ACUTE PREDICTORS OF SUCCESSFUL RETURN TO WORK 1 YEAR AFTER TRAUMATIC BRAIN INJURY - A MULTICENTER ANALYSIS

Objective: To investigate the influence of acute injury characteristic s on subsequent return to work in traumatic brain injury (TBI) patient s. Design: Descriptive statistics were performed in a comparative stud y of 49 TBI patients who were competitively employed at 1-year follow- up and 83 unemployed patients. Independent t tests were then performed to examine the differences between the two groups on specific measure s including the Disability Rating Scale (DRS), Functional Assessment M easure (FIM), Rancho Los Amigos Scale (RLAS), Glasgow Coma Scale (GCS) , Neurobehavioral Rating Scale (NRS), and neuropsychological test resu lts. Setting: Four medical centers in the federally sponsored Traumati c Brain Injury Model Systems Project that provide emergency medical se rvices, intensive and acute medical care, inpatient rehabilitation, an d a spectrum of community rehabilitation services. Participants: Patie nts were selected from a national database of 245 rehabilitation inpat ients admitted to acute care within 8 hours of TBI and seen at 1-year follow-up. Main Outcome Measure: Return to work at 1-year follow-up. R esults: Persons employed at 1-year follow-up obtained significantly be tter scores on specific acute measures of physical functioning (Admiss ion FIM, Admission DRS, Discharge DRS), cognitive functioning (Logical Memory Delay), behavioral functioning (Admission RLAS, Discharge RLAS , NRS Excitement factor), and injury severity (Admission GCS, Highest GCS, Length of Coma, Length of PTA) than their unemployed counterparts . Conclusions: Persons obtaining better scores on certain acute measur es (eg, Admission GCS) are more likely to return to the workforce. Fut ure research should focus on developing a standardized tool to assess a patient's ability to return to work, as well as an operational defin ition for successful employment. (C) 1997 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.