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Return to Work and Job Stability After Traumatic Brain Injury

The Question: At what rate do individuals return to work after experiencing a traumatic brain injury? What predicts job stability?

Past Studies recognize that individuals with traumatic brain injury can experience long-term difficulties with thinking skills, behavior, and physical mobility. Impairments can prevent individuals with traumatic brain injuries from finding and keeping a job. Because past researchers have used inconsistent research methods, there is a lack of generalizable information about rates of employment and job stability after traumatic brain injury.

This Study focused on 186 adults with mild to severe brain injury who received care in one of six TBI Model Systems rehabilitation centers. All of the participants were employed at the time of injury. The participants’ employment status was examined at follow up visits one through four years after their injury dates. The researchers gathered information by interviewing the participants and examining their medical records. The participants were rated as follows: “stably employed” if they were employed for the three years following their injury; “unstably employed” if they were employed at one or two of the following years; and “unemployed” if they were never employed after their TBI.


The researchers found that 35% of the individuals were employed one year after their injury, 37% after two years, and 42% after three or four years. After completing the three yearly follow-up assessments, the researchers found that 34% of the participants were stably employed, 27% were unstably employed, and 39% were unemployed. Those unemployed were most likely to be ethnic minority group members, non-high school graduates, unmarried, or unable to drive their own vehicles. The ability to drive a vehicle was strongly linked to stable employment. Individuals who could drive were four times as likely to be stably employed. An individual’s rating on the Disability Rating Scale (DRS) at one year was a good predictor of his or her job stability over time. The DRS measures an individual’s general functional change over the course of recovery and rates an individual’s level of disability from None to Extreme. More severe DRS scores were associated with unemployment—all of the individuals that scored as having a severe impairment on the DRS one-year post TBI were unemployed at all three follow-up times.

Who May Be Affected By These Findings: Individuals with traumatic brain injury, health care providers, researchers, and vocational rehabilitation specialists.

Caveats: The participant group in this study had a greater proportion of individuals with severe traumatic brain injuries and a low proportion of members identified as belonging to an ethnic minority. A more balanced study sample would provide information that could be generalizable to all individuals with traumatic brain injuries.

Bottom Line: The researchers found that employment rates increased over time and that unemployment rates decreased over time. Forty-two percent of the participants were employed and 34% of the participants were stably employed three years after their injury date. Individuals who could drive their own vehicles and who scored as having no impairment on the Disability Rating Scale after one year from their injury date were more likely to be stably employed. Those unemployed were most likely to be ethnic minority group members, non-high school graduates, unmarried, unable to drive their own vehicles, and have severe impairments.

Find This Study:
Kreutzer, J.S., Marwitz, J.H., Walker, W., Sander, A., Sherer, M., Bogner, J., Fraser, R., & Bushnik, T. (2003). Moderating factors in return to work and job stability after traumatic brain injury. Journal of Head Trauma Rehabilitation, (18), 128-138.


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