Article

OBJECTIVE: To evaluate the cognitive and behavioral disturbances related to
return to work (RTW) in patients with traumatic brain injury (TBI) with the
application of a differentiated outcome scale. DESIGN: Longitudinal cohort study.
SETTING: Level I trauma center. PARTICIPANTS: Adults (N=434) with TBI of various
severity. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Extended Glasgow
Outcome Scale (GOS-E), Differentiated Outcome Scale (DOS), and RTW. RESULTS:
Patients encountered problems in the physical (40%), cognitive (62%), behavioral
(55%), and social domains (49%) of the DOS, with higher frequency related to
severity of injury. Even those with mild TBI experienced cognitive (43%) and
behavioral problems (33%). Patients with good recovery (58%) according to the
GOS-E experienced problems in 1 or more domains of the DOS. Half the patients
were able to resume previous vocational activities completely, although 1 in 3
experienced cognitive or behavioral problems. Using multivariate logistic
regression analysis, the cognitive (odds ratio [OR], 10.548; confidence interval
[CI], 5.99-18.67), behavioral (OR, 2.648; CI, 1.63-4.29), and physical domains
(OR, 2.763; CI, 1.60-4.78) were significant (P<.01) predictors of RTW. For
subcategories of TBI, the cognitive domain was predictive for RTW in those with
moderate and severe TBI, whereas both the cognitive and behavioral domains were
predictive for RTW in those with mild TBI. CONCLUSIONS: With application of a
more detailed outcome scale, cognitive and behavioral impairments interfering
with RTW were present in a substantial part of patients with TBI in the chronic
phase after injury. More research is needed exploring the cognitive and
behavioral outcome in different categories of injury severity separately.

Langue : ANGLAIS