IMPACT OF PERSONAL AND ENVIRONMENTAL FACTORS ON EMPLOYMENT OUTCOME TWO YEARS AFTER MODERATE-TO-SEVERE TRAUMATIC BRAIN INJURY

Objectives: To describe employment outcomes and assess the impact of personal and environmental factors on employment outcomes 2 years after moderate-to-severe traumatic brain injury. Design/subjects: A prospective cohort of 100 patients with moderate-to-severe traumatic brain injury, aged 16-55 years, hospitalized in a Trauma Referral Centre during the period 2005-2007 and followed up at 1 and 2 years post-injury. Methods: Variables of interest were divided into personal and environmental factors. Personal factors include sociodemographics (age, gender, education, work demands, marital status and child-care). Environmental factors included social (support by friends), institutional (number of rehabilitation services, need for well-coordinated healthcare services), and physical (access to own transportation) factors. A multivariate logistic regression analysis was conducted with employment (working part-/full-time or studying) at 2-year follow-up as the dependent variable, and including independent variables based on significance from a univariate analysis, adjusting for injury severity. Results: At the 2-year follow-up, 44% of patients were employed. Patients with less severe injuries (odds ratio (OR)=1.2, p=0.03), those supported by friends (OR=3.5, p=0.07), those not in need of well-coordinated health services (OR-=4.1, p=0.04), and patients driving a vehicle at the 1-year follow-up (OR=8.4, p<0.001) were more likely to be employed at the 2-year follow-up. Conclusion: Rehabilitation professionals should be aware of the role of environmental factors when planning vocational rehabilitation services after traumatic brain injury.