title: The relationship between insomnia and disability in workers with mild traumatic brain injury/concussion: Insomnia and disability in chronic mild traumatic brain injury.
abstract: The principal aim of this study was to, for the first time, examine the relationship between insomnia and perceived disability among workers with mild traumatic brain injury (mTBI)/concussion.
  
  
  
  A cross-sectional study was conducted at the Workplace Safety and Insurance Board Clinic of the largest rehabilitation teaching hospital in Canada. Data from questionnaires, insurer records and clinical investigations were analysed. The Insomnia Severity Index measured the primary independent variable, and the Sheehan Disability Scale measured disability outcomes, classified as 'mild/moderate' or 'marked/extreme'. Two-sided t-tests and Chi-squared tests were used for bivariate associations. A binomial logistic regression model was fit using previously identified variables.
  
  
  
  The sample comprised 92 workers (45.1 ± 9.9 years old, 61% male) with mTBI/concussion at median time 196 days after injury. When compared with workers reporting lower disability, workers with higher disability were found with more severe insomnia, depression, anxiety and pain. In the multivariable analysis, the odds of reporting higher global disability increased with increasing insomnia and pain [adjusted odds ratio (OR) 1.16 (95% CI 1.03-1.31) and 1.117 (95% CI 1.01-1.24), respectively]. Insomnia was the only significant covariate in a fully adjusted work disability model. None of the variables studied were statistically significant in the social and family life disability models.
  
  
  
  Greater attention should be given to the diagnosis and management of insomnia in persons with mTBI/concussion.
authors.affiliation: Graduate Department of Rehabilitation Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Collaborative Program in Neuroscience, University of Toronto, Toronto, ON, Canada; Toronto Rehab-University Health Network, Toronto, ON, Canada. Electronic address: tatyana.mollayeva@utoronto.ca.
authors.forename: Tatyana
authors.initials: T
authors.lastname: Mollayeva
authors.affiliation: Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors.forename: Brandy
authors.initials: B
authors.lastname: Pratt
authors.affiliation: Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada; Aquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Shirin
authors.initials: S
authors.lastname: Mollayeva
authors.affiliation: Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Youthdale Child & Adolescent Sleep Clinic, Ontario, Canada.
authors.forename: Colin M
authors.initials: CM
authors.lastname: Shapiro
authors.affiliation: Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada.
authors.forename: J David
authors.initials: JD
authors.lastname: Cassidy
authors.affiliation: Graduate Department of Rehabilitation Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto Rehab-University Health Network, Toronto, ON, Canada; Aquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Colantonio
mesh_terms: D001924:Brain Concussion / Q000534:rehabilitation*; D002170:Canada; D003430:Cross-Sectional Studies; D003863:Depression; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010146:Pain; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis* / Q000209:etiology; D011795:Surveys and Questionnaires
keywords: Concussion; Family life disability; Insomnia; Mild traumatic brain injury; Social disability; Work disability