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Aliaga Á, Bracho MJ, Romero M, Saldías MJ, Jofré X, Salas C. The contribution of executive functions to the process of return to work after brain injury: A systematic review. Neuropsychol Rehabil 2024; 34:619-648. [PMID: 37427841 DOI: 10.1080/09602011.2023.2224031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 06/02/2023] [Indexed: 07/11/2023]
Abstract
Acquired brain injury (ABI) is a worldwide public health issue for its high prevalence rate and the disability it produces. The consequences of ABI, including cognitive deficits, may impact return to work. This review focuses on the association between executive functions (EFs) and return to work after ABI. A systematic review of the literature between 1998 and 2023 was conducted following PRISMA guidelines. The articles were retrieved from the Pubmed, Medline and Web of Science databases. A total of 49 studies were finally selected. Impairments of EF were consistently shown to have a negative impact on return to work after an ABI. There is evidence that specific executive functions and neurobehavioral variables may affect return to work Studies showed a significant theoretical and methodological heterogeneity, representing an important limitation to understand the relation between EFs and work. There is a robust association between EFs and return to work after brain injury. Findings in this systematic review raise the need for further research on the role of specific EF profiles in the process of returning to work after brain damage.
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Affiliation(s)
- Álvaro Aliaga
- Unidad de Neuropsicología Clínica, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | | | - Matías Romero
- Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | | | - Ximena Jofré
- Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Christian Salas
- Unidad de Neuropsicología Clínica, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Centro de Neurociencia Humana y Neuropsicología (CENHN), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
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2
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Mamman R, Grewal J, Garrone JN, Schmidt J. Biopsychosocial factors of quality of life in individuals with moderate to severe traumatic brain injury: a scoping review. Qual Life Res 2024; 33:877-901. [PMID: 37925675 PMCID: PMC10972932 DOI: 10.1007/s11136-023-03511-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Individuals with moderate to severe traumatic brain injury (TBI) experience changes in their quality-of-life (QOL) post-injury. Given the vast literature that exists about QOL after TBI, a scoping review was performed to identify the different biopsychosocial factors that affect a person's QOL after a moderate to severe TBI. METHODS A scoping review was conducted using the following electronic databases: MEDLINE, CINAHL, Embase, and PsycINFO. Terms relating to TBI and QOL were used. RESULTS There were 7576 articles obtained from the databases, resulting in 535 full-text articles. Ultimately, 52 articles were extracted, which consisted of biopsychosocial QOL factors after TBI. The biopsychosocial factors of QOL after TBI included 19 biological factors (i.e., sex, TBI severity, cognition), 16 psychological factors (i.e., depression, self-efficacy, coping styles), and 19 social factors (i.e., employment, social participation, social support). Factors such as fatigue, self-awareness, transition, and discharge from hospitals are known issues in TBI literature but were minimally reported in studies in this review, identifying them as potential gaps in research. CONCLUSION Identifying biopsychosocial factors relating to QOL after TBI can enable health services to develop targeted rehabilitation programs for individuals with TBI.
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Affiliation(s)
- Rinni Mamman
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Jasleen Grewal
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | | | - Julia Schmidt
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, Canada.
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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3
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Lai WH, Hsu HH, Yu HT, Xiao SH, Tsai YH, Wang KC, Huang SJ, Lin CP, Yang CC. Long-term work quality of patients with mild traumatic brain injury: The associations with postconcussion symptoms. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-7. [PMID: 36881988 DOI: 10.1080/23279095.2023.2186232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Return to work (RTW) has always been a determinant functional outcome in patients with mild traumatic brain injury (MTBI). However, the quality of long-term RTW was still unclear. This study thus aims to examine long-term work quality and to reveal its associating factors. A total of 110 patients with MTBI was prospectively recruited. Post-concussion symptoms (PCS) and RTW were evaluated by the Checklist of Post-Concussion Symptoms (CPCS) and Work Quality Index (WQI) respectively at one-week and long-term evaluation (M = 2.90 years, SD = 1.29) post-injury. Only 16% of patients can successfully RTW at one-week post-injury, while 69% of patients have retained their jobs at long-term evaluations. Importantly, 12% of patients had to work under the adverse impacts of PCS at one-week after MTBI, and long-term WQI was significantly associated with PCS at one-week post-injury. Almost 1/3 of patients still had unfavorable long-term work quality even though they could return to work. Thus, a careful evaluation of the early PCS endorsement and work quality for patients with MTBI is merited.
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Affiliation(s)
- Wen-Hsuan Lai
- Connect with Passions Psychological Clinic, Taipei, Taiwan
| | - Huan-Hsuan Hsu
- Department of Neurology, Taichung Tzu Chi Hospital, Tanzih Township, Taiwan
| | - Hsiu-Ting Yu
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | | | - Yi-Hsin Tsai
- Department of Neurosurgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuo-Chuan Wang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Sheng-Jean Huang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Anesthesiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Cheng Yang
- Department of Psychology, National Chengchi University, Taipei, Taiwan
- Holistic Mental Health Center, Taipei City Hospital, Taipei, Taiwan
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4
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Worm MS, Valentin JB, Johnsen SP, Nielsen JF, Svendsen SW. Vocational/educational prognosis in adolescents and young adults with acquired brain injury: a nationwide cohort study. Brain Inj 2022; 37:1-8. [PMID: 36576114 DOI: 10.1080/02699052.2022.2158221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 07/04/2022] [Accepted: 12/09/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine prognostic factors for work ability and employment/educational status among young patients referred to outpatient neurorehabilitation clinics after an acquired brain injury. METHODS A nationwide cohort study of 471 15-30-year-old patients who attended an interdisciplinary clinical assessment and provided questionnaire data at baseline and after one year. The outcomes were the Work Ability Score (WAS, 0-10 (best)) and employment/educational status after one year. Prognostic performance was analyzed using univariable regression and multivariable Ridge regression in a five-fold cross-validated procedure. RESULTS Preinjury, 86% of the patients were employed, while the percentage had decreased to 55% at baseline and 52% at follow-up. The model, which included clinical measures of function, showed moderate prognostic performance with respect to WAS (R2=0.29) and employment/educational status (area under the curve (AUC)=0.77). Glasgow Outcome Scale Extended (R2=0.15, AUC=0.68) and the cognitive subscale of the Functional Independence Measure (R2=0.09, AUC=0.64), along with fatigue measured with the Multidimensional Fatigue Inventory (R2=0.15, AUC=0.60) were the single predictors with the highest predictive performance. CONCLUSION Despite generally high scores in motor and cognitive tests, only about half of the patients were employed at baseline and this proportion remained stable. Global disability, cognitive sequelae and fatigue had the highest prognostic performance.
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Affiliation(s)
- M S Worm
- Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J B Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - S P Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - J F Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - S W Svendsen
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
- Department of Public Health, Section of Environmental Health, University of Copenhagen, Copenhagen, Denmark
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5
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Murray A, Watter K, McLennan V, Vogler J, Nielsen M, Jeffery S, Ehlers S, Kennedy A. Identifying models, processes, and components of vocational rehabilitation following acquired brain injury: a systematic scoping review. Disabil Rehabil 2022; 44:7641-7654. [PMID: 34606380 DOI: 10.1080/09638288.2021.1980622] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Acquired brain injury (ABI) is a complex injury which impacts engagement with worker roles. Return to work (RTW) rates for individuals with brain injury are low and those who do RTW often report job instability. Vocational rehabilitation (VR) can improve RTW rates and job stability; however, service provision is varied, and no gold standard has been identified. METHODS A systematic scoping review of the literature was completed to explore research activity in VR for individuals with ABI to address the following three questions: what models have been identified to underpin VR in ABI? What clinical processes have been identified to guide provision of VR in ABI? What components of VR have been described and/or recommended in the ABI literature? RESULTS The number of included articles was 57. From these articles, 16 models, nine process steps, eight components, and four service delivery components were identified that were utilised in provision of ABI VR. Implications for practice are discussed. CONCLUSIONS Key processes and components of ABI VR have been identified across a range of models and apply to clients at all phases post-injury. Findings may be used to inform service provision across a range of time points and support clinicians in their delivery of VR to adults with brain injury.Implications for RehabilitationPeople with acquired brain injury (ABI), even severe injury, can be successful with return to work (RTW) when provided appropriate supports.A wide range of models, interventions, and service components have been identified in the literature which can be used to guide clinical and policy development in ABI vocational rehabilitation.Vocational rehabilitation for individuals with brain injury involves a complex interaction of factors, and consideration should be paid to not only the person and their abilities but also job demands and the environment (physical, social, cultural).Vocational rehabilitation services should be accessible and timed to maximise chances of a successful RTW, provided by a coordinated interdisciplinary team and should involve active stakeholder engagement.
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Affiliation(s)
- Alena Murray
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia.,Division of Rehabilitation, The Hopkins Centre, Metro South Health & Griffith University, Brisbane, Australia
| | - Kerrin Watter
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia.,Division of Rehabilitation, The Hopkins Centre, Metro South Health & Griffith University, Brisbane, Australia
| | - Vanette McLennan
- Division of Rehabilitation, The Hopkins Centre, Metro South Health & Griffith University, Brisbane, Australia.,School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Jessica Vogler
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia.,Division of Rehabilitation, The Hopkins Centre, Metro South Health & Griffith University, Brisbane, Australia
| | - Mandy Nielsen
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia.,Division of Rehabilitation, The Hopkins Centre, Metro South Health & Griffith University, Brisbane, Australia
| | - Sarah Jeffery
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia.,Division of Rehabilitation, The Hopkins Centre, Metro South Health & Griffith University, Brisbane, Australia
| | - Shelley Ehlers
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia
| | - Areti Kennedy
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia.,Division of Rehabilitation, The Hopkins Centre, Metro South Health & Griffith University, Brisbane, Australia
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6
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Arango-Lasprilla JC, Watson JD, Rodriguez M, Ramos-Usuga D, Mascialino G, Perrin PB. Employment probability trajectories in hispanics over the 10 years after traumatic brain injury: A model systems study. NeuroRehabilitation 2022; 51:397-405. [DOI: 10.3233/nre-220066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Research has found that Hispanics with traumatic brain injury (TBI) have reduced functional outcomes compared to non-Hispanic Whites, including lower probabilities of post-injury employment. However, previous studies were cross-sectional, combined racial/ethnic minority groups, and did not examine the factors that predict return to work of Hispanics longitudinally. OBJECTIVE: To determine the demographic and injury-related predictors of employment probability trajectories during the first 10 years after TBI. METHODS: 1,346 Hispanics in the TBI Model Systems Database was included. Hierarchical linear modeling was used to examine baseline predictors of employment probability trajectories across this time period. RESULTS: Employment probability demonstrated a quadratic movement over time, with an initial increase followed by a plateau or slight decrease. Hispanics with TBI had higher employment probability trajectories if they had been younger at the time of injury, spent less time in posttraumatic amnesia, had greater years of education, had been employed at the time of injury, had higher annual earnings at the time of injury, and had experienced a non-violent mechanism of injury. CONCLUSION: Culturally adapted treatment programs with a focus on early intervention incorporating vocational rehabilitation and employment programs for Hispanics with TBI who present with these risk factors are needed.
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Affiliation(s)
| | - Jack D. Watson
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Miriam Rodriguez
- Department of Health and Wellness Design, School of Public Health, Indiana University - Bloomington, Bloomington, IN, USA
| | - Daniela Ramos-Usuga
- Biomedical Research Doctorate Program, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Guido Mascialino
- Escuela de Psicología, Universidad de Las Américas, Quito, Ecuador
| | - Paul B. Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA
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7
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Cheng Y, Zhang Y, Zhang Y, Wu YH, Zhang S. Reliability and validity of the Rowland Universal Dementia Assessment Scale for patients with traumatic brain injury. APPLIED NEUROPSYCHOLOGY. ADULT 2022; 29:1160-1166. [PMID: 33321049 DOI: 10.1080/23279095.2020.1856850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective and accurate cognitive assessment scales are essential for guiding cognitive rehabilitation following traumatic brain injury (TBI). The aim of this study was to evaluate the reliability and validity of the Rowland Universal Dementia Assessment Scale (RUDAS) for TBI and to verify the clinical application value. Fifty patients with TBI and 32 matched controls were assessed using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and a newly developed Chinese version of RUDAS. These scales were then compared for internal consistency, inter-rater reliability, test‒retest reliability, content validity, construct validity, and diagnostic efficacy. Among the TBI group, the RUDAS demonstrated acceptable internal consistency (Cronbach's α = 0.733), high inter-rater reliability (intraclass correlation coefficients [ICCs] of 0.910‒0.999), and high test‒retest reliability (total score ICC = 0.938). The correlation coefficients between RUDAS total score and individual subscores were all > 0.5 except for body orientation (r = 0.363), indicating generally good content validity. Total RUDAS scores were moderately correlated with both MMSE total scores (r = 0.701, p < 0.001) and MoCA total scores (r = 0.778, p < 0.001), indicating good construct validity. Receiving operating characteristic curve analysis yielded comparable areas under the curve for diagnostic efficacy (RUDAS, 0.844; MMSE, 0.769; MoCA, 0.824; all p > 0.05). A RUDAS score cutoff of 23.5 distinguished TBI patients from controls with 60% sensitivity and 100% specificity. Therefore, the RUDAS demonstrates both good reliability and validity for evaluating cognitive impairments in TBI patients.
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Affiliation(s)
- Yun Cheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Rehabilitation Medicine, School of Clinical Medicine, Soochow University, Soochow, China
| | - Yu Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yi Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ye-Huan Wu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Shuang Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Rehabilitation Medicine, School of Clinical Medicine, Soochow University, Soochow, China
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8
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Mamman R, Mortenson WB, Fleming J, Schmidt J. Living in a reshaped reality: Exploring social participation and self-identity after TBI. Neuropsychol Rehabil 2022; 32:2102-2124. [PMID: 35997174 DOI: 10.1080/09602011.2022.2113100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Individuals with a moderate to severe traumatic brain injury (TBI) experience substantial changes in their life. This constructivist grounded theory study aimed to develop an explanatory model that explores the impact of changes in social participation and self-identity after sustaining a TBI. Sixteen participants with moderate to severe TBI (mean age = 49.8, 69% male) were recruited, and were on average 16.4 years post-injury (SD = 10.4). Data from semi-structured interviews were analysed thematically. An overarching theme of "living in a reshaped reality" was identified, which depicted how changes in social participation and self-identity influenced ongoing experiences with TBI. Three main themes were generated: (1) "there's nothing that's the same" highlighted the daily challenges individuals faced post-injury, (2) "rebuilding and restarting" described how individuals with TBI navigated through their unfamiliar reality, and (3) "embrace it and run with it" explored participants' reactions towards life with a TBI. An explanatory model was developed, consisting of the overarching theme ("living in a reshaped reality") with the three integrated themes. Future research and clinical practices can build on this understanding to develop programmes to help individuals address their needs in post-injury life.
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Affiliation(s)
- Rinni Mamman
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, Canada
| | - W Ben Mortenson
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, Vancouver General Hospital, Vancouver, Canada
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Julia Schmidt
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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9
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Sharma TL. Returning to Work After Mild Traumatic Brain Injury-Considering the Impact of Employer Support. JAMA Netw Open 2022; 5:e2219454. [PMID: 35767264 DOI: 10.1001/jamanetworkopen.2022.19454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tara L Sharma
- Department of Neurology, University of Washington, Seattle
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10
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Tarnai K, Marcopulos B. Developing a model of return to school: A Traumatic Brain Injury Model Systems study. Brain Inj 2022; 36:544-552. [PMID: 35380490 DOI: 10.1080/02699052.2022.2051739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE A common goal for those recovering from moderate to severe brain injury is to reengage in education or employment. There is significant overlap between the skills relevant for successful job and academic performance in high school and college, and many deficits reported after brain injury are consistent across young adults and adults. This study utilized a return to work (RTW) model framework to develop a model of return to school (RTS). METHOD Days of post-traumatic amnesia (PTA), length of stay (LOS), rehabilitation discharge Disability Rating Scale (DRS) scores, presence of pre-injury learning limitation, and educational level were used to predict RTS one-year post-injury in a student sample (N = 158, 58.8% white, 69.6% male) within the Traumatic Brain Injury Model Systems National Database. RESULTS The overall RTS rate for this sample was 62%. Logistic regression indicated that lower DRS discharge scores and being in high school pre-injury resulted in the best outcome. CONCLUSION Results showed partial support for the translation of RTW factors to a student sample; however, results may also favor the conceptual distinction in RTS versus RTW, which are elaborated. More outreach for college students may improve awareness of disability services, thereby heightening the future return rate.
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Affiliation(s)
- Kathryn Tarnai
- Department of Graduate Psychology, James Madison University, Harrisonburg, Virginia, USA
| | - Bernice Marcopulos
- Department of Graduate Psychology, James Madison University, Harrisonburg, Virginia, USA.,Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia, USA
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11
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Association Between Self-Reported Disability and Lifetime History of Traumatic Brain Injury With Loss of Consciousness Among Veterans and Nonveterans in North Carolina. J Head Trauma Rehabil 2022; 37:E428-E437. [PMID: 35125429 PMCID: PMC9339579 DOI: 10.1097/htr.0000000000000753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Compared with civilians, service members and veterans who have a history of traumatic brain injury (TBI) are more likely to experience poorer physical and mental health. To investigate this further, this article examines the association between self-reported history of TBI with loss of consciousness and living with 1 or more current disabilities (ie, serious difficulty with hearing, vision, cognition, or mobility; any difficulty with self-care or independent living) for both veterans and nonveterans. METHODS A cross-sectional study using data from the North Carolina Behavioral Risk Factor Surveillance System for 4733 veterans and nonveterans aged 18 years and older. RESULTS Approximately 34.7% of veterans residing in North Carolina reported having a lifetime history of TBI compared with 23.6% of nonveterans. Veterans reporting a lifetime history of TBI had a 1.4 times greater risk of also reporting living with a current disability (adjusted prevalence ratio = 1.4; 95% confidence interval, 1.2-1.8) compared with nonveterans. The most common types of disabilities reported were mobility, cognitive, and hearing. CONCLUSIONS Compared with nonveterans, veterans who reported a lifetime history of TBI had an increased risk of reporting a current disability. Future studies, such as longitudinal studies, may further explore this to inform the development of interventions.
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12
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Libeson L, Ross P, Downing M, Ponsford J. Factors associated with employment stability following traumatic brain injury, in a sample who have received comprehensive vocational rehabilitation. Disabil Rehabil 2021; 44:6325-6332. [PMID: 34498992 DOI: 10.1080/09638288.2021.1965229] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To quantify employment stability of individuals with traumatic brain injury (TBI) who received comprehensive vocational rehabilitation (VR) using different measures to identify difficulties experienced and factors associated with employment stability. MATERIALS AND METHODS 72 individuals with predominantly moderate-severe TBI were interviewed. Neuropsychological assessment scores were collected. Three employment stability measures were used: number of post-injury employers, duration with employer and average weekly hours. Descriptive and predictive analyses were performed. RESULTS 90.2% remained employed at time of interview (Mean = 4.83 years post-injury). However, participants worked significantly fewer hours, 63.9% had changed roles or employers at least once and only 51% achieved their pre-injury level of responsibility. 61% reported a high level of employer support. Self-reported difficulties included physical sequelae, memory problems and fatigue. Post-injury testing found impaired memory (34.4%) and processing speed (49.2%). After accounting for time since injury, demographic and employment variables (older age, male gender, higher pre-injury skill-level, higher level of employer support), higher level of injury-related difficulties and lower level of cognitive function significantly predicted employment stability. CONCLUSION Injury-related difficulties impact employment long-term, necessitating ongoing work modifications. Individualised VR is important, not only to facilitate return to work but to support long-term employment stability after TBI.Implications for rehabilitationBeing male was associated with working more hours, and having faster processing speed, lower levels of fatigue and ongoing physical sequelae were associated with a longer duration with the same employer.Initial return to work is often the first step on a long journey as injury-related difficulties can continue to impact work in the-long term and require lasting modifications to duties and working hours.VR should include ongoing follow-up to facilitate work modifications and support both the employer and the employee in adjusting to these.VR should be individualised to support the impact of the unique cognitive and physical limitations experienced by each individual with TBI, based on the needs and employment demands of each workplace.
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Affiliation(s)
- Lauren Libeson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
| | - Pamela Ross
- Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia.,Epworth HealthCare, Richmond, Victoria, Australia
| | - Marina Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
| | - Jennie Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
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13
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Van Deynse H, Ilunga Kazadi C, Kimpe E, Hubloue I, Moens M, Putman K. Predictors of return to work after moderate-to-severe traumatic brain injury: a systematic review of current literature and recommendations for future research. Disabil Rehabil 2021; 44:5750-5757. [PMID: 34494491 DOI: 10.1080/09638288.2021.1954247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To identify factors associated with employment between six months and five years after traumatic brain injury (TBI). METHODS Using a predefined search algorithm, four electronic databases were searched for literature published between 2014 and the first half of April 2021 containing predictors of employment outcome. Data were selected in accordance with the PRISMA flow and the whole process was conducted by two reviewers who had to attain a consensus. The study results were discussed with an expert panel, in order to provide guidance for future research on this topic. RESULTS This review found clear evidence for employment status at time of injury, occupation at time of injury, Glasgow Coma Scale, length of stay, disability level and primary payer to be predictors of return to work after TBI. CONCLUSIONS More literature investigating in depth the functioning and environmental factors is required for further improvement of predictions, rehabilitation and policy.Implications for rehabilitationThis study identifies predictors of return to work in TBI patients, which can be used to identify patients with high risk early in the recovery process.Current literature shows difficulties with general functioning are a barrier for return to work, but gives no indication about effective therapeutic interventions.More knowledge about modifiable factors is desirable to improve rehabilitation and, thereby, employment outcomes after TBI.
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Affiliation(s)
- Helena Van Deynse
- Interuniversity Centre for Health Economics Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Carl Ilunga Kazadi
- Interuniversity Centre for Health Economics Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Kimpe
- Interuniversity Centre for Health Economics Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ives Hubloue
- Emergency and Disaster Medicine, Department Emergency Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Koen Putman
- Interuniversity Centre for Health Economics Research, Vrije Universiteit Brussel, Brussels, Belgium
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14
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Thor JA, Mazlan M, Waran V. Employment status after traumatic brain injury and the effect of concomitant injuries on return to work. Brain Inj 2021; 35:949-956. [PMID: 34096426 DOI: 10.1080/02699052.2021.1934729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aims to describe the employment status and pattern among survivors of traumatic brain injury after motor vehicle accidents, and to explore the effects of demographic, injury variables and concomitant injuries on the employment status . METHOD A retrospective analyses of 370 medical reports written for patients who sustained traumatic brain injury from motor vehicle accidents was conducted. To establish the employment pattern, the pre-injury employment history was compared to the latest employment status documented. Types and severity of concomitant injuries were rated according to Abbreviated Injury Scale criteria. All significant variables were further analyzed using logistic regression to explore predictors of employment. RESULTS Up to 87% of the patients sustained concomitant injuries, with more than two-thirds (72%) scoring ≤ 2 on the Abbreviated Injury Scale. One hundred and eighty-two patients (49.2%) successfully returned to work. Among those who returned to work, 34% returned to former employment with pre-injury job description. Severity of traumatic brain injury, length of acute hospital stay, ambulation status and cognitive status were found to be significant predictive factors for employment status post traumatic brain injury. Presence of concomitant extremity injuries was found to influence the employment pattern among traumatic brain injury survivors. CONCLUSION The return to work rate was somewhat low and was not influenced by presence of concomitant injuries. .
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Affiliation(s)
- Ju An Thor
- Department of Rehabilitation Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.,Department of Rehabilitation Medicine, Hospital Queen Elizabeth, Kota Kinabalu, Malaysia
| | - Mazlina Mazlan
- Department of Rehabilitation Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Vicknes Waran
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
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15
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Awan N, DiSanto D, Juengst SB, Kumar RG, Bertisch H, Niemeier J, Fann JR, Kesinger MR, Sperry J, Wagner AK. Evaluating the Cross-Sectional and Longitudinal Relationships Predicting Suicidal Ideation Following Traumatic Brain Injury. J Head Trauma Rehabil 2021; 36:E18-E29. [PMID: 32769828 PMCID: PMC10280901 DOI: 10.1097/htr.0000000000000588] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Characterize relationships among substance misuse, depression, employment, and suicidal ideation (SI) following moderate to severe traumatic brain injury (TBI). DESIGN Prospective cohort study. SETTING Inpatient rehabilitation centers with telephone follow-up; level I/II trauma centers in the United States. PARTICIPANTS Individuals with moderate to severe TBI with data in both the National Trauma Data Bank and the Traumatic Brain Injury Model Systems National Database, aged 18 to 59 years, with SI data at year 1 or year 2 postinjury (N = 1377). MAIN OUTCOME MEASURE Primary outcome of SI, with secondary employment, substance misuse, and depression outcomes at years 1 and 2 postinjury. RESULTS Cross-lagged structural equation modeling analysis showed that year 1 unemployment and substance misuse were associated with a higher prevalence of year 1 depression. Depression was associated with concurrent SI at years 1 and 2. Older adults and women had a greater likelihood of year 1 depression. More severe overall injury (injury severity score) was associated with a greater likelihood of year 1 SI, and year 1 SI was associated with a greater likelihood of year 2 SI. CONCLUSIONS Substance misuse, unemployment, depression, and greater extracranial injury burden independently contributed to year 1 SI; in turn, year 1 SI and year 2 depression contributed to year 2 SI. Older age and female sex were associated with year 1 depression. Understanding and mitigating these risk factors are crucial for effectively managing post-TBI SI to prevent postinjury suicide.
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Affiliation(s)
- Nabil Awan
- Departments of Physical Medicine and Rehabilitation (Messrs Awan and DiSanto and Dr Wagner), Biostatistics (Mr Awan), Surgery (Dr Sperry), and Neuroscience (Dr Wagner), University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Neuroscience (Dr Wagner), Safar Center of Resuscitation Research (Dr Wagner), School of Medicine (Mr Kesinger), and Clinical and Translational Science Institute (Dr Wagner), University of Pittsburgh, Pittsburgh, Pennsylvania; Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh (Mr Awan); Departments of Physical Medicine & Rehabilitation (Dr Juengst) and Rehabilitation Counseling (Dr Juengst), University of Texas-Southwestern Medical Center, Dallas; Department of Rehabilitation Medicine, Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Kumar); Department of Psychology, NYU Rusk Rehabilitation, Brooklyn (Dr Bertisch); Department of Physical Medicine & Rehabilitation, UAB Spain Rehabilitation Center, Birmingham, Alabama (Dr Niemeier); and Departments of Psychiatry and Behavioral Sciences (Dr Fann), Epidemiology (Dr Fann), and Rehabilitation Medicine (Dr Fann), University of Washington, Seattle
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16
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Ponsford J, Carrier S, Hicks A, McKay A. Assessment and Management of Patients in the Acute Stages of Recovery after Traumatic Brain Injury in Adults: A Worldwide Survey. J Neurotrauma 2020; 38:1060-1067. [PMID: 33121375 DOI: 10.1089/neu.2020.7299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Most individuals with traumatic brain injury (TBI) experience a period of confusion after emergence from coma, termed post-traumatic amnesia, post-traumatic confusional state, or delirium. Recent guidelines suggest the importance of assessment and consistent management during this phase, but current practice worldwide remains unknown. This survey aimed to elucidate current international practice in assessment and treatment of patients in the acute stages of recovery after TBI. The web-based survey was distributed to clinicians working with patients with acute TBI. There were 400 participants (68.8% females), from 41 countries, mostly neuropsychologists, rehabilitation physicians, and occupational therapists (OTs), with an average 12.8 years of experience. Of those working with adults (n = 376, 94%), most described this acute period as post-traumatic amnesia and used its duration to indicate injury severity. More than 85% used a tool to assess patients; in order of frequency, the Glasgow Coma Scale (GCS), Westmead PTA Scale (WPTAS), Galveston Orientation and Amnesia Test, Rancho Los Amigos Scale, and O-Log. Meeting criteria on the assessment tool or clinical judgment determined emergence from this phase, indicated by recovery of orientation, day-to-day memories, and ability to follow commands or participate in rehabilitation. Most patients had physiotherapy, OT, speech therapy, and environmental changes, with a third of participants indicating sedating medication was prescribed during this phase. Findings suggest that, consistent with guidelines, PTA is a widely recognized and measured TBI recovery phase, used to determine injury severity and readiness for therapy.
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Affiliation(s)
- Jennie Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia.,Epworth Healthcare, Melbourne, Victoria, Australia
| | - Sarah Carrier
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Amelia Hicks
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Adam McKay
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia.,Epworth Healthcare, Melbourne, Victoria, Australia
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17
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Howe EI, Fure SCR, Løvstad M, Enehaug H, Sagstad K, Hellstrøm T, Brunborg C, Røe C, Nordenmark TH, Søberg HL, Twamley E, Lu J, Andelic N. Effectiveness of Combining Compensatory Cognitive Training and Vocational Intervention vs. Treatment as Usual on Return to Work Following Mild-to-Moderate Traumatic Brain Injury: Interim Analysis at 3 and 6 Month Follow-Up. Front Neurol 2020; 11:561400. [PMID: 33240196 PMCID: PMC7683428 DOI: 10.3389/fneur.2020.561400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/08/2020] [Indexed: 12/25/2022] Open
Abstract
Aims: Knowledge regarding the most effective return to work (RTW) approaches after traumatic brain injury (TBI) is lacking. This trial aimed to compare the effectiveness of a combined cognitive and vocational intervention to treatment as usual (TAU) on RTW and work stability after TBI. Methods: We performed a parallel-group randomized controlled trial (RCT) at a TBI outpatient clinic at Oslo University Hospital (OUH), Norway. Patients with a history of mild-to-moderate TBI (n = 116) aged 18–60 were randomized (1:1) by an independent investigator to receive group-based compensatory cognitive training (CCT) and supported employment (SE) (n = 60) or TAU consisting of individualized multidisciplinary treatment (n = 56). Participants were enrolled 2–3 months post-injury. The nature of the intervention prevented blinding of patients and therapists, however, outcome assessors were blinded to group allocation. The primary outcome measure was RTW at 3 and 6 months following study inclusion. Secondary outcomes were work percentage, stability, and productivity. The present study provides results from an interim analysis from the first two planned follow ups, while subsequent publications will present results up to 12 months following study inclusion. Results: Mixed effects models showed no between-group differences in the RTW proportion, work percentage, and hours worked between CCT-SE and TAU from baseline to 6 months. A significantly higher proportion of participants in CCT-SE had returned to work at 3 months when adjusting for baseline differences. The majority of participants who were employed at 3 and 6 months were stably employed. There was a statistically significant within-group improvement on RTW proportion, hours worked and work percentage in both groups. Conclusion: The results revealed no difference between CCT-SE and TAU on work-related outcomes from baseline to 6 months. However, there was a higher RTW proportion in the CCT-SE group compared to TAU at 3 months. Future publications will assess the effectiveness of CCT-SE vs. TAU up to 12 months. Clinical Trial Registration: US National Institutes of Health ClinicalTrials.gov, identifier #NCT03092713.
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Affiliation(s)
- Emilie Isager Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Silje C R Fure
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Heidi Enehaug
- The Work Research Institute, Oslo Metropolitan University, Oslo, Norway
| | - Kjersti Sagstad
- Department of Vocational Rehabilitation, Norwegian Labour and Welfare Administration, Oslo, Norway
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tonje Haug Nordenmark
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Helene L Søberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Elizabeth Twamley
- Center of Excellence for Stress and Mental Health, Veterans Affairs (VA) San Diego Healthcare System, San Diego, CA, United States.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Juan Lu
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway.,Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
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18
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Vocational Rehabilitation in the Veterans Health Administration Polytrauma System of Care: Current Practices, Unique Challenges, and Future Directions. J Head Trauma Rehabil 2020; 34:158-166. [PMID: 31058758 DOI: 10.1097/htr.0000000000000493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE/PURPOSE Veterans and service members (V/SMs) with traumatic brain injury (TBI) and comorbid conditions are treated in the Veterans Health Administration (VHA) Polytrauma System of Care (PSC). These V/SMs comprise a unique population with distinct needs for restoring community reintegration, including participation in meaningful employment. Low employment rates after TBI vary and are influenced by many factors. Employment is a central aspect of the VHA priority of facilitating adjustment, and addressing vocational needs alongside healthcare is critical to community reintegration. The purpose of this article is to outline current practices of addressing vocational rehabilitation in the PSC, discuss the unique challenges in serving Veterans with polytrauma, and outline future directions to improve vocational services and outcomes. METHODS Briefly review literature on V/SM with TBI and employment, describe the PSC and VHA vocational programs for V/SM with polytrauma, and synthesize proceedings on vocational rehabilitation from the 2017 VHA "Community Reintegration in the Polytrauma System of Care" meeting. CONCLUSIONS To advance and expand vocational services the following guidelines were recommended: (1) designing flexible services based on individualized needs, (2) increasing access to vocational services through communication and collaboration, (3) promoting cross-disciplinary education and engagement in vocational care, and (4) systematically tracking employment outcomes.
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19
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Fortune DG, Walsh RS, MacConaill S, Harte M, Richards HL. Facilitating a return to productive roles following acquired brain injury: The impact of pre-injury work level, current abilities, and neuropsychological performance. Neuropsychol Rehabil 2020; 31:914-934. [PMID: 32223509 DOI: 10.1080/09602011.2020.1746674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The primary aim of this study was to examine predictors of Return to Productive Roles (RTPR) in individuals with ABI following participation in a community-based RTPR intervention. One hundred and thirty participants were inducted to an ABI-specific RTPR programme. At induction, information on clinical and social demographics, previous education and employment roles were collected. Participants underwent a comprehensive neuropsychological assessment at baseline and completed assessments of disability, mental health and community integration. Participants were followed up at the end of their programme to assess RTPR. Three out of four participants who entered the RTPR programme returned to productive roles. Despite the relatively high levels of anxiety and depression in the sample, people who returned to productive roles were not significantly less anxious or depressed than those who did not. Logistic regression suggested that participants who returned to productive roles following the programme had higher levels of pre-ABI work engagement, less disability and performed better on neuropsychological assessment in terms of their language skills. Results suggest that these factors which cut across specific prior experience, cognitive performance, and social and disability areas of functioning represent barriers to an effective return to productive roles for people with ABI accessing RTPR intervention.
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Affiliation(s)
- Dónal G Fortune
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - R Stephen Walsh
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | | | | | - Helen L Richards
- Department of Clinical Psychology, Mercy University Hospital Cork, Cork, Ireland
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20
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Salas C, Casassus M, Rowlands L, Pimm S. Developing a model of long-term social rehabilitation after traumatic brain injury: the case of the head forward centre. Disabil Rehabil 2020; 43:3405-3416. [PMID: 32212984 DOI: 10.1080/09638288.2020.1741697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Social isolation and inactivity are highly problematic long-term consequences of Traumatic Brain Injury. They are rarely addressed by rehabilitation programmes, which focus on early phases of recovery. Day centres, or "drop-in" peer support groups, have emerged as an informal solution to social rehabilitation needs. However, there is a lack of knowledge regarding the therapeutic ingredients of these services.Methods: Twelve survivors of Traumatic Brain Injury that attended a social rehabilitation service (Head Forward Centre, UK; HFC), were interviewed to explore the meanings attached to the service and its activities. Thematic analysis was used to describe emerging themes and build a model of social rehabilitation.Results: Four therapeutic functions were attached to HFC: (a) HFC as a safe and predictable milieu; (b) HFC as a space where identity can be reconstructed; (c) HFC as a place where survivors can remain cognitive and socially active; (d) HFC as a network of continuous support.Conclusion: A model of long-term social rehabilitation should consider both psychological and practical/functional ingredients. Such a model can help informal rehabilitation services reflect upon their goals and activities, as well as articulate therapeutic actions along the rehabilitation path. The conceptualization of these four therapeutic ingredients in holistic rehabilitation models is described, and contrasted with its use in long-term social rehabilitation.IMPLICATIONS FOR REHABILITATIONSocial isolation and inactivity are important problems in the long-term rehabilitation of people with TBI. Both problems can be addressed by social rehabilitation services (day centres and peer support groups).Participation in social rehabilitation can promote a sense of normality and belongingness, which contribute to the long-term process of identity reconstruction.Social rehabilitation can help maintaining people with TBI cognitive and socially active, as well as developing a network of continuous support.
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Affiliation(s)
- Christian Salas
- Unidad de Neuropsicología Clínica, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile.,Laboratorio de Neurociencia Cognitiva y Social, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile.,Head Forward Centre, Manchester, UK
| | - Martin Casassus
- Head Forward Centre, Manchester, UK.,Time Perception Laboratory, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Steve Pimm
- Head Forward Centre, Manchester, UK.,Rehabilitation Without Walls, Milton Keynes, UK
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21
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Return to Productivity Projections for Individuals With Moderate to Severe TBI Following Inpatient Rehabilitation: A NIDILRR TBIMS and CDC Interagency Collaboration. J Head Trauma Rehabil 2020; 35:140-151. [DOI: 10.1097/htr.0000000000000506] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Manoli R, Delecroix H, Daveluy W, Moroni C. Impact of cognitive and behavioural functioning on vocational outcome following traumatic brain injury: a systematic review. Disabil Rehabil 2019; 43:2531-2540. [DOI: 10.1080/09638288.2019.1706105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Romina Manoli
- PSITEC Lab (EA 4072), Department of Psychology, University of Lille, Lille, France
| | - Helene Delecroix
- PSITEC Lab (EA 4072), Department of Psychology, University of Lille, Lille, France
- UEROS, UGECAM Hauts-de-France, Lille, France
| | - Walter Daveluy
- UEROS, UGECAM Hauts-de-France, Lille, France
- Service de Rééducation Neurologique Cérébrolésion, Hopital Swynghedauw, CHRU de Lille, Lille, France
| | - Christine Moroni
- PSITEC Lab (EA 4072), Department of Psychology, University of Lille, Lille, France
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23
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Gormley M, Devanaboyina M, Andelic N, Røe C, Seel RT, Lu J. Long-term employment outcomes following moderate to severe traumatic brain injury: a systematic review and meta-analysis. Brain Inj 2019; 33:1567-1580. [PMID: 31454278 DOI: 10.1080/02699052.2019.1658222] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Returning to employment following moderate to severe traumatic brain injury (msTBI) is critical for a survivor's well-being, yet currently there are no systematic reviews that comprehensively describe employment outcomes following msTBI. The objective of this study was to systematically synthesize literature on employment outcomes following msTBI.Methods: Original studies published through April 2018 on MEDLINE/PubMed, PsychINFO, and CINAHL were eligible if the objective was to investigate employment outcomes following msTBI; outcome was measured ≥1 year; participants were ≥15; and size was ≥60. Post-injury employment prevalence and return to pre-injury level of work were summarized through meta-analysis.Results: Of 38 eligible studies, post-injury employment prevalence was most often reported (n = 35), followed by job stability (n = 6), and return to pre-injury level of work (n = 4). Overall post-injury employment prevalence was 42.2%; whereas the return-to-previous-work prevalence was 33.0%. Post-injury employment prevalence appeared to increase over time, from 34.9% at 1 year to 42.1% up to 5 years and 49.9% beyond 5 years.Conclusion: Nearly half of individuals with msTBI were employed post-injury, yet only a third returned to pre-injury level of work. Future researchers are recommended to standardize employment outcome measures to enable better comparison of outcomes across studies.
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Affiliation(s)
- Mirinda Gormley
- Department of Family Medicine and Population Health, Division of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Monika Devanaboyina
- Department of Family Medicine and Population Health, Division of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ronald T Seel
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Juan Lu
- Department of Family Medicine and Population Health, Division of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA, USA
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24
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Klyce DW, Stromberg KA, Walker WC, Sima AP, Hoffman JM, Graham KM, Agyemang AA, Marwitz JH. Depression as a Predictor of Long-term Employment Outcomes Among Individuals With Moderate-to-Severe Traumatic Brain Injury. Arch Phys Med Rehabil 2019; 100:1837-1843. [PMID: 31344363 DOI: 10.1016/j.apmr.2019.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/09/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the predictive ability of depression when considering long-term employment outcomes for individuals with moderate-to-severe traumatic brain injury (TBI) after controlling for key preinjury and injury-related variables. DESIGN Secondary data analysis. SETTING Community follow-up after discharge from an inpatient rehabilitation center. PARTICIPANTS Individuals between 18 and 60 years old with moderate-to-severe TBI enrolled in the Traumatic Brain Injury Model Systems database. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Employment status. RESULTS The prevalence of employment at 2 and 5 years post injury was 40.3% and 44.5%, respectively. Individuals identified as depressed at 1 year were more likely to be unemployed at 2 years post injury (odds ratio [OR], 1.77; 95% CI, 1.38-2.27; P<.0001). Similar relations between current depression and future employment were observed from 1- and 2-year depression status predicting 5-year employment (1-year: OR, 1.88; 95% CI, 1.48-2.40; P<.0001: 2-year: OR, 1.72; 95% CI, 1.36-2.17; P<.0001). CONCLUSIONS After controlling for baseline predictors variables, the experience of postinjury depression-a modifiable condition-contributes predictive ability to future employment outcomes. Incorporating assessments and/or interventions for depression into postacute rehabilitation programs could promote favorable employment outcomes after TBI.
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Affiliation(s)
- Daniel W Klyce
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia.
| | | | - William C Walker
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Adam P Sima
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Kristin M Graham
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Amma A Agyemang
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Jennifer H Marwitz
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
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25
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Nowell C, Downing M, Bragge P, Ponsford J. Current practice of cognitive rehabilitation following traumatic brain injury: An international survey. Neuropsychol Rehabil 2019; 30:1976-1995. [PMID: 31164047 DOI: 10.1080/09602011.2019.1623823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Traumatic brain injury (TBI) is a global public health issue, frequently resulting in impairments in the cognitive domains of attention, information processing speed, memory, executive function, and communication. Despite the importance of rehabilitating cognitive difficulties, and the release of clinical practice guidelines (CPGs) for cognitive rehabilitation, little is known about current clinician practice. This study aimed to explore current international clinician practice of cognitive rehabilitation. One hundred and fifteen English-speaking allied health professionals, including neuropsychologists and occupational therapists, from 29 countries outside Australia, were surveyed online about their current practice and reflections on cognitive rehabilitation. Both cognitive retraining and functional compensation approaches to cognitive rehabilitation were commonly utilized. Clinicians mostly targeted deficits in attention and executive functioning with retraining interventions, whilst memory deficits were mostly targeted with compensatory interventions. Clinicians were aware of and utilized various resources for cognitive rehabilitation, including CPGs. Clinicians considered the client's social support network, client engagement and motivation in rehabilitation, multidisciplinary team collaboration, and goal setting and implementation as highly impactful factors on the success of cognitive rehabilitation interventions. Whilst practice is broadly consistent with current CPG recommendations, addressing facilitating factors can further optimize client outcomes and quality of life following TBI.
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Affiliation(s)
- Clare Nowell
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monsah University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Marina Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monsah University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Peter Bragge
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Australia
| | - Jennie Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monsah University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
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26
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Spitz G, Mahmooei BH, Ross P, McKenzie D, Ponsford JL. Characterizing Early and Late Return to Work after Traumatic Brain Injury. J Neurotrauma 2019; 36:2533-2540. [PMID: 30924716 DOI: 10.1089/neu.2018.5850] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Facilitating successful return to work (RTW) is a key rehabilitation objective following traumatic brain injury (TBI). This study modelled early (within 6 months) and late (7-34 months) RTW by leveraging a large and comprehensive compensation database. The sample comprised 666 participants with TBI, the majority of whom sustained a moderate or severe injury caused by a motor vehicle accident. Early RTW was more likely for individuals who were pre-morbidly employed in a managerial or professional occupation (odds ratio [OR] = 2.1, confidence interval [CI] = 1.29-3.37), and those who experienced shorter post-traumatic amnesia (PTA) (OR = 0.96, CI = 0.94-0.98). RTW was less likely in the late phase for individuals who were older (hazard ratio [HR] = 0.99, CI = 0.98-1.00), experienced longer PTA (HR = 0.98, CI = 0.97-0.99), had an abdominal injury (HR = 0.90, CI = 0.67-1.21) and used more specialist practitioner (HR = 0.99, standard error [SE] = 0.98-1.00) and analgesic services (HR = 0.91, CI = 0.82-1.00). Conversely, RTW in the late phase was more likely for individuals using a greater number of specialist RTW supports (HR = 1.03, CI = 1.01-1.05). Patterns of early service utilization may therefore contribute to prediction of RTW outcome. It is encouraging that RTW was more likely for individuals using vocational supports.
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Affiliation(s)
- Gershon Spitz
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
| | - Behrooz Hassani Mahmooei
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Pamela Ross
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
| | - Dean McKenzie
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
| | - Jennie L Ponsford
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
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27
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Huang SW, Chang KH, Escorpizo R, Liou TH. Accuracy of a modified World Health Organization Disability Assessment Schedule 2.0 as an assessment tool for predicting return-to-work among patients with traumatic brain injury. Disabil Rehabil 2019; 42:3370-3376. [PMID: 30973023 DOI: 10.1080/09638288.2019.1594401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Patients with traumatic brain injury often experience cognition-related problems and difficulty in returning to work. This study analyzed the accuracy of a modified version of World Health Organization Disability Assessment Schedule 2.0 for predicting the return-to-work status of working-age patients diagnosed with traumatic brain injury more than 6 months ago.Materials and methods: We conducted a cross-sectional survey from a nationwide disability database. This study analyzed the data of 1312 patients diagnosed with traumatic brain injury (aged 20-60 years) more than 6 months ago from the Taiwan Data Bank of Persons with Disability for the period from July 2012 to January 2014. The demographic data and modified World Health Organization Disability Assessment Schedule 2.0 standardized scores of patients with traumatic brain injury who could and could not return to work (return-to-work and nonreturn-to-work groups, respectively) were analyzed. Receiver operating characteristic curve analysis was performed to investigate the prediction accuracy of the modified World Health Organization Disability Assessment Schedule 2.0 for predicting the return-to-work status, and the optimal cutoff point was determined using the Youden index. Binary logistic regression was used to determine the predictors of the return-to-work status of the participants.Results: The modified World Health Organization Disability Assessment Schedule 2.0 scores in all domains were lower in the return-to-work group than in the nonreturn-to-work group. Receiver operating characteristic analysis revealed the high accuracy of the summary scores of the modified World Health Organization Disability Assessment Schedule 2.0 (area under the curve >0.8). Binary logistic regression revealed that patients with standardized modified World Health Organization Disability Assessment Schedule 2.0 summary scores less than 39.50 were 11.20 (95% confidence interval, 4.80-26.14; p < 0.001) times more likely to return to work than patients with scores more than 39.50.Conclusions: The modified World Health Organization Disability Assessment Schedule 2.0 can be used as an objective and reliable assessment tool for predicting the return-to-work status of working-age patients with traumatic brain injury. This tool can facilitate goal setting and rehabilitation strategy design to enable patients with traumatic brain injury to return to work.Implications for rehabilitationSummary scores of six domains of a modified World Health Organization Disability Assessment Schedule 2.0 had better accuracy of predicting the opportunity to return to work among traumatic brain injury patients than each domain.Sex, education level and severity of impairment were related to the opportunity to return to work in traumatic brain injury patients.Higher disability scores from a modified version of the World Health Organization Disability Assessment Schedule 2.0 were associated with less opportunity to return to work and can be referenced for establishing effective rehabilitation strategies for facilitating return to work among persons with traumatic brain injury.
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Affiliation(s)
- Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kwang-Hwa Chang
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, VT, USA.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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28
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Howe EI, Løvstad M, Langlo KPS, Hellstrøm T, Spjelkavik Ø, Ugelstad H, Twamley EW, Andelic N. Feasibility of a cognitive rehabilitation program for individuals with mild-to-moderate traumatic brain injury: Participants’ engagement and satisfaction. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1565614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Emilie Isager Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Knut-Petter S. Langlo
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | | | - Helene Ugelstad
- Department of Vocational Rehabilitation, Norwegian Labour and Welfare Administration, Oslo, Norway
| | - Elizabeth W. Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
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29
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Tibæk M, Kammersgaard LP, Johnsen SP, Dehlendorff C, Forchhammer HB. Long-Term Return to Work After Acquired Brain Injury in Young Danish Adults: A Nation-Wide Registry-Based Cohort Study. Front Neurol 2019; 9:1180. [PMID: 30692963 PMCID: PMC6340062 DOI: 10.3389/fneur.2018.01180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/20/2018] [Indexed: 11/17/2022] Open
Abstract
Objective: (1) To determine patterns of return to work (RTW) after traumatic brain injury and other causes of acquired brain injury (ABI) among young adults aged 19–30 years and (2) to compare the stability of long-term labor-market attachment (LMA) to the background population. Method: Nationwide registry-based inception cohort study of 10 years weekly data of employment status. Patients (n = 8,496) aged 19–30 years with first-ever diagnosis of TBI, stroke, subarachnoid hemorrhage, encephalopathy, brain tumor, or CNS infections during 1999–2015. For comparison, a general population cohort (n = 206,025) individually matched on age, sex, and municipality was identified. The main outcome was RTW, which was defined as time to LMA, i.e., a week without public assistance benefits except education grants/leave. Stable labor-market attachment (sLMA) was defined as LMA for at least 75% over 52 weeks. The cumulative incidence proportions of RTW and stable RTW in the ABI cohort were estimated with the Aalen-Johansen estimator with death as a competing event. Results: Twelve weeks after diagnosis 46.9% of ABI cohort had returned to stable RTW, which increased to 57.4% 1 year after, and 69.7% 10 years after. However, compared to controls fewer had sLMA 1 year (OR: 0.25 [95% CI 0.24–0.27]) and 10 years after diagnosis (OR: 0.35 [95% CI: 0.33–0.38]). Despite significant variations, sLMA was lower compared to the control cohort for all subtypes of ABI and no significant improvements were seen after 2–5 years. Conclusion: Despite relatively fast RTW only a minor proportion of young patients with ABI achieves sLMA.
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Affiliation(s)
- Maiken Tibæk
- National Study of Young Survivors of Brain Injury, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Peter Kammersgaard
- Research Unit on Brain Injury Rehabilitation Copenhagen, Department of Neurorehabilitation, TBI Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren P Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Dehlendorff
- Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Hysse B Forchhammer
- National Study of Young Survivors of Brain Injury, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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30
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Howe EI, Andelic N, Perrin PB, Røe C, Sigurdardottir S, Arango-Lasprilla JC, Lu J, Løvstad M, Forslund MV. Employment Probability Trajectories Up To 10 Years After Moderate-To-Severe Traumatic Brain Injury. Front Neurol 2018; 9:1051. [PMID: 30568630 PMCID: PMC6289969 DOI: 10.3389/fneur.2018.01051] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/20/2018] [Indexed: 01/06/2023] Open
Abstract
Aims: To examine trajectories of employment probability up to 10 years following moderate-to-severe traumatic brain injury (TBI) and identify significant predictors from baseline socio-demographic and injury characteristics. Methods: A longitudinal observational study followed 97 individuals with moderate-to-severe TBI for their employment status up to 10 years post injury. Participants were enrolled at the Trauma Referral Center in South-Eastern Norway between 2005 and 2007. Socio-demographic and injury characteristics were recorded at baseline. Employment outcomes were assessed at 1, 2, 5, and 10 years. Hierarchical linear modeling (HLM) was used to examine employment status over time and assess the predictors of time, gender, age, relationship status, education, employment pre-injury, occupation, cause of injury, acute Glasgow Coma Scale (GCS) score, duration of post-traumatic amnesia (PTA), CT findings, and injury severity score, as well as the interaction terms between significant predictors and time. Results: The linear trajectory of employment probabilities for the full sample remained at ~50% across 1, 2, 5, and 10-years post-injury. Gender (p = 0.016), relationship status (p = 0.002), employment (p < 0.001) and occupational status at injury (p = 0.005), and GCS (p = 0.006) yielded statistically significant effects on employment probability trajectories. Male gender, those in a partnered relationship at the time of injury, individuals who had been employed at the time of injury, those in a white-collar profession, and participants with a higher acute GCS score had significantly higher overall employment probability trajectories across the four time points. The time*gender interaction term was statistically significant (p = 0.002), suggesting that employment probabilities remained fairly stable over time for men, but showed a downward trend for women. The time*employment at injury interaction term was statistically significant (p = 0.003), suggesting that employment probabilities were fairly level over time for those who were employed at injury, but showed an upward trend over time for those who had been unemployed at injury. Conclusion: Overall employment probability trajectories remained relatively stable between 1 and 10 years. Baseline socio-demographic and injury characteristics were predictive of employment trajectories. Regular follow-up is recommended for patients at risk of long-term unemployment.
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Affiliation(s)
- Emilie I. Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Paul B. Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Juan Carlos Arango-Lasprilla
- BioCruces Health Research Institute, Cruces University Hospital Barakaldo, Barakaldo, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Juan Lu
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Marit Vindal Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
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31
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Tran S, Kenny B, Power E, Tate R, McDonald S, Heard R, Togher L. Cognitive-communication and psychosocial functioning 12 months after severe traumatic brain injury. Brain Inj 2018; 32:1700-1711. [DOI: 10.1080/02699052.2018.1537006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Sarah Tran
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Belinda Kenny
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Emma Power
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Robyn Tate
- Rehabilitation Studies Unit, Northern Clinical School, The University of Sydney, Sydney, Australia
| | - Skye McDonald
- School of Psychology, University of NSW, Sydney, Australia
| | - Rob Heard
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Leanne Togher
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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32
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DiSanto D, Kumar RG, Juengst SB, Hart T, O'Neil-Pirozzi TM, Zasler ND, Novack TA, Dillahunt-Aspillaga C, Graham KM, Cotner BA, Rabinowitz AR, Dikmen S, Niemeier JP, Kesinger MR, Wagner AK. Employment Stability in the First 5 Years After Moderate-to-Severe Traumatic Brain Injury. Arch Phys Med Rehabil 2018; 100:412-421. [PMID: 30055162 DOI: 10.1016/j.apmr.2018.06.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To characterize employment stability and identify predictive factors of employment stability in working-age individuals after moderate-to-severe traumatic brain injury (TBI) that may be clinically addressed. DESIGN Longitudinal observational study of an inception cohort from the Traumatic Brain Injury Model Systems National Database (TBIMS-NDB) using data at years 1, 2, and 5 post-TBI. SETTING Inpatient rehabilitation centers with telephone follow-up. PARTICIPANTS Individuals enrolled in the TBIMS-NDB since 2001, aged 18-59, with employment data at 2 or more follow-up interviews at years 1, 2, and 5 (N=5683). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Employment stability, categorized using post-TBI employment data as no paid employment (53.25%), stably (27.20%), delayed (10.24%), or unstably (9.31%) employed. RESULTS Multinomial regression analyses identified predictive factors of employment stability, including younger age, white race, less severe injuries, preinjury employment, higher annual earnings, male sex, higher education, transportation independence postinjury, and no anxiety or depression at 1 year post-TBI. CONCLUSIONS Employment stability serves as an important measure of productivity post-TBI. Psychosocial, clinical, environmental, and demographic factors predict employment stability post-TBI. Notable predictors include transportation independence as well as the presence of anxiety and depression at year 1 post-TBI as potentially modifiable intervention targets.
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Affiliation(s)
- Dominic DiSanto
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Raj G Kumar
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shannon B Juengst
- Department of Physical Medicine and Rehabilitation, University of Texas-Southwestern Medical Center, Dallas, Texas; Department of Rehabilitation Counseling, University of Texas-Southwestern Medical Center, Dallas, Texas
| | - Tessa Hart
- Moss Rehabilitation Research Institute, Montgomery, Alabama
| | - Therese M O'Neil-Pirozzi
- Spaulding-Harvard Traumatic Brain Injury Model System, Boston, Massachusetts; Spaulding Rehabilitation Hospital and Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts
| | - Nathan D Zasler
- Concussion Care Centre of Virginia, Ltd, and Tree of Life Services, Inc, Richmond, Virginia; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia; Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia; International Brain Injury Association, Alexandria, Virginia
| | - Thomas A Novack
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christina Dillahunt-Aspillaga
- Rehabilitation and Mental Health Counseling Program, Department of Child and Family Studies, University of South Florida, Tampa, Florida; VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), Tampa, Florida
| | - Kristin M Graham
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Bridget A Cotner
- VA HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), Tampa, Florida; Department of Anthropology, University of South Florida, Tampa, Florida
| | - Amanda R Rabinowitz
- Moss Rehabilitation Research Institute, Montgomery, Alabama; Department of Rehabilitation, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington; Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Janet P Niemeier
- Carolinas Rehabilitation, Carolinas Medical Center, Charlotte, North Carolina
| | | | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania; Safar Center of Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania.
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33
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Libeson L, Downing M, Ross P, Ponsford J. The experience of return to work in individuals with traumatic brain injury (TBI): A qualitative study. Neuropsychol Rehabil 2018; 30:412-429. [DOI: 10.1080/09602011.2018.1470987] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Lauren Libeson
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Marina Downing
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Department of Rehabilitation, Psychology and Psychotherapy, Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | | | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Department of Rehabilitation, Psychology and Psychotherapy, Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
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34
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Sigurdardottir S, Andelic N, Wehling E, Anke A, Skandsen T, Holthe OO, Manskow US, Roe C. Return to work after severe traumatic brain injury: a national study with a one-year follow-up of neurocognitive and behavioural outcomes. Neuropsychol Rehabil 2018; 30:281-297. [PMID: 29667477 DOI: 10.1080/09602011.2018.1462719] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The objectives were to investigate the frequency of return-to-work (RTW) one year after severe traumatic brain injury (sTBI: Glasgow Coma Scale, GCS 3-8) and to identify which demographic and injury-related characteristics and neurocognitive factors are associated with RTW. This study is part of a prospective national study on sTBI conducted in all four Norwegian Trauma Referral Centres, including patients aged >15 years over a period of three years (n = 378). For the purpose of this study, only pre-employed individuals of working age (16 to 67 years) were investigated for RTW (n = 143), and of these, 104 participants underwent neuropsychological testing. Measures of acute injury severity, neuropsychological composite scores (Memory, Processing Speed, Executive Functions) at the one-year follow-up, and the Behaviour Rating Inventory of Executive Functions (patient- and relative reports) were explored as predictors of RTW. The frequency of RTW was 54.5%. Multivariate logistic regression analyses identified younger age, shorter length of stay in intensive care, better Processing Speed scores, and lower levels of metacognitive difficulties as rated by relatives as significant predictors of RTW. Findings support the importance of neuropsychological measures in predicting long-term RTW and highlight the need to address neurocognitive and behavioural difficulties to improve RTW after sTBI.
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Affiliation(s)
- Solrun Sigurdardottir
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.,Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nada Andelic
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Eike Wehling
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromso, Norway.,Department of Clinical Medicine, University of Tromso, The Arctic University of Norway, Tromso, Norway
| | - Toril Skandsen
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Heath Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Oyvor Oistensen Holthe
- Division of Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Unn Sollid Manskow
- Department of Rehabilitation, University Hospital of North Norway, Tromso, Norway.,Faculty of Health Sciences, Department of Health and Care Sciences, University of Tromso, Tromso, Norway
| | - Cecilie Roe
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
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35
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Return to Work After Severe Traumatic Brain Injury: A Nationwide Follow-up Study. J Head Trauma Rehabil 2018; 32:E57-E64. [PMID: 27323216 DOI: 10.1097/htr.0000000000000239] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine return to work (RTW) after severe traumatic brain injury (TBI) and to compare long-term labor market attachment (LMA) with the general population. PARTICIPANTS All persons aged 18 to 64 years who received highly specialized neurorehabilitation after severe TBI between 2004 and 2012 (n = 637) were matched to general population controls on age, sex, preinjury employment status, educational level, and residence (n = 2497). DESIGN Nationwide follow-up study using weekly records on public assistance benefits. MAIN MEASURES Both RTW and LMA were defined as having no public assistance benefits except education grants/leave. Stable LMA was defined as weeks with LMA of 75% or more. LMA among persons with severe TBI and controls was compared using multivariable conditional logistic regression. RESULTS RTW mainly occurred within first 2 years after severe TBI, with 30% of the people attempting RTW and 16% achieving stable LMA within 2 years. The prevalence of people with LMA decreased to 11% from 2½ years to 5 years postinjury. Adjusted odds ratios were 0.01 for LMA up to 2 years postinjury and 0.05 for stable LMA for persons with severe TBI compared with the general population. CONCLUSION Both RTW and long-term LMA after severe TBI were low in Denmark when compared with the general population and other countries.
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36
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Employment Stability in Veterans and Service Members With Traumatic Brain Injury: A Veterans Administration Traumatic Brain Injury Model Systems Study. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2017.05.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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37
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Odgaard L, Pedersen AR, Poulsen I, Johnsen SP, Nielsen JF. Return to work predictors after traumatic brain injury in a welfare state. Acta Neurol Scand 2018; 137:44-50. [PMID: 28758673 DOI: 10.1111/ane.12806] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify predictors of return to work (RTW) and stable labour market attachment (LMA) after severe traumatic brain injury (TBI) in Denmark. MATERIALS & METHODS Patients aged 18-64 years, admitted to highly specialized neurorehabilitation after severe TBI 2004-2012 were included and followed up for ≤6 years. Weekly LMA data were retrieved from a national register of public assistance benefits. Weeks without or with supplemental public assistance benefits were defined as LMA weeks. Time of RTW was defined as first week with LMA. Stable LMA was defined as weeks with LMA ≥75% first year after RTW. Multivariable regressions were used to identify predictors of RTW and stable LMA among preinjury characteristics, injury severity, functional ability and rehabilitation trajectories. RESULTS For the analyses of RTW and stable LMA, 651 and 336 patients were included, respectively. RTW was significantly associated with age (adjusted subhazard ratio 0.98, 95% CI 0.97-0.99), education (1.83, 95% CI 1.16-2.89), supplemental benefits (3.97, 95% CI 2.04-7.71), no benefits (4.86, 95% CI 2.90-8.17), length of stay in acute care (0.77, 95% CI 0.60-0.99) and time period of injury (1.56, 95% CI 1.15-2.10). The only significant predictor of stable LMA was age (adjusted odds ratio 0.97, 95% CI 0.95-0.99). CONCLUSION RTW after severe TBI was associated with several socio-economic factors, whereas maintaining LMA depended on age only. We suggest that RTW rates could be improved by extensive rehabilitation targeting people that are older and low-educated, as these were less likely to RTW.
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Affiliation(s)
- L. Odgaard
- Hammel Neurorehabilitation Center and University Research Clinic; Aarhus University; Aarhus Denmark
| | - A. R. Pedersen
- Hammel Neurorehabilitation Center and University Research Clinic; Aarhus University; Aarhus Denmark
| | - I. Poulsen
- Department of Neurorehabilitation; TBI and Research Unit on Brain Injury Rehabilitation (RUBRIC); Rigshospitalet; Copenhagen Denmark
| | - S. P. Johnsen
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
| | - J. F. Nielsen
- Hammel Neurorehabilitation Center and University Research Clinic; Aarhus University; Aarhus Denmark
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38
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Mitrushina M, Tomaszewski R. Factors associated with return to work in patients with long-term disabilities due to neurological and neuropsychiatric disorders. Neuropsychol Rehabil 2017; 29:1313-1331. [DOI: 10.1080/09602011.2017.1395746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Maura Mitrushina
- Department of Psychology, California State University, Northridge, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Robert Tomaszewski
- Department of Psychology, California State University, Northridge, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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39
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Howe EI, Langlo KPS, Terjesen HCA, Røe C, Schanke AK, Søberg HL, Sveen U, Aas E, Enehaug H, Alves DE, Klethagen P, Sagstad K, Moen CM, Torsteinsbrend K, Linnestad AM, Nordenmark TH, Rismyhr BS, Wangen G, Lu J, Ponsford J, Twamley EW, Ugelstad H, Spjelkavik Ø, Løvstad M, Andelic N. Combined cognitive and vocational interventions after mild to moderate traumatic brain injury: study protocol for a randomized controlled trial. Trials 2017; 18:483. [PMID: 29041954 PMCID: PMC5645893 DOI: 10.1186/s13063-017-2218-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/27/2017] [Indexed: 11/25/2022] Open
Abstract
Background A considerable proportion of patients with mild to moderate traumatic brain injury (TBI) experience long-lasting somatic, cognitive, and emotional symptoms that may hamper their capacity to return to work (RTW). Although several studies have described medical, psychological, and work-related factors that predict RTW after TBI, well-controlled intervention studies regarding RTW are scarce. Furthermore, there has traditionally been weak collaboration among health-related rehabilitation services, the labor and welfare sector, and workplaces. Methods/design This study protocol describes an innovative randomized controlled trial in which we will explore the effect of combining manualized cognitive rehabilitation (Compensatory Cognitive Training [CCT]) and supported employment (SE) on RTW and related outcomes for patients with mild to moderate TBI in real-life competitive work settings. The study will be carried out in the southeastern region of Norway and thereby be performed within the Norwegian welfare system. Patients aged 18–60 years with mild to moderate TBI who are employed in a minimum 50% position at the time of injury and sick-listed 50% or more for postconcussive symptoms 2 months postinjury will be included in the study. A comprehensive assessment of neurocognitive function, self-reported symptoms, emotional distress, coping style, and quality of life will be performed at baseline, immediately after CCT (3 months after inclusion), following the end of SE (6 months after inclusion), and 12 months following study inclusion. The primary outcome measures are the proportion of participants who have returned to work at 12-month follow-up and length of time until RTW, in addition to work stability as well as work productivity over the first year following the intervention. Secondary outcomes include changes in self-reported symptoms, emotional and cognitive function, and quality of life. Additionally, a qualitative RTW process evaluation focused on organizational challenges at the workplace will be performed. Discussion The proposed study will combine cognitive and vocational rehabilitation and explore the efficacy of increased cross-sectoral collaboration between specialized health care services and the labor and welfare system. If the intervention proves effective, the project will describe the cost-effectiveness and utility of the program and thereby provide important information for policy makers. In addition, knowledge about the RTW process for persons with TBI and their workplaces will be provided. Trial registration ClinicalTrials.gov, NCT03092713. Registered on 10 March 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2218-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emilie I Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Knut-Petter S Langlo
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | | | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne-Kristine Schanke
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Helene L Søberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Unni Sveen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Eline Aas
- Department of Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Heidi Enehaug
- The Work Research Institute, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Daniele E Alves
- The Work Research Institute, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Pål Klethagen
- The Work Research Institute, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Kjersti Sagstad
- Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway
| | - Christine M Moen
- Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway
| | - Karin Torsteinsbrend
- Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway
| | | | - Tonje Haug Nordenmark
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Birte Sand Rismyhr
- The Norwegian User Organization (Personskadeforbundet LTN), Oslo, Norway
| | - Grete Wangen
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Juan Lu
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennie Ponsford
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Faculty of Medicine, Nursing and Health Sciences , Clayton, Victoria, Australia
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Helene Ugelstad
- Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway
| | - Øystein Spjelkavik
- The Work Research Institute, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Marianne Løvstad
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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40
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Predictors of Employment Outcomes in Veterans With Traumatic Brain Injury: A VA Traumatic Brain Injury Model Systems Study. J Head Trauma Rehabil 2017; 32:271-282. [DOI: 10.1097/htr.0000000000000275] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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41
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Wilson NM, Gurney ME, Dietrich WD, Atkins CM. Therapeutic benefits of phosphodiesterase 4B inhibition after traumatic brain injury. PLoS One 2017; 12:e0178013. [PMID: 28542295 PMCID: PMC5438188 DOI: 10.1371/journal.pone.0178013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/05/2017] [Indexed: 12/22/2022] Open
Abstract
Traumatic brain injury (TBI) initiates a deleterious inflammatory response that exacerbates pathology and worsens outcome. This inflammatory response is partially mediated by a reduction in cAMP and a concomitant upregulation of cAMP-hydrolyzing phosphodiesterases (PDEs) acutely after TBI. The PDE4B subfamily, specifically PDE4B2, has been found to regulate cAMP in inflammatory cells, such as neutrophils, macrophages and microglia. To determine if PDE4B regulates inflammation and subsequent pathology after TBI, adult male Sprague Dawley rats received sham surgery or moderate parasagittal fluid-percussion brain injury (2 ± 0.2 atm) and were then treated with a PDE4B - selective inhibitor, A33, or vehicle for up to 3 days post-surgery. Treatment with A33 reduced markers of microglial activation and neutrophil infiltration at 3 and 24 hrs after TBI, respectively. A33 treatment also reduced cortical contusion volume at 3 days post-injury. To determine whether this treatment paradigm attenuated TBI-induced behavioral deficits, animals were evaluated over a period of 6 weeks after surgery for forelimb placement asymmetry, contextual fear conditioning, water maze performance and spatial working memory. A33 treatment significantly improved contextual fear conditioning and water maze retention at 24 hrs post-training. However, this treatment did not rescue sensorimotor or working memory deficits. At 2 months after surgery, atrophy and neuronal loss were measured. A33 treatment significantly reduced neuronal loss in the pericontusional cortex and hippocampal CA3 region. This treatment paradigm also reduced cortical, but not hippocampal, atrophy. Overall, these results suggest that acute PDE4B inhibition may be a viable treatment to reduce inflammation, pathology and memory deficits after TBI.
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Affiliation(s)
- Nicole M. Wilson
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Mark E. Gurney
- Tetra Discovery Partners, Grand Rapids, Michigan, United States of America
| | - W. Dalton Dietrich
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Coleen M. Atkins
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- * E-mail:
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42
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Ruet A, Jourdan C, Bayen E, Darnoux E, Sahridj D, Ghout I, Azerad S, Pradat Diehl P, Aegerter P, Charanton J, Vallat Azouvi C, Azouvi P. Employment outcome four years after a severe traumatic brain injury: results of the Paris severe traumatic brain injury study. Disabil Rehabil 2017; 40:2200-2207. [PMID: 28521527 DOI: 10.1080/09638288.2017.1327992] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe employment outcome four years after a severe traumatic brain injury by the assessment of individual patients' preinjury sociodemographic data, injury-related and postinjury factors. DESIGN A prospective, multicenter inception cohort of 133 adult patients in the Paris area (France) who had received a severe traumatic brain injury were followed up postinjury at one and four years. Sociodemographic data, factors related to injury severity and one-year functional and cognitive outcomes were prospectively collected. METHODS The main outcome measure was employment status. Potential predictors of employment status were assessed by univariate and multivariate analysis. RESULTS At the four-year follow-up, 38% of patients were in paid employment. The following factors were independent predictors of unemployment: being unemployed or studying before traumatic brain injury, traumatic brain injury severity (i.e., a lower Glasgow Coma Scale score upon admission and a longer stay in intensive care) and a lower one-year Glasgow Outcome Scale-Extended score. CONCLUSION This study confirmed the low rate of long-term employment amongst patients after a severe traumatic brain injury. The results illustrated the multiple determinants of employment outcome and suggested that students who had received a traumatic brain injury were particularly likely to be unemployed, thus we propose that they may require specific support to help them find work. Implications for rehabilitation Traumatic brain injury is a leading cause of persistent disablity and can associate cognitive, emotional, physical and sensory impairments, which often result in quality-of-life reduction and job loss. Predictors of post-traumatic brain injury unemployment and job loss remains unclear in the particular population of severe traumatic brain injury patients. The present study highlights the post-traumatic brain injury student population require a close follow-up and vocational rehabilitation. The study suggests that return to work post-severe traumatic brain injury is frequently unstable and workers often experience difficulties that caregivers have to consider.
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Affiliation(s)
- Alexis Ruet
- a Service de Médecine Physique et de Réadaptation , CHU de Caen , France.,b U1077, INSERM , Caen , France
| | - Claire Jourdan
- c Service de Médecine Physique et de Réadaptation , APHP, Hôpital Raymond Poincaré , Garches , France.,d EA 4047 HANDIReSP , Université de Versailles Saint-Quentin , France
| | - Eléonore Bayen
- e Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière , Service de Médecine Physique et Réadaptation, Paris, France, Université Pierre et Marie Curie , Paris , France
| | - Emmanuelle Darnoux
- f Assistance Publique-Hôpitaux de Paris , Hôpital Ambroise Paré, Unité de Recherche Clinique (URC) , Boulogne , France.,g Centre Ressources Francilien du Traumatisme Crânien (CRFTC) , Paris , France
| | - Dalila Sahridj
- c Service de Médecine Physique et de Réadaptation , APHP, Hôpital Raymond Poincaré , Garches , France
| | - Idir Ghout
- f Assistance Publique-Hôpitaux de Paris , Hôpital Ambroise Paré, Unité de Recherche Clinique (URC) , Boulogne , France
| | - Sylvie Azerad
- f Assistance Publique-Hôpitaux de Paris , Hôpital Ambroise Paré, Unité de Recherche Clinique (URC) , Boulogne , France
| | - Pascale Pradat Diehl
- e Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière , Service de Médecine Physique et Réadaptation, Paris, France, Université Pierre et Marie Curie , Paris , France
| | - Philippe Aegerter
- f Assistance Publique-Hôpitaux de Paris , Hôpital Ambroise Paré, Unité de Recherche Clinique (URC) , Boulogne , France
| | - James Charanton
- g Centre Ressources Francilien du Traumatisme Crânien (CRFTC) , Paris , France
| | - Claire Vallat Azouvi
- d EA 4047 HANDIReSP , Université de Versailles Saint-Quentin , France.,h Antenne UEROS-SAMSAH 92-UGECAM IDF , Hôpital Raymond Poincaré , Garches , France
| | - Philippe Azouvi
- c Service de Médecine Physique et de Réadaptation , APHP, Hôpital Raymond Poincaré , Garches , France.,d EA 4047 HANDIReSP , Université de Versailles Saint-Quentin , France
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43
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Cogné M, Wiart L, Simion A, Dehail P, Mazaux JM. Five-year follow-up of persons with brain injury entering the French vocational and social rehabilitation programme UEROS: Return-to-work, life satisfaction, psychosocial and community integration. Brain Inj 2017; 31:655-666. [PMID: 28406316 DOI: 10.1080/02699052.2017.1290827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Social and vocational reintegration of persons with brain injury is an important element in their rehabilitation. AIMS To evaluate the 5-year outcome of persons with brain injury included in 2008 in the Aquitaine Unit for Evaluation, Training and Social and Vocational Counselling programme (UEROS). METHOD 57 persons with brain injury were recruited from those who completed the 2008 UEROS programme. Five years later, an interview was done to assess family and vocational status, autonomy and life satisfaction. These results were compared with those from persons completing the 1997-1999 programme. RESULTS The typical person entered the 2008 UEROS programme 6 years after a severe brain injury (42%) and was male, single and 35 years. At the 5-year follow-up, more persons lived with a partner (+23%) and lived in their own home (+21%). 47% were working vs 11% on entering the programme. Approximately half were satisfied or very satisfied with their quality of life. Having a job in 2013 was associated with a high education level, less cognitive sequelae, having a job in 2008 and no health condition. CONCLUSIONS The UEROS programme is effective with regard to return-to-work and improvement of autonomy in persons with brain injury, irrespective of length of time from injury.
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Affiliation(s)
- M Cogné
- a Rehabilitation Medicine Unit, Centre Hospitalier Universitaire of Bordeaux , Bordeaux , France.,b EA4136, University of Bordeaux , Bordeaux , France
| | - L Wiart
- a Rehabilitation Medicine Unit, Centre Hospitalier Universitaire of Bordeaux , Bordeaux , France.,c UEROS Aquitaine , Bordeaux , France
| | - A Simion
- a Rehabilitation Medicine Unit, Centre Hospitalier Universitaire of Bordeaux , Bordeaux , France.,c UEROS Aquitaine , Bordeaux , France
| | - P Dehail
- a Rehabilitation Medicine Unit, Centre Hospitalier Universitaire of Bordeaux , Bordeaux , France.,b EA4136, University of Bordeaux , Bordeaux , France
| | - J-M Mazaux
- a Rehabilitation Medicine Unit, Centre Hospitalier Universitaire of Bordeaux , Bordeaux , France.,b EA4136, University of Bordeaux , Bordeaux , France
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44
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Scaratti C, Leonardi M, Sattin D, Schiavolin S, Willems M, Raggi A. Work-related difficulties in patients with traumatic brain injury: a systematic review on predictors and associated factors. Disabil Rehabil 2016; 39:847-855. [DOI: 10.3109/09638288.2016.1162854] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Chiara Scaratti
- Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy
| | - Davide Sattin
- Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy
| | - Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy
| | - Michelle Willems
- Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy
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45
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Dillahunt-Aspillaga C, Jorgensen Smith T, Hanson A, Ehlke S, Stergiou-Kita M, Dixon CG, Quichocho D. Exploring Vocational Evaluation Practices following Traumatic Brain Injury. Behav Neurol 2015; 2015:924027. [PMID: 26494945 PMCID: PMC4606095 DOI: 10.1155/2015/924027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 08/05/2015] [Accepted: 08/18/2015] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Christina Dillahunt-Aspillaga
- Department of Rehabilitation and Mental Health Counseling, College of Behavioral and Community Sciences, University of South Florida, 13301 Bruce B Downs Boulevard, MHC 1632, Tampa, FL 33612-3807, USA
| | - Tammy Jorgensen Smith
- Department of Rehabilitation and Mental Health Counseling, College of Behavioral and Community Sciences, University of South Florida, 13301 Bruce B Downs Boulevard, MHC 1632, Tampa, FL 33612-3807, USA
| | - Ardis Hanson
- College of Behavioral and Community Sciences, University of South Florida, 13301 Bruce B Downs Boulevard, MHC 1139, Tampa, FL 33612-3807, USA
| | - Sarah Ehlke
- American Legacy Foundation, 1724 Massachusetts Avenue NW, Washington, DC 20036, USA
| | - Mary Stergiou-Kita
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, Canada M5G 1V7
| | - Charlotte G. Dixon
- C.G. Dixon & Associates Inc., 42 S. Ingram Street, Alexandria, VA 22304, USA
| | - Davina Quichocho
- Department of Rehabilitation and Mental Health Counseling, College of Behavioral and Community Sciences, University of South Florida, 13301 Bruce B Downs Boulevard, MHC 1632, Tampa, FL 33612-3807, USA
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46
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Cuthbert JP, Pretz CR, Bushnik T, Fraser RT, Hart T, Kolakowsky-Hayner SA, Malec JF, O'Neil-Pirozzi TM, Sherer M. 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. Arch Phys Med Rehabil 2015; 96:2128-36. [PMID: 26278493 DOI: 10.1016/j.apmr.2015.07.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/19/2015] [Accepted: 07/23/2015] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Jeffrey P Cuthbert
- Rocky Mountain Regional Brain Injury System, Craig Hospital, Englewood, CO.
| | - Christopher R Pretz
- Rocky Mountain Regional Brain Injury System, Craig Hospital, Englewood, CO; Traumatic Brain Injury Model Systems National Statistical and Data Center, Englewood, CO
| | - Tamara Bushnik
- Rusk Institute for Rehabilitation Medicine, New York University Langone School of Medicine, New York, NY
| | | | - Tessa Hart
- Moss Rehabilitation Research Institute, Elkins Park, PA
| | | | - James F Malec
- Department of Physical Medicine and Rehabilitation, Indiana University, Indianapolis, IN
| | - Therese M O'Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Department of Speech-Language Pathology and Audiology, Northeastern University, Boston, MA
| | - Mark Sherer
- The Institute for Rehabilitation and Research Memorial Hermann, Houston, TX; Baylor College of Medicine, Houston, TX
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47
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Willmott C, Spitz G, Ponsford JL. Predictors of productivity outcomes for secondary and tertiary students following traumatic brain injury. Brain Inj 2015; 29:929-36. [DOI: 10.3109/02699052.2015.1022882] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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