosis and ineffective treatments (Van der Kolk, 2002;Collins et al, 2004;Hoge et al, 2014). Ultimately, ineffective treatment impacts a patient's ability to return to work, daily function, and social interactions; severely impairing the quality of life for both the patient and caregivers (Trahan et al, 2001;Guerin et al, 2006;van der Horn et al, 2013). Clinical and preclinical data demonstrate that dTBI causes profound lasting changes in the amygdala.…”

Labor Force Reentry: Issues for Injured Service Members and Veterans

“…Robust evaluations of supported employment programs have been conducted mostly among individuals with severe mental illness-e.g., schizophrenia (Bond, Drake, & Becker, 2008;Burns et al, 2007;Campbell, Bond, & Drake, 2011;Guerin et al, 2006). For moderate to severe TBI, the Virginia Commonwealth University's Rehabilitation Research and Training Center offers a university-based supported employment program that is not specific to service members or veterans, but is reserved for individuals with severe disabilities who would not be able to secure gainful employment without ongoing job support; it provides permanent assistance through vocational intervention, on-thejob training and neuropsychological assessments, and behavioral modification (Wehman et al, 1993).…”