Impact of personal and environmental factors on employment outcome two years after moderate-to-severe traumatic brain injury.

Abstract

OBJECTIVES: To describe employment outcomes and assess the impact of personal and environmental factors on employment outcomes 2 years after moderate-to-severe traumatic brain injury. DESIGN/SUBJECTS: A prospective cohort of 100 patients with moderate-to-severe traumatic brain injury, aged 16-55 years, hospitalized in a Trauma Referral Centre during the period 2005-2007 and followed up at 1 and 2 years post-injury. METHODS: Variables of interest were divided into personal and environmental factors. Personal factors include socio-demographics (age, gender, education, work demands, marital status and child-care). Environmental factors included social (support by friends), institutional (number of rehabilitation services, need for well-coordinated healthcare services), and physical (access to own transportation) factors. A multivariate logistic regression analysis was conducted with employment (working part-/full-time or studying) at 2-year follow-up as the dependent variable, and including independent variables based on significance from a univariate analysis, adjusting for injury severity. RESULTS: At the 2-year follow-up, 44% of patients were employed. Patients with less severe injuries (odds ratio (OR)_=_1.2, p_=_0.03), those supported by friends (OR_=_3.5, p_=_0.07), those not in need of well-coordinated health services (OR_=_4.1, p_=_0.04), and patients driving a vehicle at the 1-year follow-up (OR_=_8.4, p_<_0.001) were more likely to be employed at the 2-year follow-up. CONCLUSION: Rehabilitation professionals should be aware of the role of environmental factors when planning vocational rehabilitation services after traumatic brain injury.