Occupational Categories and Return to Work After Traumatic Brain Injury: A Multicenter Study

doi:10.1016/j.apmr.2006.08.335

Archives of Physical Medicine and Rehabilitation

Volume 87, Issue 12, December 2006, Pages 1576-1582

https://doi.org/10.1016/j.apmr.2006.08.335 Get rights and content

Abstract

Walker WC, Marwitz JH, Kreutzer JS, Hart T, Novack T. Occupational categories and return to work after traumatic brain injury: a multicenter study.

Objective

To further evaluate determinants of return to work (RTW) after traumatic brain injury (TBI), with focus on the relation between preinjury occupational category and RTW outcome.

Design

Prospective collaborative cohort study.

Setting

Seventeen National Institute on Disability and Rehabilitation Research–designated Traumatic Brain Injury Model Systems.

Participants

Consecutive sample of 1341 patients (age range, 18–62y) who were hospitalized with a TBI diagnosis, received both acute neurotrauma services and inpatient rehabilitation services, consented to participate, were employed before injury, and completed a 1-year follow-up assessment.

Intervention

An inpatient interdisciplinary brain injury rehabilitation program.

Main Outcome Measure

Competitive employment at 1 year postinjury.

Results

Participants were categorized into 1 of 3 groups depending on preinjury occupational title: professional/managerial (n=192), skilled (n=751), or manual labor (n=398). Chi-square analyses were computed to examine changes across occupation groups between preinjury occupation group and postinjury RTW. The rate of successful RTW was greatest for professional/managerial (56%), lower for skilled (40%), and lowest for manual labor (32%), yielding an odds ratio of 2.959 between the highest and lowest groups. Of those with successful RTW, most did so within the same occupational category grouping. A multiple logistic regression showed that preinjury occupation, education level, discharge FIM score, age, sex, marital status, and hospital length of stay each influenced RTW.

Conclusions

Prior research has shown that preinjury employment status (employed vs unemployed) greatly influences the odds of successful RTW after TBI. A related hypothesis, that occupational classification also influences RTW outcome, has been understudied and has yielded conflicting results. The current study shows convincingly that the type of occupation influences RTW outcome, with the best prospect for RTW among people with professional/managerial jobs. Occupational category should be examined in the future development of predictive models for RTW after TBI.

Section snippets

Participants

All subjects were participants in the NIDRR-funded TBIMS program, a collaborative multicenter project initiated in 1987.22, 23 At the time of this study, there were 17 participating centers. Each center includes emergency medical services, intensive and acute medical care, inpatient rehabilitation, and a spectrum of community rehabilitation services. All patients were admitted to an acute care hospital within 24 hours of injury. People with a history of prior brain injury, preexisting

Results

As noted in table 1, most participants held skilled positions preinjury (55%). The least, 15%, were in professional/managerial jobs, and 30% were manual laborers. Demographic and injury severity information for the entire sample and by occupation group is given in Table 2, Table 3. There were differences among the preinjury occupation groups with regard to age, sex, minority status, marital status, and education level. Professional/managerial participants were significantly older than

Discussion

A number of researchers have contended that postinjury RTW rates are a function of preinjury job classifications. In particular, Fleming,²¹ Vogenthaler,¹⁸ and Mackenzie¹⁶ and colleagues suggested that people in higher-paying or more technically demanding jobs preinjury were more likely to return to work postinjury. With a substantially larger sample and participants from multiple research sites, the present findings provide support for the findings of earlier researchers. People who were

Conclusions

The NIDRR TBIMS study confirmed the influence that preinjury occupational factors have on RTW after TBI. Among patients employed at the time of injury, those in manual labor jobs had the lowest rate of RTW, implying that this group may have a greater need for early vocational rehabilitation services. Patients in professional/managerial jobs had the highest rate of RTW at 1 year. Age, sex, marital status, hospital LOS, functional status at rehabilitation discharge, preinjury job category, and

Acknowledgment

The contributions of the NIDRR-funded TBIMS centers are gratefully acknowledged.

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Supported by the National Institute on Disability and Rehabilitation Research, U.S. Department of Education (grant nos. H133A020516, H133A020509, and H133A020505).

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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Original articleOccupational Categories and Return to Work After Traumatic Brain Injury: A Multicenter Study

Abstract

Objective

Design

Setting

Participants

Intervention

Main Outcome Measure

Results

Conclusions

Section snippets

Participants

Results

Discussion

Conclusions

Acknowledgment

Neuropsychological rehabilitation after closed head injury in young adults

J Neurol Neurosurg Psychiatry

Providing care to persons with physical disability: effect on family caregivers

Am J Phys Med Rehabil

Brain injury rehabilitation: the need to bridge paradigms

Brain Inj

Prediction of employment status 2 years after traumatic brain injury

Brain Inj

Prediction of employment outcome one to three years following traumatic brain injury

Brain Inj

Return to productive activity after traumatic brain injury: relationship with measures of disability, handicap, and community integration

Arch Phys Med Rehabil

Early cognitive status and productivity outcome after traumatic brain injury: findings from the TBI Model Systems

Arch Phys Med Rehabil

Factors influencing failure to return to work due to traumatic brain injury

Brain Inj

Acute predictors of successful return to work one year after traumatic brain injury: a multicenter analysis

Arch Phys Med Rehabil

Acute predictors of return to employment following traumatic brain injury: a longitudinal follow-up

Arch Phys Med Rehabil

Predictors and indicators of work status after traumatic brain injury: a meta-analysis

Neuropsychol Rehabil

Investigation of factors related to employment outcome following traumatic brain injury: a critical review and conceptual model

Disabil Rehabil

Brain injury rehabilitation4. Postacute rehabilitation and community integration

Arch Phys Med Rehabil

Return to work after traumatic brain injury

J Rehabil

The measurement of social class in health studies: old measures and new formulations

IARC Sci Publ

Factors influencing return to work following hospitalization for traumatic injury

Am J Public Health

Employability of head injury survivors: first year post-injury

Rehabil Couns Bull

Head injury, a multivariate study: predicting long-term productivity and independent living outcome

Brain Inj

Return to work within the first seven years of severe head injury

Brain Inj

Traumatic brain injury: factors predicting return to work or school

Brain Inj

Prediction of community integration and vocational outcome 2-5 years after traumatic brain injury rehabilitation in Australia

Brain Inj

A model systems database for traumatic brain injury

J Head Trauma Rehabil

Descriptive findings from the traumatic brain injury model systems national database

J Head Trauma Rehabil

Alphabetical index of industries and occupations1990 census of population and housing

Original article
Occupational Categories and Return to Work After Traumatic Brain Injury: A Multicenter Study