Prediction of functional and employment outcome 1 year after traumatic brain injury: a structural equation modelling approach

Background Traumatic brain injury (TBI) can cause lasting functional changes and lead to unemployment. The purpose of this study was to create and test a structural equation model (SEM) of the prediction of functional and employment outcome after TBI. Methods Participants were 949 individuals with predominantly moderate to severe TBI (74% males, median age 25.7 years) who attended a follow-up interview 1 year post-injury. Outcome (employment and mood, cognitive and behavioural changes) was measured using the Structured Outcome Questionnaire. An SEM, based on existing research, was developed, tested and modified. Results A comparative fit index of 0.99 and a root mean square error of approximation of 0.03 supported the fit of the final model. Age, education, pre-injury employment, injury severity and limb injuries were direct predictors of employment outcome. Gender, pre-injury psychiatric disorders and limb injuries were related to employment outcome by their association with mood, cognitive and behavioural changes. Conclusions The results demonstrate the complex interplay between various factors predicting outcome after TBI and provide evidence for the importance of tailoring rehabilitation to the individual's needs. Further research, including other conditions, can build on this model and include additional predictor and outcome measures.