Associations between disability and employment 1 year after traumatic brain injury in a working age population

Exploring Vocational Evaluation Practices following Traumatic Brain Injury

BACKGROUND

Individuals with traumatic brain injury (TBI) face many challenges when attempting to return to work (RTW). Vocational evaluation (VE) is a systematic process that involves assessment and appraisal of an individual's current work-related characteristics and abilities.

OBJECTIVE

The aims of this study are to (1) examine demographic and employment characteristics of vocational rehabilitation providers (VRPs), (2) identify the specific evaluation methods that are used in the VE of individuals with TBI, and (3) examine the differences in assessment method practices based upon evaluator assessment preferences.

METHODS

This exploratory case study used a forty-six-item online survey which was distributed to VRPs.

RESULTS

One hundred and nine VRPs accessed the survey. Of these, 74 completed the survey. A majority of respondents were female (79.7%), Caucasian (71.6%), and holding a master's degree (74.3%), and more than half (56.8%) were employed as state vocational rehabilitation counselors (VRCs). In addition, over two-thirds (67.6%) were certified rehabilitation counselors (CRCs). Respondents reported using several specific tools and assessments during the VE process.

CONCLUSIONS

Study findings reveal differences in use of and rationales for specific assessments amongst VRPs. Understanding VRP assessment practices and use of an evidence-based framework for VE following TBI may inform and improve VE practice.

Ten-Year Employment Patterns of Working Age Individuals After Moderate to Severe Traumatic Brain Injury: A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study

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.

Prognostic factors of return to work after traumatic or non-traumatic acquired brain injury

PURPOSE

To investigate and to determine evidence of prognostic factors for return to work (RTW) after acquired brain injury (ABI).

METHOD

A systematic literature search was conducted in PubMed (2008-2014), applying terms for ABI and RTW. In addition, studies published after 2003 of a previous review on the same topic were added. The methodological quality of the included studies was assessed and evidence was classified.

RESULTS

Twenty-seven studies were included. There is strong evidence that a high education level is positively associated with RTW after traumatic ABI; a low education level, unemployment and length of stay in rehabilitation are negatively associated, and a clear tendency has been deduced from the studies that conscious state in the Emergency Department is not associated with RTW. After non-traumatic ABI, there is strong evidence that independence in activities of daily living is positively associated with RTW and aetiology of stroke is not.

CONCLUSIONS

This study confirms earlier findings that after both traumatic and non-traumatic ABI injury related factors in the Emergency Department are not associated with RTW. In addition, it provides further evidence that personal factors after traumatic ABI and activity-related factors after non-traumatic ABI are strongly associated with RTW. Implications for Rehabilitation We found strong evidence for a significant association between RTW and personal factors (education level, unemployment) after traumatic ABI, and activities of daily living (ADL) after non-traumatic ABI. We advise to focus on work-related activities during the RTW process besides ADL-training and pay attention to and support patients at risk for not returning to work.

Using information from the electronic health record to improve measurement of unemployment in service members and veterans with mTBI and post-deployment stress

OBJECTIVE

The purpose of this pilot study is 1) to develop an annotation schema and a training set of annotated notes to support the future development of a natural language processing (NLP) system to automatically extract employment information, and 2) to determine if information about employment status, goals and work-related challenges reported by service members and Veterans with mild traumatic brain injury (mTBI) and post-deployment stress can be identified in the Electronic Health Record (EHR).

DESIGN

Retrospective cohort study using data from selected progress notes stored in the EHR.

SETTING

Post-deployment Rehabilitation and Evaluation Program (PREP), an in-patient rehabilitation program for Veterans with TBI at the James A. Haley Veterans' Hospital in Tampa, Florida.

PARTICIPANTS

Service members and Veterans with TBI who participated in the PREP program (N = 60).

MAIN OUTCOME MEASURES

Documentation of employment status, goals, and work-related challenges reported by service members and recorded in the EHR.

RESULTS

Two hundred notes were examined and unique vocational information was found indicating a variety of self-reported employment challenges. Current employment status and future vocational goals along with information about cognitive, physical, and behavioral symptoms that may affect return-to-work were extracted from the EHR. The annotation schema developed for this study provides an excellent tool upon which NLP studies can be developed.

CONCLUSIONS

Information related to employment status and vocational history is stored in text notes in the EHR system. Information stored in text does not lend itself to easy extraction or summarization for research and rehabilitation planning purposes. Development of NLP systems to automatically extract text-based employment information provides data that may improve the understanding and measurement of employment in this important cohort.

Relationship between employment status and sexual functioning after traumatic brain injury

OBJECTIVE

To determine if correlations exist between employment status and sexual functioning in persons with traumatic brain injury (TBI).

DESIGN

Descriptive cross-sectional.

SETTING

Community.

PARTICIPANTS

One hundred and forty-six English-speaking, community dwelling adults, without other neurological or psychiatric disorder that could impact outcome and (1) enrolled in TBI Model Systems sexuality study database or (2) admitted to Rehabilitation Institute of Chicago with primary diagnosis of TBI between 2004-2006.

MAIN OUTCOME MEASURES

Employment status, annual income, Derogatis Interview for Sexual Functioning Self Report (DISF-SR) sum and sub-scale scores, Global Sexual Satisfaction Index (GSSI).

RESULTS

No significant difference was found in GSSI scores between employed, unemployed or students/volunteers (p = 0.20); however, lower income marginally correlated with lower GSSI scores (p = 0.09). Marginally significant lower DISF-SR Sexual Cognition sub-group (p = 0.09) scores were found in unemployed vs. employed. Lower annual income also correlated with lower DISF-SR sum scores (p = 0.06), Sexual cognition/fantasy (p = 0.07), Orgasm/ejaculation (p = 0.003) and Sexual drive and relationship (p = 0.01) scores.

CONCLUSIONS

Lower quality sexual functioning and satisfaction was present in persons with TBI and concomitant unemployment or lower annual income. Efforts are needed to increase awareness amongst the TBI population and rehabilitation professionals of the potential impact unemployment or financial stress has on sexual functioning and satisfaction.

Multi-level modelling of employment probability trajectories and employment stability at 1, 2 and 5 years after traumatic brain injury

PRIMARY OBJECTIVES

To examine trajectories of employment probability and stability over the first 5 years after traumatic brain injury (TBI) by using multi-level modelling and multinomial logistic regressions.

RESEARCH DESIGN

A longitudinal cohort study.

METHODS AND PROCEDURES

One hundred and five individuals with moderate-to-severe TBI who had been admitted to the Trauma Referral Centre for the Southeast region of Norway were followed up at 1, 2 and 5 years after the injury.

MAIN OUTCOMES AND RESULTS

Employment status was dichotomized into employed and unemployed, while employment stability was categorized into stably employed, unstably employed and unemployed at 1, 2 and 5 years after injury. Being single, unemployment prior to injury, blue collar occupation, lower Glasgow Coma Scale (GCS) score at hospital admission and greater length of post-traumatic amnesia (PTA) were significantly associated with being unemployed at 1, 2 and 5 years post-injury. Further, younger patients, those with a lower GCS, greater length of PTA and greater length of hospital stay were negatively associated with employment stability.

CONCLUSIONS

It could be wise to target patient population with these demographic and injury characteristics for more extensive follow-ups and vocational rehabilitation to help improve employment outcomes following injury.