Predicting return to work after brain injury using occupational therapy assessments

Purpose: The aim of this study was to evaluate the value of occupational therapy assessments used in an outreach rehabilitation programme to predict return to work after brain injury. The assessments represent the ICIDH-2 levels of body function and activity. Method: Fifty-six persons in a late phase after brain injury who had been admitted to the rehabilitation programme during 2 years were followed up according to work status. The follow up was made at a minimum of 2 years after injury. Demographic data and scores from the occupational therapy assessments were compared for the two groups who were back to work or studies (BTW) and not back to work or studies (NBTW). Results: Assessments of memory, visual perception and apraxia separated between the two groups BTW and NBTW. Logistic regression showed that memory score in combination with data on PADL made up the best predictive model. In a subgroup with 21 persons where data on IADL were added to memory and PADL the predictive value was even stronger. Conclusions: In this study we found that occupational therapy assessments were valuable in predicting failure to return to work or studies after brain injury.     

Predicting return to work in traumatic brain injury using assessment scales.

This study compared two frequently used brain injury assessment scales with a comprehensive functional scale in their capability to predict return to work in a traumatic brain injured population. Fifty-seven consecutive admissions to an inpatient brain injury program were rated at admission and discharge using the following scales: Patient Evaluation and Conference System (PECS), Disability Rating Scale, and Levels of Cognitive Functioning Scale. Their relative accuracy in predicting return to work or school up to 26 months after the injury was assessed using hierarchical logistic regression analysis. In each analysis, return to work/school was the dependent variable. The independent variables were initial status and discharge status on each rating scale. Overall these scales predicted return to work with 73.5% to 84.4% accuracy. Total PECS and PECS Cognition scores were the most accurate predictors. Analysis of incorrect predictions revealed the importance of additionally tracking the social factors of substance abuse, family/community support and financial need to return to work.     

Prognostic factors of return to work after traumatic or non-traumatic acquired brain injury

Purpose: To investigate and to determine evidence of prognostic factors for return to work (RTW) after acquired brain injury (ABI). Method: A systematic literature search was conducted in PubMed (2008–2014), applying terms for ABI and RTW. In addition, studies published after 2003 of a previous review on the same topic were added. The methodological quality of the included studies was assessed and evidence was classified. Results: Twenty-seven studies were included. There is strong evidence that a high education level is positively associated with RTW after traumatic ABI; a low education level, unemployment and length of stay in rehabilitation are negatively associated, and a clear tendency has been deduced from the studies that conscious state in the Emergency Department is not associated with RTW. After non-traumatic ABI, there is strong evidence that independence in activities of daily living is positively associated with RTW and aetiology of stroke is not. Conclusions: This study confirms earlier findings that after both traumatic and non-traumatic ABI injury related factors in the Emergency Department are not associated with RTW. In addition, it provides further evidence that personal factors after traumatic ABI and activity-related factors after non-traumatic ABI are strongly associated with RTW.

• Implications for Rehabilitation

• We found strong evidence for a significant association between RTW and personal factors (education level, unemployment) after traumatic ABI, and activities of daily living (ADL) after non-traumatic ABI.

• We advise to focus on work-related activities during the RTW process besides ADL-training and pay attention to and support patients at risk for not returning to work.

     

Factors affecting return to work after hand injury

The study of 61 hand-injured subjects suggested that it is more than surgical and technical excellence that facilitates the return-to-work status among the hand-injured wage earners. Financial need, level of activities of daily living, and participation in occupational therapy were found to be directly related to return-to-work status. Additional findings indicated no difference between the rate of return to work for those whose injuries affected their dominant hand over those who had nondominant hand injuries. The amount of medical care needed and whether it was delivered as an outpatient or an inpatient were not associated with the return to work. The hand-injured subjects' relevant medical history, participation in occupational therapy, capacity in activities of daily living, desire and ability to return to work, and financial support were quantified through chart audit and interview. Occupational development was measured by using the Moorhead Occupational Work History.     

Occupational categories and return to work after traumatic brain injury: a multicenter study

OBJECTIVE: To further evaluate determinants of return to work (RTW) after traumatic brain injury (TBI), with focus on the relation between preinjury occupational category and RTW outcome. DESIGN: Prospective collaborative cohort study. SETTING: Seventeen National Institute on Disability and Rehabilitation Research-designated Traumatic Brain Injury Model Systems. PARTICIPANTS: Consecutive sample of 1341 patients (age range, 18-62y) who were hospitalized with a TBI diagnosis, received both acute neurotrauma services and inpatient rehabilitation services, consented to participate, were employed before injury, and completed a 1-year follow-up assessment. INTERVENTION: An inpatient interdisciplinary brain injury rehabilitation program. MAIN OUTCOME MEASURE: Competitive employment at 1 year postinjury. RESULTS: Participants were categorized into 1 of 3 groups depending on preinjury occupational title: professional/managerial (n=192), skilled (n=751), or manual labor (n=398). Chi-square analyses were computed to examine changes across occupation groups between preinjury occupation group and postinjury RTW. The rate of successful RTW was greatest for professional/managerial (56%), lower for skilled (40%), and lowest for manual labor (32%), yielding an odds ratio of 2.959 between the highest and lowest groups. Of those with successful RTW, most did so within the same occupational category grouping. A multiple logistic regression showed that preinjury occupation, education level, discharge FIM score, age, sex, marital status, and hospital length of stay each influenced RTW. CONCLUSIONS: Prior research has shown that preinjury employment status (employed vs unemployed) greatly influences the odds of successful RTW after TBI. A related hypothesis, that occupational classification also influences RTW outcome, has been understudied and has yielded conflicting results. The current study shows convincingly that the type of occupation influences RTW outcome, with the best prospect for RTW among people with professional/managerial jobs. Occupational category should be examined in the future development of predictive models for RTW after TBI.     

Indicators of long-term return to work after severe traumatic brain injury: A cohort study

Background

Return to work (RTW) is a major objective in the rehabilitation of individuals with severe traumatic brain injury (TBI). Implications for long-term occupational integration (beyond 5 years) have rarely been studied.

急性职业性手外伤患者回归工作的影响因素分析

目的：探讨影响急性职业性手外伤患者回归工作（RTW）的因素,以期为工伤职工回归工作提供参考。方法：对福州地区60例急性职业性手外伤患者通过电话采访进行问卷调查,调查内容包括受伤的类型、职业、工作性质、教育程度、损伤部位、住院时间、受伤归因、单位的性质、雇佣类型、伤前对工作的满意度、伤前与同事间关系、是否为家庭主要劳动力、工伤保险状况以及是否接受正规康复治疗等。采用单因素相关分析和Logistic回归分析方法获得影响返回工作岗位的潜在因素。结果：在被调查的内容中得到4个有意义的影响因素,包括工作类型（白领）（OR=19.195,95%可信区间为1.001~368.014）、受伤归因（内因）（OR=6.256,95%可信区间为1.024~38.215）、伤前与同事有良好关系（OR=11.016,95%可信区间为1.715~70.755）及是家庭主要劳动力（OR=10.568,95%可信区间为1.528~73.086）。结论：RTW是一个受多因素影响的过程。     

职业性手外伤患者重返工作预测工具的效度研究

目的:研究指定工作的功能性能力评估对职业性手外伤工人就业状况的预测效度,检测其有效性。方法:依据142例参加者的功能性能力评估表现给予他们重返工作建议。3个月内,通过电话随访以确定参加者的就业状况,以此检查功能性能力评估的预测有效性。结果:治疗师给出的重返工作建议与参加者3个月后的就业情况有中等强度的联系(k=0.355),McNemar-Bowker测试在统计学上有非常显著意义(P0.01),功能性能力评估预测重返受伤前原工作岗位的准确率可达91.38%,重返原工作岗位但需要调整部分工作任务的准确率为72.22%,改变工作岗位的准确率为77.08%,不适宜工作的准确率为19.23%。是否进行现场工作评估及工作的体能要求对功能性能力评估的预测效度有影响。结论:指定工作的功能性能力评估对手外伤患者的重返工作岗位有较好的预测效力。     

The relationship between post-traumatic growth and return to work following mild traumatic brain injury

Abstract

Purpose: To investigate the prevalence of post-traumatic growth (PTG) following mild traumatic brain injury (mTBI) and to examine whether PTG is associated with vocational status.

Materials and methods: Archival data from a random sample of 74 individuals who sustained mTBI (mean age: 43.23; male, 55%) were obtained from a larger sample of litigating patients who were referred for a neuropsychological examination. Factors associated with return to work were ascertained using a multiple regression analysis. The demographic variables age, sex, and education were added to the first block, whilst relating to others, new possibilities, personal strength, spiritual change, and appreciation of life, as measured by the Posttraumatic Growth Inventory (PTGI), were added in the second block.

Results: Approximately 31% of the sample exhibited moderate levels of PTG, as defined by endorsing a 3 or more on each item of the PTGI, with the most common aspects of PTG being appreciation of life, relating to others, and personal strength. The multiple regression analysis revealed that new possibilities and personal strength were independently associated with return to work.

Conclusions: Results of this study suggest that there is evidence for the development of PTG among individuals with mTBI. These findings have important implications for rehabilitation planning, individual and family adjustment, and the prediction of long-term outcome as it pertains to return to work in particular.

• Implications for Rehabilitation

• Return to work is an integral component of rehabilitation following mild traumatic brain injury (mTBI) and should not be overlooked.

• Results of this study indicate that post-traumatic growth (PTG) can be used to inform intervention approaches that seek to promote growth and resiliency post-injury.

• Informing patients about the prospects of a positive post-injury recovery trajectory could help manage the individual’s expectations of recovery.

     

Successful return to work following a musculoskeletal injury

Successful return to work following a musculoskeletal injury is facilitated by early intervention and rehabilitation that addresses the physical, psychosocial, and environmental factors in recovery. Job simulation and work hardening programs that involve the employee, the employer, and the health care providers are an effective approach to injured worker rehabilitation. The occupational health nurse's role can include early identification of injury, treatment coordination and follow up, matching worker abilities and restrictions to the job, and implementation of an injury prevention program. An injury prevention program should be worksite specific, and can include identification of injury hazards, preplacement testing, employee training, and ergonomic job redesign.     

Functional and occupational characteristics associated with very early return to work after stroke in Japan

Tanaka H, Toyonaga T, Hashimoto H. Functional and occupational characteristics associated with very early return to work after stroke in Japan.

Objectives

To examine clinical, functional, and occupational factors associated with very early return to work after stroke, and to identify factors manageable through occupational arrangements, patient education, and other welfare programs.

Design

Prospective cohort study.

Setting

Acute care of the first stroke event in 21 acute care hospitals specializing in clinical and occupational health.

Participants

Consecutive patients with stroke in working age (N=335).

Interventions

Not applicable.

Main Outcome Measures

Data pertaining to demographic, clinical, functional, and occupational factors were collected from hospital records. Multiple logistic regression analysis with backward stepwise selection was used to obtain a final model to predict the likelihood of patients returning very early to work.

Results

The sample was predominantly men (80%) with a mean age ± SD of 55.2±7.2 years; 30% succeeded in very early return to work. After adjusting for age, sex, and modified Rankin scale at discharge, white-collar versus blue-collar occupation (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.00–4.21), Barthel Index at onset (OR, 1.02; 95% CI, 1.01–1.03), and employment status at discharge (OR, 17.36; 95% CI, 3.15–95.72) were selected in the final model as significant predictors of very early return to work. Patients with mild physical disability and higher cortical dysfunction found it more difficult to return to work very early compared with those without these conditions.

Conclusions

We found that patients with stroke who had mild disability at onset, were in a white collar occupation, and were employed at discharge were more likely to return to work very early, even after adjusting for functional levels at discharge. Cognitive rehabilitation is needed for those with mild physical disability and higher cortical dysfunction.     

Head injury victims and their return to work after 6 months to 1 year

A prospective and longitudinal study about head injury victims was carried out in order to identify their return to productivity after 6 months and 1 year post-trauma and to analyze the relationship between their return to work and their educational level as well as to determine the relationship between their return to work and their type of job before the onset of the injury. Of the 72 patients who were students or employees pre-injury, or housewives at the time of injury, the majority (73.6%) had returned to productivity 6 months after onset of injury. Of the victims who had returned to productivity, 25.0% had changed their original occupations or reported significant problems when returning to productivity. Baseline return was achieved in 48.6% of the victims at 6 months. Return to productivity was higher at 1 year after injury than at 6 months. When the relationship between return to work and educational level and job type was analyzed, return to work was not related to educational level or job type.     

Able or unable to work? Life trajectory after severe occupational injury

Purpose: To study the probabilities and permanence of return to work, inability to work and rehabilitation, and to explore the connection between these life situations and later working after a severe occupational injury.

Materials and methods: A historical cohort of Finnish workers with a severe occupational injury during 2008 (N?=?11,585) were followed up annually on the outcomes of return to work over a 5-year observation period. We examined transition probabilities from one life situation to another with Markov chain analysis, and applied logistic regression with generalized estimating equations to assess the effect of register-based determinants on return to work.

Results: Within the five anniversaries, 85% of the injured were working, 9% were unable to work (fully or partly) and 2% received rehabilitation. Age, gross annual income, type of work, injured body part, injury type and the injured’s annual condition subsequent to the work injury were significant determinants of return to work.

Conclusions: The probability of return to work decreased with time, but, on average, one-fifth of the injured workers succeeded in return to work after being unable to work on the previous anniversary, which indicates that it is worthwhile to conduct efforts for this target group in order to promote return to work.

• Implications for Rehabilitation

• The current life situation of the injured should be taken into account when promoting return to work, as it is a strong predictor of later working after a serious occupational injury.

• Rehabilitation and return to work programs should start in time due to declining return to work rates as the disability continues.

• Return to work on a part-time basis could be a good option during the early phases of recovery, since a notable proportion of those partly unable to work on the first anniversary returned later to full-time workers.

• The probability of recovery is relatively high even for those with long-term disabilities, so the promotion of return to work is highly recommended also for this target group.

     

Mild traumatic brain injury from motor vehicle accidents: factors associated with return to work

OBJECTIVES: To describe return to work (RTW) for motor vehicle accident (MVA) survivors with mild traumatic brain injury (MTBI) and to examine relationships between RTW and injury severity, cognitive impairment, social interaction, discharge disposition, and sociodemographics. DESIGN: Inception cohort assessed within 1 month of injury and at follow-up 6 to 9 months (mean = 7.4) after injury, for comparisons on outcome of RTW. SETTING: Tertiary care center in Toronto (time 1); at home for follow-up. PARTICIPANTS: Fifty patients with MTBI resulting from MVA who were consecutively admitted during a 20-month period ending April 1994. Thirteen of 63 eligible patients refused consent or were lost to follow-up. Mean age was 31; 62% were men. Eligibility criteria: (1) patients had been working; (2) they had no history of head injury, neurologic disease, or psychiatric illness requiring hospitalization; and (3) they had no catastrophic impairment from accident. MAIN OUTCOME MEASURE: Return to work (at premorbid or modified level). RESULTS: Of the 42% who returned to work, 12% resumed their premorbid level of employment and 30% returned to modified work. There were significant differences (p<.05) between the groups in level of social interaction, premorbid occupation, and discharge disposition. On one test of cognitive functioning the difference was at p = .06. CONCLUSION: Social interaction, jobs with greater decision-making latitude, and discharge home were positively related to RTW for this population. Cognitive impairment within the first month was not a reliable indicator of RTW potential.     

Documentation of paediatric assessments using the occupational therapy guidelines for client-centred practice

Although documentation is required in occupational therapy, there is little uniformity in content or format between therapists or facilities. The purpose of this article is to present a format that reflects the Canadian Guidelines for the Client-Centred approach to assessment and to share the experience of implementing this format at the Arbutus Society for Children in Victoria, British Columbia. It is hoped that client-centred documentation will facilitate role clarification, service promotion, and quality assurance. As the format reflects the conceptual framework described in the Occupational Therapy Guidelines for Client-Centred Practice (Canadian Association of Occupational Therapists, 1991b), it should be appropriate for use in other areas of practice.     

An occupational therapy work skills assessment for individuals with head injury

BACKGROUND: Comprehensive and accurate evaluation is a critical step in the return-to-work process for individuals with head injury. Research findings have been reported on the barriers for a successful return to work. Assessment frameworks have been published, but they do not include a protocol that contains each component for the assessment. METHOD: This paper describes an occupational therapy assessment protocol developed and used in the evaluation of the work skills of individuals with head injury. This protocol focuses on assessment of physical, cognitive and behavioural abilities in relation to the demands of the workplace and measures these within the framework of productivity, interpersonal skills and safety. PRACTICE IMPLICATIONS: The functional approach inherent in this protocol provides information to complement the findings of other interdisciplinary team members. This paper also explores the strengths and limitations of this protocol.     

Predictors for return to work after spinal cord injury: a 3-year multicenter analysis

OBJECTIVE: To examine the ability of the Motor Index Score (MIS), in combination with demographic variables, to predict return to work during a 3-year period for individuals with spinal cord injury (SCI). METHODS: Prospectively collected data, between 1986 and 1995, submitted to the National Spinal Cord Injury Statistical Center were analyzed to determine the prediction of return to work utilizing variables of education, ethnicity, age, marital status, gender, and MIS. Individuals, aged 18 to 65 yrs, employed at the time of their injury, were evaluated at discharge from rehabilitation and at 1 (YR1), 2 (YR2), and 3 (YR3) years postinjury (sample sizes of 1,857, 1,486, and 1,177, respectively). RESULTS: The most important predictors of return to work were education, MIS, ethnicity, and age at onset of SCI. These variables resulted in a high rate of accuracy for predicting across all 3 yrs (YR1, 81%; YR2, 82%; YR3, 77%). CONCLUSIONS: The ability to predict return to work after SCI was shown utilizing MIS and demographic variables, with nearly 80% accuracy. This suggests that return to work after SCI is a dynamic process, with the level of importance of each variable changing with time postinjury.     

Acute predictors of return to employment after traumatic brain injury: a longitudinal follow-up

OBJECTIVE: To investigate the relation between selected acute injury and patient characteristics and subsequent return to work 1 to 5 years postinjury. DESIGN: Longitudinal design with prospectively collected data. Data were collected on patients at the time of injury and each year postinjury for up to 5 years. SETTING: Four medical centers in the federally sponsored Traumatic Brain Injury Model Systems project that provide emergency medical services, intensive and acute medical care, inpatient rehabilitation, and a spectrum of community rehabilitation services. PARTICIPANTS: Patients were selected from a national database of 538 rehabilitation inpatients admitted to acute care within 8 hours of traumatic brain injury (TBI) and seen at 1 to 5 years follow-up. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Employment status (employed vs not employed) at 1 to 5 years postinjury. Logistic regression analyses were performed to determine the extent to which selected variables predicted employment status at years 1 to 5 postinjury. RESULTS: At year 1 postinjury, preinjury productivity, age, education, and rehabilitation length of stay were all significantly associated with postinjury employment. Preinjury employment and productivity and age significantly predicted employment at postinjury year 2. At year 3 postinjury, preinjury productivity, age, and FIMtrade mark instrument discharge score significantly predicted employment status. Age was significantly associated with employment status at year 4 postinjury. Preinjury employment and productivity and Disability Rating Scale discharge score were found to be significant predictors of postinjury employment at year 5 follow-up. CONCLUSIONS: The relationship between certain acute injury and patient variables (eg, age, preinjury productivity, education, discharge FIM) and subsequent return to work may provide rehabilitation professionals with useful information regarding the intensity and types of services needed for individuals in the vocational rehabilitation planning process.