Factors Predicting Return to Work Following Mild Traumatic Brain Injury: A Discriminant Analysis

Abstract Background: Post-traumatic headache (PTH) is a common symptom following mild traumatic brain injury (mTBI). Patients at risk to develop acute PTH (aPTH) and further persistent PTH (pPTH) need to be recognized. Methods: This is a one-year follow-up of 127 patients with mTBI, aged 18 to 68, referred to outpatient clinic in the Helsinki University Hospital. Symptoms were assessed at the emergency department (ED), with structured interview at outpatient clinic visit and with Rivermead post-concussion symptom questionnaire at one, three, and 12 months after injury. Psychiatric disorders were assessed with Structured Clinical Interview for DSM-IV Axis I disorders at 3-4 months and return to work (RTW) from patient records. Results: At one month, 77/127 patients (61%) had aPTH. According to multiple logistic regression analysis, risk factors for aPTH were headache at the emergency department (ED) (OR 5.43), other pain (OR 3.19), insomnia (OR 3.23), and vertigo (OR 5.98). At three months, 17 patients (22% of aPTH patients) had developed pPTH, and at one year, 4 patients (24% of pPTH patients) still presented with pPTH. Risk factors for pPTH at three months were older age (OR 1.06) and current insomnia (OR 12.3). The frequency of psychiatric disorders did not differ between the groups. pPTH patients performed worse on their RTW. Conclusions: Risk factors for aPTH were insomnia, headache at ED, other pain, and vertigo and for pPTH, insomnia and older age. RTW rate was lower among pPTH patients.

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Predictors for Return to Work in Subjects with Mild Traumatic Brain Injury

Behavioural Neurology ◽

10.1155/2016/8026414 ◽

2016 ◽

Vol 2016 ◽

pp. 1-10 ◽

Cited By ~ 17

Author(s):

Eirik Vikane ◽

Torgeir Hellstrøm ◽

Cecilie Røe ◽

Erik Bautz-Holter ◽

Jörg Aßmus ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Psychological Distress ◽

Brain Injury ◽

Sick Leave ◽

Return To Work ◽

Mild Traumatic Brain Injury ◽

Self Report ◽

University Hospitals ◽

Global Functioning ◽

One Year

Objective. To predict return to work (RTW) at 12 months for patients who either were sick-listed or were at risk to be sick-listed with persistent postconcussion symptoms (PCS) at six to eight weeks after injury.Method. A prospective cohort study of 151 patients with mild traumatic brain injury (MTBI) admitted consecutively to outpatient clinics at two University Hospitals in Norway. The study was conducted as part of a randomised clinical trial. Injury characteristics were obtained from the medical records. Sick leave data from one year before to one year after MTBI were obtained from the Norwegian Labour and Welfare Service. Self-report questionnaires were used to obtain demographic and symptom profiles.Results. We observed a significant negative association between RTW at 12 months and psychological distress, global functioning, and being sick-listed at two months after MTBI, as well as having been sick-listed the last year before injury.Conclusion. Psychological distress, global functioning postinjury, and the sick leave trajectory of the subjects were negative predictors for RTW. These findings should be taken into consideration when evaluating future vocational rehabilitation models.

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A Longitudinal Study of Compensation-Seeking and Return to Work in a Treated Mild Traumatic Brain Injury Sample

Journal of Head Trauma Rehabilitation ◽

10.1097/00001199-200303000-00005 ◽

2003 ◽

Vol 18 (2) ◽

pp. 139-147 ◽

Cited By ~ 36

Author(s):

Shawn Reynolds ◽

Chris Paniak ◽

Geraldine Toller-Lobe ◽

Julianna Nagy

Keyword(s):

Traumatic Brain Injury ◽

Longitudinal Study ◽

Brain Injury ◽

Return To Work ◽

Mild Traumatic Brain Injury ◽

Compensation Seeking

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Predictors of six-month inability to return to work in previously employed subjects after mild traumatic brain injury: A TRACK-TBI pilot study

Journal of Concussion ◽

10.1177/20597002211007271 ◽

2021 ◽

Vol 5 ◽

pp. 205970022110072

Author(s):

John K Yue ◽

Ryan RL Phelps ◽

Debra D Hemmerle ◽

Pavan S Upadhyayula ◽

Ethan A Winkler ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Pilot Study ◽

Return To Work ◽

Mild Traumatic Brain Injury ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Full Time ◽

Emotional Symptoms ◽

Post Injury

Introduction Return to work (RTW) is an important milestone of mild traumatic brain injury (mTBI) recovery. The objective of this study was to evaluate whether baseline clinical variables, three-month RTW, and three-month postconcussional symptoms (PCS) were associated with six-month RTW after mTBI. Methods Adult subjects from the prospective multicenter Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with mTBI (Glasgow Coma Scale 13–15) who were employed at baseline, with completed three- and six-month RTW status, and three-month Acute Concussion Evaluation (ACE), were extracted. Univariate and multivariable analyses were performed for six-month RTW, with focus on baseline employment, three-month RTW, and three-month ACE domains (physical, cognitive, sleep, and/or emotional postconcussional symptoms (PCS)). Odds ratios (OR) and 95% confidence intervals [CI] were reported. Significance was assessed at p < 0.05. Results In 152 patients aged 40.7 ± 15.0 years, 72% were employed full-time at baseline. Three- and six-month RTW were 77.6% and 78.9%, respectively. At three months, 59.2%, 47.4%, 46.1% and 31.6% scored positive for ACE physical, cognitive, sleep, and emotional PCS domains, respectively. Three-month RTW predicted six-month RTW (OR = 19.80, 95% CI [7.61–51.52]). On univariate analysis, scoring positive in any three-month ACE domain predicted inability for six-month RTW (OR = 0.10–0.11). On multivariable analysis, emotional symptoms predicted inability to six-month RTW (OR = 0.19 [0.04–0.85]). Subjects who scored positive in all four ACE domains were more likely to be unable to RTW at six months (4 domains: 58.3%, vs. 0-to-3 domains: 9.5%; multivariable OR = 0.09 [0.02–0.33]). Conclusions Three-month post-injury is an important time point at which RTW status and PCS should be assessed, as both are prognostic markers for six-month RTW. Clinicians should be particularly vigilant of patients who present with emotional symptoms, and patients with symptoms across multiple PCS categories, as these patients are at further risk of inability to RTW and may benefit from targeted evaluation and support.

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Prognosis after Mild Traumatic Brain Injury: Influence of Psychiatric Disorders

Brain Sciences ◽

10.3390/brainsci10120916 ◽

2020 ◽

Vol 10 (12) ◽

pp. 916

Author(s):

Ivan Marinkovic ◽

Harri Isokuortti ◽

Antti Huovinen ◽

Daniela Trpeska Marinkovic ◽

Kaisa Mäki ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Psychiatric Disorder ◽

Return To Work ◽

Psychiatric Disorders ◽

Mild Traumatic Brain Injury ◽

University Hospital ◽

Kaplan Meier ◽

Time Work ◽

Axis I

Background: We evaluated the prevalence of psychiatric disorders in mild traumatic brain injury (MTBI) patients and investigated psychiatric comorbidity in relation to subjective symptoms and return to work (RTW). Methods: We recruited 103 MTBI patients (mean age 40.8 years, SD 3.1) prospectively from University Hospital. The patients were followed up for one year. The Rivermead Post-Concussion Symptom Questionnaire (RPQ) and Extended Glasgow Outcome Scale (GOSE) were administered one month after MTBI. Three months after MTBI, any psychiatric disorders were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders. Results: Psychiatric disorders were diagnosed in 26 patients (25.2%). The most common disorders were previous/current depression. At three months, there was no difference between patients with psychiatric disorders versus those without them in RTW (95.7% vs. 87.3%, p = 0.260) or at least in part-time work (100% vs. 94.4%, p = 0.245). In Kaplan–Meier analysis, the median time to RTW was 10 days for both groups. The median RPQ score was 13.0 (Interquartile range (IQR) 6.5–19.0) in patients with a psychiatric disorder compared to 8.5 (IQR 2.3–14.0) in those without one (p = 0.021); respectively, the median GOSE was 7.0 (IQR 7.0–8.0) compared to 8.0 (IQR 7.0–8.0, p = 0.003). Conclusions: Approximately every fourth patient with MTBI had a psychiatric disorder. These patients reported more symptoms, and their functional outcome measured with GOSE at one month after MTBI was worse. However, presence of any psychiatric disorder did not affect RTW. Early contact and adequate follow-up are important when supporting the patient’s return to work.

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