Citation

Cuthbert JP, Pretz CR, Bushnik T, Fraser RT, Hart T, Kolakowsky-Hayner SA, Malec JF, O'Neil-Pirozzi TM, Sherer M. Arch. Phys. Med. Rehabil. 2015; 96(12): 2128-2136.

Affiliation

Department of Speech-Language Pathology and Audiology, Northeastern University, Boston, MA, (10)TIRR Memorial Hermann, Houston, TX; Baylor College of Medicine, Houston, TX.

Copyright

(Copyright © 2015, Elsevier Publishing)

DOI

10.1016/j.apmr.2015.07.020

PMID

26278493

Abstract

OBJECTIVE: 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 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 post-injury years 1, 2, 5 and 10 (n=3,618). 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 relationships 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, pre-injury substance misuse, pre-injury vocational status and days of post-traumatic amnesia. Calendar year in which the injury occurred also greatly influenced trajectories. An interactive tool was developed to provide visualization of all post-employment trajectories, with many showing decreasing probabilities of employment between 5 and 10 years post-injury.

CONCLUSIONS: These results confirm that post-injury employment after moderate to severe 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 post-injury suggests that moderate to severe TBI may have unfavorable chronic effects, and/or 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 post-injury is recommended, as are interventions that target influencing factors.

Language: en