Article

OBJECTIVE: To describe the 10-year patterns of employment for individuals of
working age discharged from a Traumatic Brain Injury Model Systems (TBIMS) center
between 1989 and 2009. DESIGN: Secondary data analysis. SETTING: Inpatient
rehabilitation centers. PARTICIPANTS: Patients aged 16 to 55 years (N=3618) who
were not retired at injury, received inpatient rehabilitation at a TBIMS center,
were discharged alive between 1989 and 2009, and had at least 3 completed
follow-up interviews at postinjury years 1, 2, 5, and 10. INTERVENTIONS: Not
applicable. MAIN OUTCOMES MEASURE: Employment. RESULTS: Patterns of employment
were generated using a generalized linear mixed model, where these patterns were
transformed into temporal trajectories of probability of employment via random
effects modeling. Covariates demonstrating significant relations to growth
parameters that govern the trajectory patterns were similar to those noted in
previous cross-sectional research and included age, sex, race/ethnicity,
education, preinjury substance misuse, preinjury vocational status, and days of
posttraumatic amnesia. The calendar year in which the injury occurred also
greatly influenced trajectories. An interactive tool was developed to provide
visualization of all postemployment trajectories, with many showing decreasing
probabilities of employment between 5 and 10 years postinjury. CONCLUSIONS: These
results highlight that postinjury employment after moderate to severe traumatic
brain injury (TBI) is a dynamic process, with varied patterns of employment for
individuals with specific characteristics. The overall decline in trajectories of
probability of employment between 5 and 10 years postinjury suggests that
moderate to severe TBI may have unfavorable chronic effects and that employment
outcome is highly influenced by national labor market forces. Additional research
targeting the underlying drivers of the decline between 5 and 10 years postinjury
is recommended, as are interventions that target influencing factors.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS