Article

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.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS