Employment Trajectories and Productivity Outcomes at One-, Two-, and Five-years Following Traumatic Brain Injury With Disorder of Consciousness
Harrison Jacobs1, Natalie Gilmore2, Yelena Bodien3, Andrew Brumett1, Macy Deckard1, Tushar Sardesai1, Bobby Woodburn IV1, Therese Pirozzi4, Brick Johnstone5, Joseph Giacino6, Matthew Pease1, Flora Hammond1
1Indiana University School of Medicine, 2James A. Haley VA Hospital, 3Vanderbilt University Medical Center, 4Northeastern University, 5Shepherd Center, 6Harvard Medical School
Objective:
Assess the productivity outcomes and employment trajectories at 1-, 2-, and 5- years postinjury following inpatient rehabilitation for Traumatic Brain Injury (TBI) with Disorder of Consciousness (DoC).
Background:
Employment status is used as a marker of function and independence. Persons who are undergoing rehabilitation for chronic illness or injury often consider return to work as a key milestone in recovery. Within the population of persons with TBI diagnosed with a DoC, it is poorly understood what factors may contribute or hinder return-to-work. Our study aims to better understand the upstream and downstream determinants of employability and employment among persons with DoC.
Design/Methods:
Participants were individuals with TBI enrolled into the TBI Model System National Database, a longitudinal study that collects data at 16 rehabilitation centers across the country. For this retrospective study, participants needed to be eligible for their 5-year follow-up window between June 25, 1998, and December 31, 2024, and have completed follow up interviews at 1-, 2-, and 5- years post-injury with complete employment data. Participants who were retired or age 65 or greater at the time of injury were excluded. Analyses assessed what extenuating factors (age, education, injury type, etc.) predicted higher likelihood for return-to-work in patients with DoC.
Results:
Employment, employability and productive participation gradually increase across years 1, 2, and 5 post-TBI. 15-17% of patients with DoC are employed by year 5 follow-up. Younger age and lower injury severity are associated with better long-term employment outcomes.
Conclusions:
These findings expand the knowledge base regarding meaningful long-term outcomes for this subpopulation. This information may be particularly useful in prognostic counseling after severe TBI allowing for more accurate and better-informed decisions in the context of treatment options and quality of life. Limitations include attrition in follow-up and lack of uniformity across centers.
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