ArticlesReturn to productive activity after traumatic brain injury: Relationship with measures of disability, handicap, and community integration☆,☆☆,★,★★,♢
Section snippets
Subjects
A total of 378 adults (age, >17yr) had sustained a TBI between September 1997 and May 1998 and were enrolled in the Carolinas Medical Center Trauma Registry. This registry includes those patients who were admitted through the trauma system or required an inpatient admission for longer than 24 hours. Patients in this study were excluded if they had retired from employment before their injury or if their premorbid activity level was unknown. Of the 378 candidates, 185 patients and family members
Study sample
Demographic and premorbid characteristics of the population are in table 1.Empty Cell Empty Cell n % Gender Male 82 78 Female 23 22 Race White, non-Hispanic 81 77 All others 24 23 Age (yr) <50 86 82 ≥50 19 18 Payer Medicare 3 3 Medicaid 24 23 Managed Care/BCBS/commercial/auto/government 58 55 Workers compensation 11 10 Self-pay 9 9 Education KN8 5 5 9-12 28 27 High school/GED 32 30 Some college 27 26 Associate’s degree 5 5 Bachelor’s degree 6 6 Master’s degree 2 2 Employed full-time preinjury Yes 88 84 No 13 12 Missing 5 5 Alcohol use preinjury Yes 37 35 No 68
Discussion
Return to employment has traditionally been used to define successful vocational outcome. However, that criterion may be misleading if one does not consider those who return as homemakers or students or go from employment to homemaker or student as having a successful vocational outcome. This error becomes particularly important when the heterogeneous demographics and injury severity levels of the TBI population are taken into account. Consequently, we chose RTPA, as opposed to return to work,
Acknowledgements
The authors gratefully acknowledge the support of the Carolinas Medical Center Trauma Registry, Linda Spallone, RRA, and Michael Thomason, MD, and Charlotte Institute of Rehabilitation research analysts, Hadley Hartwell, Anne Abner, and Anita Kubin.
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2016, International Journal of Law and PsychiatryCitation Excerpt :The literature indicates that educational background and pre-injury employment are predictive of vocational outcome following a TBI (Asikainen et al., 1996; Gollaher et al., 1998; Kraft et al., 1993; Ponsford, 2013). Specifically, higher levels of education and socioeconomic status are associated with a greater likelihood of RTW post-injury (Cuthbert et al., 2015; Guilmette, 2008; Keyser-Marcus et al., 2002), positive work status (Klonoff et al., 2006; Wagner, Hammond, Sasser, & Wiercisiewski, 2002), and employment stability (Kreutzer et al., 2003), whereas lower levels of education have been associated with worse employment outcomes (Nakase-Richardson et al., 2007) and delayed RTW (Cancelliere et al., 2014). For example, among TBI patients, those who lack a high school diploma are less likely to RTW, compared to those who have completed high school or post-secondary education (Dikmen et al., 1994; Greenspan et al., 1996).
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Supported by the Health Services Foundation of the Carolinas HealthCare System and the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model System at the Charlotte Institute of Rehabilitation (grant no. H133A980025).
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No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.
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Reprint requests to Amy Wagner, MD, Dept of Physical Medicine and Rehabilitation, University of Pittsburgh, 3471 Fifth Ave, Kaufmann Bldg Ste #901, Pittsburgh, PA 15213, e-mail: [email protected].
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