A Multicenter Longitudinal Investigation of Return to Work and Community Integration Following Traumatic Brain Injury

Abstract

Objectives: To characterize changes in employment status and community integration following traumatic brain injury and to investigate relationships among outcome, sociodemographic, and injury-related variables. Design: Longitudinal analyses of employment (n=42) and community Integration (n=53) were conducted, with data examined at three follow-up periods. Chi-square (x2) and analysis of variance (ANOVA) were used to investigate the relationship between employment, time since injury, and demographic and injury-related variables. Repeated measures ANOVA and multiple regression analyses were utilized to investigate similar relationships for the community integration sample. Setting: Outpatient clinics affiliated with the TBI Model Systems programs. Participants: Patients with traumatic brain injury who received acute medical care at a Level I Trauma Center and received inpaticnt rehabilitation. Mean age of subjects was 33.9 years. The full range of injury severity was represented. Main Outcome Measures: Employment status determined through structured interview and scores on the Community Integration Questionnaire. Results: Less than 40% of persons employed before injury were employed at any follow-up interval. Fewer persons were employed at year 2 than at year 1 and years 3 or 4. Seventy-five percent of persons employed at year 1 were also employed at year 3 or 4. Fifty percent of persons unemployed at year 1 were either employed or otherwise productively engaged at year 3 or 4. Unemployed persons had longer acute hospital stays than employed persons at all follow-up intervals. Conclusions: Till has an adverse, long-term impact on employment and productivity. Findings highlight the need for postacute rehabilitation programs with particular emphasis on vocational rehabilitation. Uncertainties remain about the impact of brain injury on socialization and home activity patterns, partly because of limitations in measurement of community integration