Years to employment after spinal cord injury

OBJECTIVE: To identify factors related to the length of time between spinal cord injury (SCI) onset and return to work among 259 participants with SCI, all of whom have worked at some point since SCI onset. DESIGN: All data were cross-sectional and collected by survey methodology. SETTING: A midwestern university hospital and private hospital in the same metropolitan area. PARTICIPANTS: Participants were identified from outpatient records of 2 participating hospitals. They met 4 exclusion and inclusion criteria: (1) traumatic SCI; (2) 18 years of age or older; (3) a minimum of 2 years postinjury; and (4) had been employed at some time since SCI. The 259 participants' average age was 46.4 years at the time of the study, with an average of 23.5 years having passed since SCI onset. INTERVENTIONS: Not applicable. Main Outcome Measures: Years from injury onset to beginning first postinjury job, years to the first full-time postinjury job, and the Life Situation Questionnaire. RESULTS: Participants averaged 4.8 years from the time of SCI onset to their first postinjury job and 6.3 years until their first full-time postinjury job. However, these figures varied greatly depending on whether the individual returned to the preinjury job, was working as a professional at the time of injury, had a noncervical injury, and the amount of education by the time of injury. CONCLUSION: There are 2 general tracks to employment after SCI-a fast track where people return to their preinjury job or preinjury profession and a slower track that is generally associated with needs for further reeducation and training. Working to return the individual to the preinjury job or to a position related to their preinjury occupation may substantially shorten the interval to return to work. In cases where this is not possible, counselors must work with individuals to understand the timeline of return to work and identify realistic educational goals that fit both the individual's interest pattern and postinjury abilities.     

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.     

Return to work after spinal cord injury in Taiwan: the contribution of functional independence

OBJECTIVE: To study the employment rate and determinants of return to work for persons with traumatic spinal cord injury (SCI) in Taiwan. DESIGN: Cross-sectional. SETTING: Taiwan community. PARTICIPANTS: One hundred sixty-nine people who had sustained traumatic SCI, had been completely rehabilitated in a university hospital between 1989 and 2002, and who were between 18 and 60 years of age at the time of interview in 2003. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A structured questionnaire was used to identify demographic and injury-related status, functional status, and pre- and postinjury work-related information. RESULTS: At the time of survey, only 47% of the participants were engaged in remunerative employment. Cox regression analysis, with time elapsed between injury and survey as the underlying time axis, showed that education and functional independence were associated with employment. Subjects with a high school education had a 2.2-fold higher chance (95% confidence interval [CI], 1.3-3.8) of returning to work than those without. Subjects with higher scores on the Barthel Index and ability to use public or private transport independently had a 2.7-fold higher chance (95% CI, 1.5-4.9) of returning to work than those unable to travel independently. Other factors significantly associated with employment included marital status, with marriage having a favorable influence; age at injury, with age below 25 years being favorable; preinjury occupation; and vocational training after injury. The importance of functional independence training in rehabilitation is stressed. CONCLUSIONS: Functional independence was a strong factor predicting return to work. Rehabilitation focused on education, vocational training, self-care ability, community mobility, and environmental modifications could improve employability after SCI.     

Prediction of postinjury employment and percentage of time worked after spinal cord injury

Krause JS, Terza JV, Erten M, Focht KL, Dismuke CE. Prediction of postinjury employment and percentage of time worked after spinal cord injury.ObjectiveTo use a 2-part model to identify biographic, injury, educational, and vocational predictors of postinjury employment and the percentage of time employed after spinal cord injury (SCI) onset.DesignSurvey.SettingData were collected at 3 hospitals in the Southeastern and Midwestern United States.ParticipantsParticipants were adults with traumatic SCI of at least 1 year duration, all under 65 years at the time of SCI onset. A total of 1329 observations were used in the analysis.InterventionsNot applicable.Main Outcome MeasuresPostinjury employment, defined by whether the individual had ever been employed after SCI and percentage of time employed after SCI onset.ResultsAlmost 52% of participants worked at some point in time postinjury. Among those who had worked postinjury, the mean portion of time spent working was 0.56. Several factors were significantly related to postinjury employment and portion of time worked postinjury. The probability of postinjury employment increased with successively less severe injury. However, only ambulatory participants were found to have a significantly greater portion of time postinjury among those who became employed. Having obtained either a 4-year or graduate degree after injury was associated with a greater likelihood of postinjury employment. Conversely, among those who worked postinjury, having obtained those degrees prior to injury was associated with a greater portion of time employed. Being white, a man, having completed a 4-year degree or a graduate degree, and having worked in the service industry prior to SCI onset were all associated with a greater portion of time working among those who had worked.ConclusionsThe factors precipitating PE are not identical to those associated with a greater portion of time employed after SCI onset.     

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.     

A medical/vocational case coordination system for persons with brain injury: an evaluation of employment outcomes

OBJECTIVE: To evaluate initial placement and 1-year employment outcomes of a Medical/Vocational Case Coordination System (MVCCS) for persons with brain injury (BI) that provides: (1) early case identification and coordination, (2) appropriate medical and vocational rehabilitation interventions, (3) work trials, and (4) supported employment interventions including job coaching. PARTICIPANTS: One hundred fourteen Minnesota residents, ages 18 to 65 years, with acquired BI. MAIN OUTCOME MEASURES: Outcome: Five levels of Vocational Independence Scale (VIS). Predictor: Preinjury employment status (VIS) and years of education, severity of initial injury, time since injury, current impairment/disability as measured by the Rasch-analyzed Staff Mayo-Portland Adaptability Inventory (MPAI), and impaired self-awareness measured by staff rating and the difference between Staff MPAI and Survivor MPAI. RESULTS: At placement, 46% in independent work; 25% in transitional placements; 9% in long-term supported employment; 10% in sheltered work; and 10% not placed. At 1-year follow-up (n = 101), 53% in independent work; 19% in transitional placement; 9% in supported work; 6% in sheltered work; and 13% unemployed. Regression analyses showed time since injury and Rasch Staff MPAI predicted VIS at placement; only VIS at placement independently predicted VIS at 1-year follow-up; Rasch Staff MPAI and preinjury education level predicted time to placement. CONCLUSIONS: The MVCCS optimized vocational outcome after BI. Time since injury and impairment/disability best predicted vocational placement. Level of initial placement best predicted employment status at follow-up. Persons with greater disability required more extended time and more extensive rehabilitation services before placement.     

Spinal cord injury: a comparison of preinjury and postinjury marriages.

A study of the preinjury and postinjury marriages of 55 spinal cord injured persons and their partners revealed several differences between the relationships. Although all patients had comparable levels of spinal cord injury, the disabled persons in preinjury marriages were judged to have less motivation for independence; a larger proportion of them received daily personal care assistance from their spouses. Furthermore, those in postinjury marriages were more likely to be employed and were judged to be better adjusted psychologically. Psychologists' assessment of marriages based on interviews with the spinal cord injured subjects and their spouses revealed that the postinjury marriages were happier than the preinjury marriages. Possible explanations for these findings are discussed, which include age and state of health, the impact of disability on the marital relationship and the personal assets of disabled persons who attract new partners.     

Racial Differences in Employment Outcome After Traumatic Brain Injury at 1, 2, and 5 Years Postinjury

Gary KW, Arango-Lasprilla JC, Ketchum JM, Kreutzer JS, Copolillo A, Novack TA, Jha A. Racial differences in employment outcome after traumatic brain injury at 1, 2, and 5 years postinjury.

Objectives

To examine racial differences in competitive employment outcomes at 1, 2, and 5 years after traumatic brain injury (TBI) and to determine whether changes in not competitive employment rates over time differ between blacks and whites with TBI after adjusting for demographic and injury characteristics.

Design

Retrospective cohort study.

Setting

Sixteen TBI Model System Centers.

Participants

Blacks (n=615) and whites (n=1407) with moderate to severe TBI.

Interventions

Not applicable.

Main Outcome Measure

Employment status dichotomized as competitively employed versus not competitively employed.

Results

After adjusting for demographic and injury characteristics, repeated-measures logistic regression indicated that (1) the odds of not being competitively employed were significantly greater for blacks than whites regardless of the follow-up year (all P<.001); (2) the odds of not being competitively employed declined significantly over time for each race (P≤.004); and (3) changes over time in the odds of not being competitively employed versus being competitively employed were not different between blacks and whites (P=.070). In addition, age, discharge FIM and Disability Rating Scale, length of stay in acute and rehabilitation, preinjury employment, sex, education, marital status, and cause of injury were significant predictors of employment status postinjury.

Conclusions

Short- and long-term employment is not favorable for people with TBI regardless of race; however, blacks fare worse in employment outcomes compared with whites. Rehabilitation professionals should work to improve return to work for all persons with TBI, with special emphasis on addressing specific needs of blacks.     

Chronic stress conditions do explain posttraumatic brain injury depression

Psychosocial and biologic mechanisms are implicated in depression after traumatic brain injury (TBI). Using McEwen's stress theory of allostasis as a guidepost, this study examined whether pre- and postinjury chronic stress conditions could explain post-TBI depressive symptoms. Seventy-five community-dwelling persons who sustained a mild-to-moderate TBI and were within 2 years of the injury participated in this cross-sectional study. The participants completed measures of chronic stress and depression, measured with the Neurobehavioral Functioning Inventory. Data were collected also on brain injury severity. Using multiple regression analysis, the frequency of childhood adversities and postinjury stress explained post-TBI depression. When time-since-injury was in the regression model, the frequency of preinjury stressors and postinjury stress significantly explained post-TBI depressive symptoms while the combined effect of childhood adversity with postinjury stress was not significant in explaining depressive symptoms. Pre- and postinjury chronic stress explained post-TBI depressive symptoms. These findings support stress-diathesis theory within the psychiatric literature and a linkage between chronic stress, an indicator of allostatic load, and post-TBI depression. These findings are important for nurse specialists working with persons who sustained brain injury, for chronic stress can be buffered by efficient and effective support systems.     

Injury and demographic factors predictive of disparities in earnings after spinal cord injury

OBJECTIVE: To identify differences in earnings after spinal cord injury (SCI) attributable to demographic factors, injury severity, and education using a regression model that accounts for employment status, conditional earnings (earnings of those employed only), and unconditional earnings (earnings from employment for all participants with $0 recorded for those unemployed). DESIGN: Secondary analysis of cross-sectional survey data. SETTING: A midwestern university hospital and a private hospital in the southeastern United States. PARTICIPANTS: Adults with traumatic SCI of at least 2 years duration and under the traditional retirement age of 65 completed mailed surveys (n=615). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Conditional and unconditional earnings. Earnings were measured by a single item that grouped earnings into the following 8 categories: (1) less than $10,000, (2) $10,000 to $14,999, (3) $15,000 to 19,999, (4) $20,000 to 24,999, (5) $25,000 to 34,999, (6) $35,000 to 49,999, (7) $50,000 to 74,999, and (8) $75,000 or more. RESULTS: Several factors investigated were significantly associated with employment status (sex, race, age, neurologic level of injury, ambulatory status, years since injury, educational level), but conditional earnings were significantly related to only 3 factors. Higher conditional earnings were obtained by men, non-African Americans, and those with a college degree. Unconditional earnings were significantly higher among those with the following characteristics: male, non-African Americans, age 34 and less, ambulatory, and those who completed some education beyond high school. CONCLUSIONS: There are substantial differences in the likelihood of postinjury employment as a function of participant characteristics. These disparities are compounded for women, African Americans, and those with less than a college degree by differences in conditional earnings among those employed.     

Early cognitive status and productivity outcome after traumatic brain injury: findings from the TBI model systems

OBJECTIVE: To evaluate the contribution of early cognitive assessment to the prediction of productivity outcome after traumatic brain injury (TBI) adjusted for severity of injury, demographic factors, and preinjury employment status. DESIGN: Inception cohort. SETTING: Six inpatient brain injury rehabilitation programs. PARTICIPANTS: A total of 388 adults with TBI whose posttraumatic amnesia (PTA) resolved before discharge from inpatient rehabilitation. INTERVENTIONS: Administered neuropsychologic tests during inpatient stay on emergence from PTA. Follow-up interview and evaluation. Predictor measures also determined. MAIN OUTCOME MEASURE: Productivity status at follow-up 12 months postinjury. RESULTS: Multiple logistic regression analysis revealed that preinjury productivity status, duration of PTA, education level, and early cognitive status each made significant, independent contributions to the prediction of productivity status at follow-up. When adjusted for all other predictors, persons scoring at the 75th percentile on early cognitive status (less impaired) had 1.61 times greater odds (95% confidence interval [CI], 1.07-2.41) of being productive follow-up than those scoring at the 25th percentile (more impaired). Without adjustment, persons scoring at the 75th percentile had 2.46 times greater odds (95% CI, 1.77-3.43) of being productive at follow-up. CONCLUSIONS: Findings support the utility of early cognitive assessment by using neuropsychologic tests. In addition to other benefits, early cognitive assessment makes an independent contribution to prediction of late outcome. Findings support the clinical practice of performing initial neuropsychologic evaluations after resolution of PTA.     

Self-reported psychosocial health among adults with traumatic brain injury

OBJECTIVE: To measure the subjective psychosocial health of a population-based sample of adults with traumatic brain injury (TBI). DESIGN: Retrospective, cohort study involving a 1-year postinjury interview. SETTING: Sixty-two acute care, nonfederal hospitals in South Carolina. PARTICIPANTS: Persons (> or =15y) hospitalized with TBI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The psychosocial health scales of the Medical Outcomes Study 36-Item Short-Form Health Survey. RESULTS: Of the 7612 participants, 29% reported poor psychosocial health. Factors associated with poor psychosocial well-being included younger age, female sex, Medicaid coverage, no health insurance, inadequate or moderate social support, comorbidities (eg, a preinjury substance abuse problem), cognitive complaints, and some or a lot of limitation with activities of daily living. Only 36% of participants who reported poor psychosocial health reported receiving any mental health services. CONCLUSIONS: A substantial proportion of persons hospitalized with TBI reported poor psychosocial health at 1 year postinjury. To optimize recovery, clinicians need to ensure that patients' psychosocial health needs are addressed during the postacute period.     

Longitudinal changes in adjustment after spinal cord injury: a 15-year study.

Research on changes in adjustment after spinal cord injury (SCI) has produced mixed results. Whereas cross-sectional research has suggested that adjustment declines with increasing age, but improves with greater time since injury, longitudinal research has suggested that some limited positive changes in adjustment occur over an 11-year period. The purpose of the current study was to identify the stability of adjustment over a 15-year period after SCI. One hundred thirty-five participants with SCI completed Life Situation Questionnaires (LSQ) in both 1974 and 1989. T-test comparisons were made on five adjustment scales and 15 individual items. The results suggested several positive changes in adjustment during the 15 years including increased sitting tolerance, more years of education, greater satisfaction with finances and employment, and a higher percentage of persons working. Decreases were noted in the number of hospitalizations and the number of days hospitalized. Given the average number of years since injury (9.3 years in 1974; 24.3 years in 1989), the results suggest that adjustment will at worst be stable, and at best will improve significantly with time.     

Employment of persons with spinal cord lesions injured more than 20 years ago

Purpose.?The primary objective was to study factors influencing post-injury employment and withdrawal from work in persons who sustained traumatic spinal cord injury (SCI) more than 20 years ago. A secondary objective was to study life satisfaction in the same patients.

Method.?A cross-sectional study with retrospective data of 165 SCI-patients admitted to Sunnaas Rehabilitation Hospital 1961–1982. Multiple logistic regression was used to identify predictors for obtaining work post-injury. A Cox proportional hazards regression model was used to study factors influencing early withdrawal from work, i.e. time from injury until discontinuing employment.

Results.?Sixty-five percent of the participants were employed at some point after the injury. Thirty-five percent still had work at the time of the survey. The odds of obtaining work after injury were higher in persons of younger age at injury, higher in males versus females, higher for persons with paraplegia versus tetraplegia, and for persons classified as Frankel D-E compared to a more severe SCI. Factors associated with shorter time from injury until discontinuing employment were higher age at injury, incidence of injury after 1975 versus before, and a history of pre-injury medical condition(s). Life satisfaction was better for currently employed participants.

Conclusion.?The study indicates a low employment-rate in persons with SCI, even several years after injury. From the results, we suggest more support, especially to persons of older age at injury and/or with a history of pre-injury medical condition(s), to help them to obtain work and sustain employed for more years after injury.     

Chronologic age, time since injury, and time of measurement: effect on adjustment after spinal cord injury

People are now living longer after spinal cord injury (SCI), yet only limited research has addressed the issue of aging and adjustment after SCI. The purpose of this study was to use a time-sequential design to identify the relationship between adjustment after SCI and three facets of aging; chronologic age, time since injury, and time of measurement. Life Situation Questionnaires were obtained from one sample of participants with SCI in 1974 (n = 256) and from a second sample in 1985 (n = 193). Participants were grouped into five cohorts based on chronologic age, five cohorts based on time since injury, and two groups based on time of measurement (1974, 1985). Two two-way MANOVA's were performed, one between chronologic age and time of measurement, and the other between time since injury and time of measurement. Results indicated that chronologic age and time since injury often worked in opposing directions; as some aspects of adjustment declined with greater chronologic age, but other aspects improved with increasing time since injury. Activity was strongly related to chronologic age, but medical stability was more strongly related to time since injury. Both chronologic age and time since injury were correlated with some aspects of life satisfaction. Comparisons between the two times of measurement (1974, 1985) indicated some limited positive changes in adjustment with time. The results point to the complexity of the relationship between aging and adjustment and the need for rehabilitation professionals to consider multiple aging factors.     

Trends in spinal cord injury demographics and treatment outcomes between 1973 and 1986.

A study of the National Spinal Cord Injury Statistical Center database on 6,563 persons treated at Spinal Cord Injury Care Systems was conducted to detect demographic and treatment outcome trends over time. Data from the initial hospitalization and first two years postinjury were divided into four time periods based on injury year (1973 to 1977, 1978 to 1980, 1981 to 1983, 1984 to 1986). Between 1973 and 1986, mean age at injury increased, as did the percentage of nonwhites and the percentage of persons with quadriplegia, while the percentage of neurologically complete lesions decreased. There was an increase in long-term use of intermittent catheterization. Ventilator use during hospitalization also increased. Mean lengths of stay for acute care and rehabilitation decreased, although mean inflation-adjusted hospital charges increased. The percentage of persons rehospitalized during the second postinjury year decreased substantially. From 1973 to 1986, for persons admitted to the model system within 24 hours of injury, there was a 66% decrease in the risk of dying within the first two years postinjury. Overall, these data document changing demographics and treatment practices as well as an improved prognosis for persons with spinal cord injuries.     

A prospective study on employment outcome 3 years after moderate to severe traumatic brain injury

Grauwmeijer E, Heijenbrok-Kal MH, Haitsma IK, Ribbers GM. A prospective study on employment outcome 3 years after moderate to severe traumatic brain injury.ObjectivesTo evaluate the employment outcome in patients with moderate to severe traumatic brain injury (TBI) and to identify which patients are at risk of unemployment 3 years after injury.DesignProspective cohort study.SettingPatients with moderate and severe TBI discharged from the neurosurgery departments of 3 level 1 trauma centers in The Netherlands.ParticipantsPatients aged 18 to 65 years (N=113; mean age ± SD, 33.2±13.1y; 73% men) who were hospitalized with moderate (26% of patients) to severe (74% of patients) TBI.InterventionsNot applicable.Main Outcome MeasuresThe main outcome measure was employment status. Potential predictors included patient characteristics, injury severity factors, functional outcome measured at discharge from the acute hospital with the Glasgow Outcome Scale (GOS), Barthel Index (BI), and FIM, and cognitive functioning measured with the Functional Assessment Measure (FAM).ResultsNinety-four patients (83%) completed the 3-year follow-up. The employment rate dropped from 80% preinjury to 15% at 3 months postinjury and gradually increased to 55% after 3 years. The employment rate significantly increased from 3 months up to 1 year, but it did not change significantly from 1 to 3 years postinjury. Age, length of hospital stay, discharge to a nursing home (vs home), psychiatric symptoms, and BI, GOS, FIM, and FAM scores were found to be significant univariate determinants for employment status. By using multiple logistic regression analysis, the FAM score (adjusted odds ratio 1.1; P<.000) and psychiatric symptoms (adjusted odds ratio .08; P<.019) were selected as independent predictors for employment status. A FAM cutoff score of less than 65 to identify patients at risk of long-term unemployment had a good diagnostic value.ConclusionsPatients with TBI with psychiatric symptoms and impaired cognitive functioning at hospital discharge are at the highest risk of long-term unemployment. These factors should be the focus of vocational rehabilitation.     

Employment after spinal cord injury

A predictive model for employment after spinal cord injury was developed. The study population consisted of 154 spinal cord injured persons who were treated at our hospital between 1973 and 1979, and followed for seven years after injury. Demographic, social, and injury severity data were abstracted from each subject's hospital record. Motivation to work, employment history, and sources of postinjury financial support, were assessed by a vocational rehabilitation counselor. The study population was divided into four groups: persons continuously unemployed after injury, homemakers, students, and those employed at some time during the seven-year follow-up period. Stepwise discriminant analysis was used to develop a predictive model that ultimately included seven variables: gender, motivation to work, whether the patient's last job required ambulation, race, educational level, a functional ability score, and whether the patient had children. The model correctly classified 82% of those persons who were continuously unemployed, 100% of homemakers, 63% of students, and 72% of employed subjects. Overall, 79% of subjects were classified correctly. The most important classification errors were between the unemployed and employed groups. Seventeen percent of employed patients were incorrectly classified as unemployed, and 11% of unemployed patients were incorrectly classified as employed. Although there are other determinants of postinjury vocational status, individual potential can be assessed by means of a comparatively small set of predictor variables.     

Return to work for persons with traumatic brain injury: a supported employment approach

Supported employment was used to place 41 persons into competitive employment during 30 months. All individuals had experienced severe head injuries; almost 70% of injuries were due to motor vehicle accidents. A mean of seven years had passed since injury for all referred clients, who had been unconscious a mean of 53 days. Only 36% of referred clients had achieved any competitive postinjury employment, compared with 91% of the same group who were competitively employed before injury. A job retention rate of 71% was reported, with most jobs in warehouse, clerical, and service-related occupations. A mean of 291 hours of job coaching was required to place and maintain all clients in supported employment.