OBJECTIVES: To evaluate the employment outcome in patients with moderate to severe traumatic brain injury (TBI) and to identify which patients are at risk of unemployment 3 years after injury. DESIGN: Prospective cohort study. SETTING: Patients with moderate and severe TBI discharged from the neurosurgery departments of 3 level 1 trauma centers in The Netherlands. PARTICIPANTS: Patients aged 18 to 65 years (N=113; mean age ± SD, 33.2±13.1y; 73% men) who were hospitalized with moderate (26% of patients) to severe (74% of patients) TBI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The main outcome measure was employment status. Potential predictors included patient characteristics, injury severity factors, functional outcome measured at discharge from the acute hospital with the Glasgow Outcome Scale (GOS), Barthel Index (BI), and FIM, and cognitive functioning measured with the Functional Assessment Measure (FAM). RESULTS: Ninety-four patients (83%) completed the 3-year follow-up. The employment rate dropped from 80% preinjury to 15% at 3 months postinjury and gradually increased to 55% after 3 years. The employment rate significantly increased from 3 months up to 1 year, but it did not change significantly from 1 to 3 years postinjury. Age, length of hospital stay, discharge to a nursing home (vs home), psychiatric symptoms, and BI, GOS, FIM, and FAM scores were found to be significant univariate determinants for employment status. By using multiple logistic regression analysis, the FAM score (adjusted odds ratio 1.1; P<.000) and psychiatric symptoms (adjusted odds ratio .08; P<.019) were selected as independent predictors for employment status. A FAM cutoff score of less than 65 to identify patients at risk of long-term unemployment had a good diagnostic value. CONCLUSIONS: Patients with TBI with psychiatric symptoms and impaired cognitive functioning at hospital discharge are at the highest risk of long-term unemployment. These factors should be the focus of vocational rehabilitation.
OBJECTIVES: To evaluate the employment outcome in patients with moderate to severe traumatic brain injury (TBI) and to identify which patients are at risk of unemployment 3 years after injury. DESIGN: Prospective cohort study. SETTING:Patients with moderate and severe TBI discharged from the neurosurgery departments of 3 level 1 trauma centers in The Netherlands. PARTICIPANTS: Patients aged 18 to 65 years (N=113; mean age ± SD, 33.2±13.1y; 73% men) who were hospitalized with moderate (26% of patients) to severe (74% of patients) TBI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The main outcome measure was employment status. Potential predictors included patient characteristics, injury severity factors, functional outcome measured at discharge from the acute hospital with the Glasgow Outcome Scale (GOS), Barthel Index (BI), and FIM, and cognitive functioning measured with the Functional Assessment Measure (FAM). RESULTS: Ninety-four patients (83%) completed the 3-year follow-up. The employment rate dropped from 80% preinjury to 15% at 3 months postinjury and gradually increased to 55% after 3 years. The employment rate significantly increased from 3 months up to 1 year, but it did not change significantly from 1 to 3 years postinjury. Age, length of hospital stay, discharge to a nursing home (vs home), psychiatric symptoms, and BI, GOS, FIM, and FAM scores were found to be significant univariate determinants for employment status. By using multiple logistic regression analysis, the FAM score (adjusted odds ratio 1.1; P<.000) and psychiatric symptoms (adjusted odds ratio .08; P<.019) were selected as independent predictors for employment status. A FAM cutoff score of less than 65 to identify patients at risk of long-term unemployment had a good diagnostic value. CONCLUSIONS:Patients with TBI with psychiatric symptoms and impaired cognitive functioning at hospital discharge are at the highest risk of long-term unemployment. These factors should be the focus of vocational rehabilitation.
Authors: Daniel W Klyce; Katharine A Stromberg; William C Walker; Adam P Sima; Jeanne M Hoffman; Kristin M Graham; Amma A Agyemang; Jennifer H Marwitz Journal: Arch Phys Med Rehabil Date: 2019-07-22 Impact factor: 3.966
Authors: Jeffrey P Cuthbert; Cynthia Harrison-Felix; John D Corrigan; Jeneita M Bell; Juliet K Haarbauer-Krupa; A Cate Miller Journal: J Head Trauma Rehabil Date: 2015 May-Jun Impact factor: 2.710
Authors: Joan Machamer; Nancy Temkin; Sureyya Dikmen; Lindsay D Nelson; Jason Barber; Phillip Hwang; Kim Boase; Murray B Stein; Xiaoying Sun; Joseph Giacino; Michael A McCrea; Sabrina R Taylor; Sonia Jain; Geoff Manley Journal: J Neurotrauma Date: 2022-02-09 Impact factor: 5.269
Authors: Cassidy Q B Mostert; Ranjit D Singh; Maxime Gerritsen; Erwin J O Kompanje; Gerard M Ribbers; Wilco C Peul; Jeroen T J M van Dijck Journal: Acta Neurochir (Wien) Date: 2022-01-31 Impact factor: 2.816
Authors: Angelle M Sander; Anthony H Lequerica; Jessica M Ketchum; Flora M Hammond; Kelli Williams Gary; Monique R Pappadis; Elizabeth R Felix; Douglas Johnson-Greene; Tamara Bushnik Journal: J Head Trauma Rehabil Date: 2018 Jul/Aug Impact factor: 2.710
Authors: Latha Ganti; Aakash N Bodhit; Yasamin Daneshvar; Pratik Shashikant Patel; Christa Pulvino; Kelsey Hatchitt; Robyn M Hoelle; Keith R Peters; Sudeep Kuchibhotla; Lawrence Lottenberg; Andrea Gabrielli; Anna Mazzuoccolo; Marie-Carmelle Elie-Turenne; Tricia Falgiani; Porter W Maerz; Shivam M Kharod; Lauren M Conroy; Hussain M Khalid; J Adrian Tyndall Journal: Adv Prev Med Date: 2013-09-25