Ten-Year Employment Patterns of Working Age Individuals After Moderate to Severe Traumatic Brain Injury: A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study.
OBJECTIVE
To describe the 10-year patterns of employment for individuals of working age discharged from a Traumatic Brain Injury Model Systems (TBIMS) center between 1989 and 2009.


METHODS
Secondary data analysis.


METHODS
Inpatient rehabilitation centers.


METHODS
Patients aged 16 to 55 years (N=3618) who were not retired at injury, received inpatient rehabilitation at a TBIMS center, were discharged alive between 1989 and 2009, and had at least 3 completed follow-up interviews at postinjury years 1, 2, 5, and 10.


METHODS
Not applicable.


METHODS
Employment.


RESULTS
Patterns of employment were generated using a generalized linear mixed model, where these patterns were transformed into temporal trajectories of probability of employment via random effects modeling. Covariates demonstrating significant relations to growth parameters that govern the trajectory patterns were similar to those noted in previous cross-sectional research and included age, sex, race/ethnicity, education, preinjury substance misuse, preinjury vocational status, and days of posttraumatic amnesia. The calendar year in which the injury occurred also greatly influenced trajectories. An interactive tool was developed to provide visualization of all postemployment trajectories, with many showing decreasing probabilities of employment between 5 and 10 years postinjury.


CONCLUSIONS
These results highlight that postinjury employment after moderate to severe traumatic brain injury (TBI) is a dynamic process, with varied patterns of employment for individuals with specific characteristics. The overall decline in trajectories of probability of employment between 5 and 10 years postinjury suggests that moderate to severe TBI may have unfavorable chronic effects and that employment outcome is highly influenced by national labor market forces. Additional research targeting the underlying drivers of the decline between 5 and 10 years postinjury is recommended, as are interventions that target influencing factors.
Rocky Mountain Regional Brain Injury System, Craig Hospital, Englewood, CO. Electronic address: jcuthbert@craighospital.org.
Jeffrey P
JP
Cuthbert
Rocky Mountain Regional Brain Injury System, Craig Hospital, Englewood, CO; Traumatic Brain Injury Model Systems National Statistical and Data Center, Englewood, CO.
Christopher R
CR
Pretz
Rusk Institute for Rehabilitation Medicine, New York University Langone School of Medicine, New York, NY.
Tamara
T
Bushnik
University of Washington, Seattle, WA.
Robert T
RT
Fraser
Moss Rehabilitation Research Institute, Elkins Park, PA.
Tessa
T
Hart
Santa Clara Valley Medical Center, Rehabilitation Research Center, San Jose, CA.
Stephanie A
SA
Kolakowsky-Hayner
Department of Physical Medicine and Rehabilitation, Indiana University, Indianapolis, IN.
James F
JF
Malec
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Department of Speech-Language Pathology and Audiology, Northeastern University, Boston, MA.
Therese M
TM
O'Neil-Pirozzi
The Institute for Rehabilitation and Research Memorial Hermann, Houston, TX; Baylor College of Medicine, Houston, TX.
Mark
M
Sherer
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001930:Brain Injuries / Q000534:rehabilitation*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012047:Rehabilitation Centers; D000066768:Rehabilitation Research; D012737:Sex Factors; D012959:Socioeconomic Factors; D015599:Trauma Severity Indices; D055815:Young Adult
Brain injuries; Employment; Rehabilitation