Abstract 24: Occupational categories and return to work after traumatic brain injury.

Abstract

Objectives: To further evaluate determinants of return to work (RTW) after traumatic brain injury (TBI) by examining the relationship between preinjury occupational category and RTW outcome. Design: Prospective collaborative cohort study. Setting: To be eligible for this study, patients had to have been hospitalized with a diagnosis of TBI and have received both acute neurotrauma services and inpatient rehabilitation services at any of the 17 Traumatic Brain Injury Model Systems centers. Participants: Consecutive sample of 1173 patients with TBI who consented to participate, were employed prior to injury, and had completed 1-year follow-up assessment. Intervention: Included an inpatient interdisciplinary brain injury rehabilitation program. Main Outcome Measure: Competitive employment 1 year after rehabilitation. Results: Participants (N=1173) were categorized into 1 of 3 groups, depending on preinjury occupational title: high decision making (n=170), service related (n=622), or manual labor (n=381). Chi-square analysis showed an association between these categories and RTW at 1 year ( P<.005). The chance of successful RTW was greatest for high decision making (58.8%), less for service related (42.8%), and lowest for manual labor (32.5%). Of those with successful RTW, the majority did so within the same occupational category grouping. Preinjury manual labor jobs were most likely to shift to a different category postinjury (39.1%), whereas service-related jobs were least likely to shift (25.5%). Conclusions: Prior research has shown that preinjury employment status (employed vs unemployed) greatly influences the odds of successful RTW after TBI. The current study convincingly demonstrates that the type of occupation also influences RTW outcome, with the best prospect for RTW being among persons with high decision-making jobs. Occupational category should be examined in the future development of predictive models for RTW after TBI.