title: Modeling community integration in workers with delayed recovery from mild traumatic brain injury.
abstract: BACKGROUND
  Delayed recovery in persons after mild traumatic brain injury (mTBI) is poorly understood. Community integration (CI) is endorsed by persons with neurological disorders as an important outcome. We aimed to describe CI and its associated factors in insured Ontario workers with delayed recovery following mTBI.
  
  
  METHODS
  A cross-sectional study of insured workers in the chronic phase following mTBI was performed at a rehabilitation hospital in Ontario, Canada. Sociodemographic, occupational, injury-related, clinical, and claim-related data were collected from self-reports, medical assessments, and insurers' referral files. Community Integration Questionnaire (CIQ) scores were compared using analysis of variance or Spearman's correlation tests. Stepwise multivariable linear regression models were used to evaluate the associations with CI.
  
  
  RESULTS
  Ninety-four workers with mTBI (45.2 ± 9.9 years old, 61.2% male) at 197 days post-injury (interquartile range, 139-416 days) were included. The CIQ total and subscale scores were similar to those reported in more severe TBI samples. The CIQ scores were moderately to strongly correlated with various sociodemographic, claim-related, and clinical variables. In the multivariable regression analysis, several covariates accounted for 36.4% of the CIQ variance in the final fully adjusted model.
  
  
  CONCLUSIONS
  This study evaluated CI in workers with mTBI, and analyzed its associated variables. Analysis revealed insomnia, head or neck pain, being married or in a relationship, time since injury, and a diagnosis of possible/probable malingering were independently associated with limited CI.
  
  
  CONCLUSIONS
  Workers with delayed recovery from mTBI experience difficulty with CI. Insomnia is a particularly relevant covariate, explaining the greater part of its variance. To enhance participation, care should focus on clinical and non-clinical covariates.
authors.affiliation: Graduate Department of Rehabilitation Science, Collaborative Program in Neuroscience, University of Toronto, Toronto, Canada. tatyana.mollayeva@utoronto.ca.|Toronto Rehab-University Health Network, Ontario, Canada. tatyana.mollayeva@utoronto.ca.
authors.forename: Tatyana
authors.initials: T
authors.lastname: Mollayeva
authors.affiliation: Toronto Western Hospital, University Health Network, Ontario, Canada. colinshapiro@rogers.com.|Youthdale Child & Adolescent Sleep Clinic, Ontario, Canada. colinshapiro@rogers.com.
authors.forename: Colin M
authors.initials: CM
authors.lastname: Shapiro
authors.affiliation: Faculty of Arts and Science, University of Toronto, Toronto, Canada. shirin.mollayeva@utoronto.ca.|Aquired Brain Injury Research Lab, University of Toronto, Toronto, Canada. shirin.mollayeva@utoronto.ca.
authors.forename: Shirin
authors.initials: S
authors.lastname: Mollayeva
authors.affiliation: Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. dcassidy@health.sdu.dk.|Department of Sport Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark. dcassidy@health.sdu.dk.
authors.forename: J David
authors.initials: JD
authors.lastname: Cassidy
authors.affiliation: Toronto Rehab-University Health Network, Ontario, Canada. angela.colantonio@utoronto.ca.|Department of Occupational Science and Occupational Therapy, University of Toronto Ontario, Ontario, Canada. angela.colantonio@utoronto.ca.
authors.forename: Angela
authors.initials: A
authors.lastname: Colantonio
mesh_terms: D001930:Brain Injuries / Q000453:epidemiology*; D062309:Community Integration; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008306:Malingering / Q000453:epidemiology; D017533:Marital Status; D008875:Middle Aged; D008954:Models, Biological; D019547:Neck Pain / Q000453:epidemiology; D009864:Ontario / Q000453:epidemiology; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology; D013997:Time Factors