Article
Mild traumatic brain injury from motor vehicle accidents: Factors associated with return to work,☆☆

https://doi.org/10.1016/S0003-9993(99)90275-7Get rights and content

Abstract

Objectives: To describe return to work (RTW) for motor vehicle accident (MVA) survivors with mild traumatic brain injury (MTBI) and to examine relationships between RTW and injury severity, cognitive impairment, social interaction, discharge disposition, and sociodemographics.

Design: Inception cohort assessed within 1 month of injury and at follow-up 6 to 9 months (mean = 7.4) after injury, for comparisons on outcome of RTW.

Setting: Tertiary care center in Toronto (time 1); at home for follow-up.

Participants: Fifty patients with MTBI resulting from MVA who were consecutively admitted during a 20-month period ending April 1994. Thirteen of 63 eligible patients refused consent or were lost to follow-up. Mean age was 31; 62% were men. Eligibility criteria: (1) patients had been working; (2) they had no history of head injury, neurologic disease, or psychiatric illness requiring hospitalization; and (3) they had no cata-strophic impairment from accident.

Main Outcome Measure: Return to work (at premorbid or modified level).

Results: Of the 42% who returned to work, 12% resumed their premorbid level of employment and 30% returned to modified work. There were significant differences (p < .05) between the groups in level of social interaction, premorbid occupation, and discharge disposition. On one test of cognitive functioning the difference was at p = .06.

Conclusion: Social interaction, jobs with greater decision-making latitude, and discharge home were positively related to RTW for this population. Cognitive impairment within the first month was not a reliable indicator of RTW potential.

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      Social isolation and reduced social support are sometimes a consequence of TBI (Oddy & Humphrey, 1980), and a lack of community integration and support, in turn, plays a negative role in occupational outcome. Ruffolo, Friedland, Dawson, Colantonio, and Lindsay (1999) found that social interaction was positively associated with RTW in cases of mild TBI, and Devitt et al. (2006) reported that instrumental support was associated with lower occupational disability in cases of moderate-to-severe TBI. In a systematic review of 27 studies, Nightingale et al. (2007) similarly concluded that participation in the community post-injury is a significant predictor of RTW.

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    Supported by a grant from the Ontario Mental Health Foundation. This study was conducted at Sunnybrook Health Science Centre, Toronto, Canada.

    ☆☆

    No commercial party having a direct or indirect interest in the subject matter of this article has or will confer a benefit upon the author or upon any organization with which the authors are association.

    1

    Ms. Ruffolo is currently affiliated with Giant Steps, Toronto, Canada.

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