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Pre-injury Alcohol Use is Associated with Poor Long-term Employment Outcome

Categories: Employment

The Question

Are functional ratings useful for predicting long-term employment outcome after traumatic brain injury? Does pre-injury alcohol use affect long-term employment outcome after traumatic brain injury?

Past Studies

Past Studies measured successful outcome from traumatic brain injury in terms of survival rates. In recent years, since more individuals have survived traumatic brain injury, the meaning of successful outcome after traumatic brain injury has changed. It has shifted more towards the attainment of long-term functional abilities, such as the ability to return to work or live independently. Prediction of long-term functional outcome appears to be complex. Previous studies suggest that functional ratings taken months after injury can contribute with pre-injury and injury-related factors to predict long-term employment outcomes. Past studies attempting to predict return to work following traumatic brain injury have produced mixed results.

This Study

This study included 76 individuals with moderate to severe traumatic brain injury. At the time of injury, 55 individuals (72%) were employed, 18 (24%) were students, one (1%) did volunteer work, and two (3%) were unemployed. The individuals participated in a day treatment program. Their therapy included job preparation at practice settings made to resemble a workplace and employment re-entry at community locations. The researchers evaluated the participants’ functional levels and need for supervision with cognitive (thinking skills), behavioral, emotional and social functioning. The researchers also considered the individuals’ pre-injury level of education and substance abuse, along with the initial severity of brain injury as possible factors for predicting long-term employment outcome. Productivity status was assessed at about two years after the individuals’ injury dates. At follow-up, 54 individuals (71%) were employed or attending school. Twenty-two individuals (29%) were unemployed. Simple correlations showed that level of education, need for physical supervision, need for behavioral supervision, and pre-injury alcohol use were predictive of employment outcome. However, when all predictors were considered at the same time, only history of substance abuse was associated with poorer outcome. Individuals with no history of substance abuse were eight times more likely to be employed at follow-up compared to those with a history of substance abuse.

Who May Be Affected By These Findings

Individuals with traumatic brain injury, rehabilitation personnel, community integration planners, and researchers.


The finding of this study that functional ratings had limited usefulness for predicting long-term employment outcome after traumatic brain injury was surprising. This is the opposite finding of some former studies. The researchers suspect that the rating scale they used lacked sensitivity to show enough variability in scores.

Bottom Line

Pre-injury alcohol use had a powerful effect on post-injury employment outcome. This indicates that it may be very important to address substance use issues early in rehabilitation after traumatic brain injury. In this study, functional ratings had only limited usefulness for predicting long-term employment outcome after traumatic brain injury.

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Find This Study


Sherer, M., Bergloff, P., High, Jr., W., & Nick, T. G. (1999). Contribution of functional ratings to prediction of longterm employment outcome after traumatic brain injury. Brain Injury, 13, 973-981.