Introduction Fatigue is one of the most disabling symptoms in patients with Traumatic Brain Injury (TBI) and it is difficult to clarify the nature of this symptom and manage it. In the context of workplace disability, fatigue is defined subjectively by self-report and objectively as degraded performance and inability to perform occupational duties. While workers have little difficulty recognizing physical tiredness, they have less insight in detecting the more subtle signs of mental fatigue, and may fail to indicate and appreciate its impact on their performance. As fatigue after head trauma may be the end result of a common pathway integrating multiple factors, the aim of this study is to evaluate the frequency and correlations of fatigue in a sample of Ontario workers with trauma to the head. Materials and methods A cross-sectional study of a population with mild to moderate TBI with persistent symptoms, who were seen for assessment at the Toronto Rehabilitation Institute’s Worker’s Safety and Insurance Board outpatient clinic May–September 2012. Twenty-five Ontario workers (60% males, 40% females) were asked to complete the Fatigue Severity Scale (FSS), Patient’s Health Questionnaire (PHQ-9), Hospital Anxiety Scale (HADS-A), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS) and Toronto Hospital Alertness Test (THAT) questionnaires. Frequency distribution and Pearson correlation were used for data analysis. Workers also reported on the number of work-related injuries occurring in the past 5 years. Results Twenty-eight percent of workers named fatigue as one of their three most disabling symptoms. Fifty-two percent of our sample performed shift work at the time of their injury. Fatigue requiring further evaluation based on self-report (FSS total) was found in 88%, depression in 96%, anxiety in 64%, excessive daytime sleepiness in 52%, and impaired alertness in 64% of our participants. Clinical insomnia based on ISS was found in 96% of workers. A significant association was found between outcome of interest (FSS total score) and the number of work-related injuries occurring in the past 5 years (r = 0.48, p = 0.016), PHQ-9 total score (r = 0.49, p = 0.012), anxiety total score (r = 0.48, p = 0.015) and alertness total score (r = −0.78, p Conclusion Fatigue was strongly associated with depression and weakly with insomnia. A moderate positive association found between fatigue and the number of previous work-related injuries and the strong negative association between fatigue and alertness may indicate workers’ inability to perform tasks that require sustained attention. Future research in the area of sleep timing and medications effect as a determinant of fatigue, alertness and performance is warranted. Acknowledgements Shirin Mollayeva was funded through the Ontario Work Study Program, University of Toronto.
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